Ive worked full time on a med/surg/tele unit for a couple years. Ive found that often MOST of my patients seem to have some behavorial or cognitive issues, or for whatever reason dont always act appropriately. Im not sure why that is. Obviously with geriatrics a big part of it is dementia, but I think its simply that most disease processes affect the brain in some way, and add in the fact these people are stressed out, in pain, are often sleep deprived, are sleeping in a strange bed surrounded by strangers with little privacy, maybe for the first time in their lives, and are doped up on meds.
As a result unless its something medically relevant or related to making the patient more comfortable, I let most of what they say go in one ear and out the other, and usually dont get too chummy or informal with them. I try to make a good impression, but Im not really concerned with what the patient thinks of me. That way if or when they start acting pysychotic or just plain mean, im not bothered by it. I just assume every patient is going to be a little crazy. I wont even get into dealing with some of these family members. Hospitals make a big deal out of patient satisfaction surveys, but theres a limit to how much butt kissing ill do. The important thing is to not lose your temper, at least not in front of the patient, as that can have consequences.
So yeah Ive seen patients go off. On me, on RNs, Doctors, lab techs, RTs and their own family. Its just part of the job unfortunately, so just let it bounce off you and just do your job. If the patient says they dont want you in the room, I guess just notify the RN and try to work around it. Ive even had a patient tell me they dont want a certain RN or doctor to step foot in their room.