Attacked by confused patient

[guineapignurse, BSN, RN]

Yesterday I had a confused patient become violent. I work on a med surg floor and this patient was in with a UTI. She was on IV abx and A&Ox 1 but sometimes 2. o do not know what her baselime mental status was.She became agitated when she was insisting on needing to urinate and I tried to explain to her that she had a catheter in because she was retaining urine the day before. She was trying to get out of bed and go to the bathroom but I asked her to stay in bed so she would not fall. She grabbed both of my wrists and then started grabbing at my head. By this time I called my charge nurse twice and my CNA was going to get restraints for me. My charge nurse finally came and we got the patient settled and placed her in wrist restraints and tied them down tight but not too tight that they caused harm to patient (I could place 2 fingers between the patients wrist and the restraint). Well she managed to pull out her I V shortly after and was still agitated so I placed mitts on her and contacted the attending MD for a med for agitation and got an order for haldol IM which I never needed. I did all the required  documentation and contacted the family. Has anyone had a similar experience? Today I’m still not feeling well with a headache, nausea, and neck pain. I think this made an existing neck injury worse. I was in a bicycle accident 2 weeks ago and  was OK to return to work by physical therapy and work knows about my accident as they were asking me to come back less than a week after the accident which caused a grade 2 concussion.  I’m off today but I’m back tomorrow 

[JKL33]

1 hour ago, guineapignurse said:

Has anyone had a similar experience?

Yes. Most of us have had an experience with a patient who was agitated for one reason or another.

* Your own safety is important. One option for future experiences might be to keep the second person there at the bedside with you if that is required to maintain everyone's safety and notify a 3rd person of your immediate need for additional help or equipment. Also review soft skills which may come in handy--your words/tones/actions can be a help or hindrance. This is not to say that you did something to make the situation worse; just that more effective and less effective interventions are a thing. 

* In general you should know the baseline mental status of your patients. Sometimes situations such as this can be anticipated and avoided by using information about a patient's baseline status. Other times it is important to know so that you are aware when something is a significant change or a worsening trend. In any case understanding your patient's mental status is a critical portion of your overall nursing assessment.

* If you are not feeling well you need to discuss with your employer and occ med or your primary care provider. Hope you are feeling better soon.