Confused, agitated, medicated, and refusing

[Rocker]

Hey guys, I just wanted to get your opinion on a scenario I experienced tonight at work. I'm sure you work with many confused pts so I'd appreciate your insight.

I'm a CNA/nursing student and tonight I was caring for a 70/M 2nd-day post op total knee replacement pt with acute confusion (no hx of confusion/dementia). He was alert but not oriented. He was having visual hallucinations of animals and of his family members. The staff suspected his confusion was due to Percocet, but the house Dr ordered a urinalysis/culture as well (results are still pending). His mobility was shaky and required a walker with an assist of one. VS 98.4 108 20 113/78 O2sat=94%

Now that you have his background, I wonder how you guys would respond to some situations I faced with him...

He constantly wanted to get up and "go home" or "leave this hotel". The staff and I ambulated him in the halls often. Everytime he ambulated he would get tired and want to go back to bed. This intervention seemed to be working to keep him calm, but then he started trying to leave the floor and became agitated when we stopped him. He basically got agitated whenever we told him 'no'. I can't imagine any nurse spending all their time with this Pt and getting anything done..

Question #1: is it better to ambulate the pt any time he wants to get up? or sit in the room and ask him to stay in bed (and cause agitation)?

Question #2: is it a good idea to hand him his cell phone so he can call someone to "come over" and "pick him up"? (Part of me says he has a right to call his family, but then another part of me thinks that I'd have to explain to the people on the phone the situation and possibly cause unnecessary fear and worry about their loved one).

Question #3: should we let him refuse his sedative/antipsychotic or is it okay to 'persuade' him into taking a sedative/antipsychotic by saying things like "this will calm your nerves, this will help you sleep/feel better"?

Lemme know what you think.. I appreciate your help :)

[britgirl37]

I had a similar situation once. The pt was post TURP, and was going through alcohol withdrawals and just went nuts on me; wanting to leave, trying to get dressed, yelling at me etc. I had 2 rns and 2 security guards preventing him from leaving his room/pulling out iv and foley. the Dr refused to prescribe any sedatives and told me" you'll have to just deal with it". I called the family in myself and explained the situation. They were great, they came in and sat with him until he calmed down. Yes, they were worried but sometimes a pt just responds better to family in these situations.

[P_RN, ADN, RN]

What did the doc say? I'd wonder about his sodium and magnesium levels. Also wonder if he is a closet drinker who might have incipient withdrawal coming on.

[P_RN, ADN, RN]

What did you find out?