Did I do the right thing, or did I not do enough?

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Specializes in Med Surg, Hospice.

Second day on the floor this week, and the second day of taking care of a geriatric patient who has a habit of being mean and nasty. He's managed to pull out his IV's, his PICC line, and gets worked into a frenzy if you look at him the wrong way.

First day in caring for him, no problem. Cooperative when getting vitals done, bathed, etc.

Today, total turnaround. I went in for his blood sugar, and I no sooner got the lancet to make the skin pierce when he started screaming, yelling, jerked his hand away, and tried to bite me. He's in isolation, so that meant taking off the gown, gloves, and mask, going out for another alcohol pad, lancet, and strips (I only take what is needed into isolation so more than necessary is contaminated. The meter stays outside in the hall). When I came back in after regowning and regloving, he pulled back his covers and pulled up his gown and gave me a show I really didn't need to see. Then he said to me really mean and nastily "Look at what I've got for you! You see that?" I pulled down his gown and pulled up the blankets and said "Gee, we don't want you getting a cold, do we?" Then tried to take the sugar again. Again, no luck. Then he started growling and tried to take another bite at me. I looked him straight in the eye and told him I wasn't afraid of him. Soon as I said that, something must have registered because the evil twin went away and Mr, Nice appeared.

After getting his sugar and charting, I reported what happened to his RN. I didn't report it to the charge nurse or fill out an incident report (mainly because I'm still not sure of floor protocol regarding incidents like this since this is the first time this has happened).

Should I have reported this to the Charge Nurse too? Or filled out an incident report?

As always, I appreciate any advice.

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Specializes in LTC , SDC and MDS certified (3.0).

No incident report needed if no harm was done But chart the behavior

CLEARLY.

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No incident report, but the charge nurse should have been told, so s/he could have passed it on to the next charge in report.

May I make a suggestion: I was going to ignore it but I keep going back to it. The "we" statement......"We don't want you getting cold".......not the best choice of words......

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Specializes in Travel Nursing, ICU, tele, etc.

That's a tough one. I think you handled it very well. You were able to diffuse his behavior and that you didn't react negatively was very good.

This guy needs a psych consult if he doesn't have one. If that happened out in the world he could be arrested.

You should definitely chart objectively everything that happened both as a warning to others who will care for him, but also so the Docs can see what he's doing and try to help him in some way. Its not too late to do that.

You should be proud how you handled that one. Good job.

:uhoh21::uhoh21::uhoh21: I doubt I would have done as well.:uhoh3::uhoh3::uhoh3:

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No incident report, but the charge nurse should have been told, so s/he could have passed it on to the next charge in report.

May I make a suggestion: I was going to ignore it but I keep going back to it. The "we" statement......"We don't want you getting cold".......not the best choice of words......

Just curious.. But why do you say that "we" wasn't the best choice of words?

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"We don't want you to get cold, do we?"

"We don't want you to get sicker, do we?"

"We don't want you to (fill in the blank)"

Very condescending, along the lines of "Let's fluff our pillow so we feel better, shall we?"

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Specializes in Travel Nursing, ICU, tele, etc.

Yes, that may be condescending, but you've got a guy exposing himself after trying to bite her and growl at her, I think she deserves a medal for even trying to treat and interact with the guy, I think I would have had to walk away and call the Doc immediately. That is pretty severe behavior. I think she deserves positive feedback for the positive outcome.

:bow::bow:

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I never said she didn't do the right thing.

Never mind, forget I said anything. Sorry for making the suggestion.

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i personally would have reported it to the charge nurse.

sounds like you did a great job.

the only reason i wouldn't use "we" is in the event the pt is confused (and thinks someone else is with you, lol).

other than that, i don't see a problem.

leslie

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Specializes in Med Surg, Hospice.

I used We in meaning we, the members of the nursing staff. It wasn't meant to be condescending. I'm just glad he didn't get his teeth into me. Last I had heard, they're going to change his meds and I thought I heard a Psych consult has been ordered. I didn't have to take care of him today since I was on the other wing.

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Specializes in Med Surg, Hospice.

Tazzi,

Thank you! I didn't think when I said we, but you brought something to my attention that I needed to hear. I appreciate it. :)

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Thanks Tazzi, I didn't think of it being condescending. I probably would have walked out and told the nurse what he was doing and that if she wanted the blood glucose, come help or get it herself! I had a pt with Downs try to bite me once while trying to get his blood sugar, and I had the nurse come help me with him.

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