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?
You can also look a patient like this man firmly in the eye and state" That is inappropriate behavior and not acceptable, I will be back to take care of you when you calm down and leave for about 10 to 15 minutes and return with another staff member making this gentleman an assist of 2 for cares. Share in care conference and care plan this man's negative behavior so everyone on your staff is on the same page on how to react when he acts out in negative ways. Good Luck and glad you survived
Specializes in Community Health, Med-Surg, Home Health.
I think you did well. And, you are human, so, the remark you made was not bad considering what you were probably thinking. Make sure you chart the behavior and of course, tell the charge nurse so that others may be made aware. Sometimes, we let behaviors slide by, but that is a mistake in nursing because if another unsuspecting nurse walks in there and he does in fact, bite her, would not be fair to that nurse. I have no criticisms here.
I sometimes use the term "we", but when I say it I am meaning the general nursing team, not just myself, to let the patients know "we" are all trying to take care of them.
Very condescending, along the lines of "Let's fluff our pillow so we feel better, shall we?"
It is not explaining anything. This person wants guidance not put downs. Usually in a situation like this you say, "you need to cover up, this is not acceptable" or "this is inappropriate behavior". You'll get better as you go along. Being new, you did great!!
i can see both sides of the "we" issue......i think tone of voice would make the difference, providing the patient is not confused......i think you may have found one way of dealing with him... when you stated you were not afraid and it seemed to work, THAT is what needs to be passed on to other care givers....i think psych is a good call, but perhaps a part of the issue is control, and he is willing to act out to this extent to have any.....what can be done to meet that need?
Specializes in SICU, EMS, Home Health, School Nursing.
There was a patient like that in my unit one time and one of the nurses got so frustrated that she looked at the patient and said "how old are you... 2?!?!" not the best thing to say, but we all got a good laugh out of it. Most of the time when I have patients acting up like that I just tell them in a very stern voice that they need to stop and that what they are doing is inappropriate. Guessing by what you said, you are a patient aide... sounds like you did the right thing to me! Just make sure that the patients behavior is documented and what you did about it. Also make sure that the patients primary nurse is aware of the whole situation, if you want, you can tell the charge nurse, but really it is up to the patients primary RN to pass that info along. Anyways, good job on not biting back
Definitely needs a workup to figure out why the mental status changes. Glad to hear he's getting some med changes and a Psych consult. Have they checked his electrolytes? Is he adequately hydrated? Any infection?
I think "we" can denote teamwork and partnership.:balloons:
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.
Update: I wasn't assigned to him again today, but since I only had 7 patients and 3 were discharged, I took care of my own, and then helped out where I was needed. I came back from lunch and asked his nurse if he needed fed (she had mentioned that he needed fed, but she would find someone else if I was at lunch), and she said his tray hadn't come yet, but could I assist pulling him up in bed. Of course, I said I would help, and while we were pulling him up, his lunch tray came. I offered to feed him, and she was surprised I did offer. I fed him with no incident, and he actually told me he liked the ice cream and pudding. Progress! :balloons: His doctor came in just as we were finishing up lunch and I gave him an update. I also told him he said he wanted to go to the movies, so I turned on the TV for him and he seemed to like that.
I gave a lunch report to his nurse, and reported that he was very good behaviour wise-- no acting out, talking to me, etc. She said they changed his meds and it's made all of the difference in the world. It has. He hasn't acted out since, but he's still confused. She also thanked me for feeding him. I thanked her for letting me do so because I needed to spend time with him after the trying to bite me incident. She told me I did good.
For those who asked, I am a nursing assistant full time, and a student Practical part time.
Thank you everyone who offered advice. It is appreciated.
Marie-123
6 Posts
You can also look a patient like this man firmly in the eye and state" That is inappropriate behavior and not acceptable, I will be back to take care of you when you calm down and leave for about 10 to 15 minutes and return with another staff member making this gentleman an assist of 2 for cares. Share in care conference and care plan this man's negative behavior so everyone on your staff is on the same page on how to react when he acts out in negative ways. Good Luck and glad you survived