This pt sounds inappropriate for med surg. Especially with a CIWA score of 23. Reason being, that high of a score triggers more frequent assessments and is very difficult to manage on med surg. What was his code status? I come from med surg and we had a pt similar sounding (etoh, encephalopathy, resisting care although not violent per se) and the docs were basically just letting her sit there, full code, not giving any meds, fluids, anything. Our big question was how can you let this pt lay here like this and not do anything and she is a full code?? We actually got the director of medical affairs involved when no doctor would listen to us, and then things started to happen. So for your pt in particular, things to remember for next time, if you start an IV and you're able to, try to grab some labs. Even if they aren't ordered, you can let the doc know you obtained them and see if they want them...I would have grabbed a tube for a cmp/bmp, a CBC, and an ammonia level...I wonder what his ammonia level was bc that could also be contributing to his catatonic state and violence. Then document that you did the iv/labs, called the doc, suggested labs, and what the response was. Document everything you suggested and what the response was. I definitely think you should have called about the seizure. Sometimes I see people not call a doc bc previous nurses were reporting "everyone knows about it" but really...can you be sure? The worst that can happen is the doctor gets snippy with you but at least you've done your part, let him/her know, and documented it. The slipping meds into foods, he is not alert and oriented and so you do what you have to do, especially if he needed lactulose eventually if his ammonia level was high...I'd be pouring that into some applesauce or something! When a previous person said it violates the principle of autonomy...he was not alert and oriented I gather? We crush meds and put them in food all the time to get people to take their meds, even when they are confused. This is common.
Anyway my advice here, to summarize, is document document document, go up your chain of command when you feel something isn't right or the pt isn't getting what they need, don't assume the doctor knows something and don't be afraid to call them, don't ever be afraid to ask questions. You were right to question this pt.