Looking for some feedback on a work situation

[WCSU1987]

Call the patient X. So X on our unit for a week with intermittent psychotic breaks of delusions, responding to hallucinations, labiliry, psychomotor restlessness, and paranoia.

X behavior is tough to predict aa some days can be perfectly normal.

Tried to fight staff, but shortly after forgets why he tried to fight staff and superficially pleasant.

Tried to leave our locked unit 2 to 3 times. Tried to flip a computer and history of entering other patient's rooms.

So X is sporadic with medication sone days takes it, sone days cheeks it, and some days just so it's it out.

So X was in desperate need of medication took a lot of prompting by staff and security. Xs behavior was getting to the point of an injection

Due to Xs prior behavior we took off chairs, computers, and on my own accord the chair/dresser in Xs room.

X responded well to medication. X had a family member visit going well and then things got interesting. X began to perseverate on Xs dresser. Entering others patents rooms and trying to fight staff. X ended up in restraints with more medication.

Question is trying to think if leaving the dresser in the room could of avoided this. Xs behavior is so erratic could of used it as a weapon against us. Also X was in such a state of psychosis that X would have difficulty processing the information or trigger X.

Feedback?

One fellow coworker thought shouldn't have taken Xs dresser as this was the cause of the next level of aggressiion with X.

[Grateful Murse]

I work inpatient mental health as well, I find that with the truly psychotic and delusional that a lot of times it does not matter what you do, they get themselves worked up - because dresser or no dresser they are responding to lots of stimuli that they can not make sense of. If you had left the dresser it probably would have been something else that caused him to escalate.

It is interesting that this happened when family was there visitng, this happens a lot. The patient will be stable then family will come for a visit...they have a flood of feelings related to seeing family that they can not process because of their mental state. They see family and think, "why can't I go home with them, I am stuck here and they get to leave and go home"..."they must not care about me", or the family can sometimes say or do things to escalate the patient - intentionally or unintentionally.

[workingot]

25 years psych rn here. like the other person said, you can do the best you can and think everything to death and they will still " go off" sometimes. dont second guess yourself too much. you could have taken the dresser so it wouldnt be used as a weapon and the patient could barge into another room and use that dresser. sometimes there is no right answer in this job. best of luck to you