Once Bitten Twice Shy

[AmyCardsNP, RN, NP]

Yesterday, I had a new experience as a nurse.... I was bitten by a patient.

I was team leading (same as a relief charge nurse) & helping another nurse admit a patient to the ICU from the cath lab. He was in his 50s, had a heart attack, and the lesion was successfully opened and stented by the cardiologist. This patient was spanish-speaking (surprisingly, something we don't see in my area of Phoenix as often as you'd think) and he was waking up from sedation very wildly - thrashing all over the bed and trying to sit up. I was holding one of his arms down, and the other nurse was on his other side, because he still had a sheath (big IV access) in his groin and if he sat up, he would run the risk of severe bleeding. We were attempting to get him to calm down, when he pulled his arm (the one I was holding) up to his face and bit my arm. I pulled away quickly and used my other hand on his forehead to keep it on the pillow.

Two more male staff members came into the room to help us physically restrain the patient (now for our safety as well as his own). We then called for security and the house supervisors to come to the room and the patient was placed in restraints and his sedation from the procedure kicked back in.

I know that there were many variables that act as excuses for this patient to act how he did (language barriers, confusion from sedatives), but there was a spanish-speaking staff member in the room while the patient was acting out and the patient was fully aware of what was going on. He knew that he was in the hospital and remembered coming to the emergency room with chest pain. If a person is awake enough to realize these things, I think there is no real excuse for actions like that. I'm sure it's hard being in that situation - not knowing what exactly is going on and having people trying to restrain you, but to lash out and bite someone when you willingly came into the hospital for help is inexcusable.

Situations like these make me weary of getting as close to patients as we often have to. But, my two options as a nurse are to 1) attempt to restrain him and put myself in danger, or 2) let him do what he wants, which would cause a life-threatening bleed from his artery onto the bed or into his abdomen.

What's a nurse to do?

[pinkiepie_RN]

This is just my $0.02, but some people come out of anesthesia badly. I would like to think that your patient wasn't intentionally being combative. I work on a psych unit and more often than not, when pts get combative, there's a reason behind it - either their psychotic, or anxious, or scared, etc.

[dudette10, MSN, RN]

This is just my $0.02, but some people come out of anesthesia badly. I would like to think that your patient wasn't intentionally being combative. I work on a psych unit and more often than not, when pts get combative, there's a reason behind it - either their psychotic, or anxious, or scared, etc.

Agreed. I'm just a nursing student, so I'm not offering any professional opinions here, just my own experience.

My pre-pubescent son has been under general anesthesia twice. The first time in short-term recovery in the hospital, he was very happy-go-lucky--nearly euphoric. The second time in recovery at the outpatient office, he was angry, belligerent and every other word was a cuss word (something he doesn't do), and he kept trying to get up and leave, requiring both me and the nurse to physically restrain him.

This child is the most mild-mannered kid, and he seemed perfectly coherent, albeit not his normal self. It's funny what different types of anesthesia can do to a person. :)

[mustlovepoodles, RN]

You've not seen many people wake up from sedation, I"m guessing? My mild mannered DH went completely berserk during an oral surgery procedure. I could hear the whole thing, sounded like there were bears in the back duking it out. Instruments clanging, roaring & screaming. In a few moments the dental assistant came out and told me they had had "a little difficulty". That was the understatement of the year. See, DH had told them NOT to give him any nitrous oxide because he had a previous negative experience with it. Well, you know what happened. Even though DH was conscious, he was not in control of his reasoning and started lashing out at anyone and anything within reach. He nailed 2 dental assistants and pretty much tore the room apart. At the time they couldn't do anything with him, he was just insane! Once they stopped the nitrous and turned on the O2 he quickly regained control and of course, he was MORTIFIED. Thankfully, the staff and doctor took it with grace and finished up the procedure without incident.

You never know how someone is going to react to sedation or anesthesia. My son pukes his guts up for hours, it doesn't matter what they give him or how long he's under. I"m talking 8-12 hours. And he's not awake during that time either, so aspiration is a real concern. He had sinus surgery a few years back and slept for 18 hours straight. He vomited so much they finally had to just admit him to run IV fluids--he slept through all 8 episodes, including 3 that resulted in complete bed changes.

Everybody's different. Just because a patient appears to "know what's going on", he may not *Understand* what's going on around him. Sedation skews your perception and it lowers inhibitions. Kinda like too many margaritas.