Orientation to reality?

We tend to get the good 'ole confused and combative patient from time to time. I find myself at a loss for words when communicating with these pts. I just try to tell myself that "they cannot think rationally when I am trying to keep them in the bed and not falling" but the whole orientation to reality crap just does not cut it sometimes. What are your thoughts on the concept. We had an elderly man who kept trying to jerk out his foley and picc line so we had wrist restraints on him and he kept askinng us to cut his hands off...haha. It is a real problem for me to calm down these people and i was wondering how you dal with them 1:1?