Confused patient takes a swing
So this week I copped a few punches from a patient. (Not the first time!) This was a guy who had come to us from a nursing home, after chopping the end of his catheter off. That’s right, catheter as in urinary catheter! Joy…
“So what, pull it out!” I hear you say. You are correct: in theory, when chopped, an IDC balloon should self deflate as the fluid runs out of the newly chopped catheter. I recall another presentation of the same man a few months back where he had chopped the end of the IDC off, and the nurses at the nursing home weren’t sure what to do with it now that it was hanging out, so sent him in with it just hanging there!
It was an easy fix by pulling the stump out, replacing and sending him back home, but an interesting use of hospital/ambulance resources, I have to say…
But I digress… This time around there was no catheter in sight, and we were not entirely sure whether or not it had disappeared up into the unknown! It was some time before he was able to be seen, and at one point he became pretty angry when he couldn’t walk up through the main docs/nurses station, and thats when the punching began. (I swear I didn’t throw any!)
Fortunately the situation de-escalated pretty quickly after some sleight of hand and misdirection that Penn & Teller would be proud of (heeeey… what’s that over there? Tea and bikkies?!)
Elderly patients can be really difficult to manage when there is an element of confusion added to the equation. People with alzheimer’s or dementia have fluctuating levels of comprehension and anxiety at the best of times – thrown into a foreign environment like an emergency department however, there are often even more dramas for both patients and staff!
What are your experiences with confused patients? I’ve found that they can certainly add some interesting dynamics to the day! One time I recall I was sitting in front of a (supposedly) sweet old lady, when out of nowhere I copped an almighty slap to the face! Ahhh nursing… You gotta love it!
NB – For those who want a bit more info, you can learn crucial inputs on treatment for symptoms through the expert ideas of Dr Daniel Amen on causes and prevention of alzheimers. Head over to Dr. Amen’s profile for more background information.
Those old ladies can certainly pack a punch!
I often worked in the dementia wing of a nursing home while I was doing my training, and I loved it. The residents were confused, but still had the basic need to feel that they were safe. Reassurance & distraction were the best methods of keeping them feeling safe & happy. Fortunately, episodes of aggression were very few & far between.
That contrasted with working in neuro, where confusion, agitation and violence were frequently encountered. Some people are just not nice people to begin with. Add a head injury and there’s a recipe for trouble. The value of doing an Aggressive Behaviour Management course was proven to me by noticing how some of us were able to verbally de-escalate most patients without getting physical; whereas you would wish that some other staff members would just keep their mouths shut as they only made things worse – in which case a takedown would be inevitable. I’d much rather talk someone down than have to take them down
@PRN Penguin – Hi, thanks for visiting. Reassurance and distraction are definitely techniques that work fairly well a lot of the time..