The State of Confusion, Capital: the Hospital
Really, there are two different types of confusion: pleasant and combative.
It's hard to say which kind is more amusingly frustrating.
Case for Combative:
The night shift report was uneventful, so I was quite surprised to go in at start of shift and find that, although he is the only person in the room, he is talking to his wife--who is apparently in the bathroom wearing a helmet. And she must have been talking back, because every once in a while he would try to clarify something she said. Really not sure how that conversation continued. But then, I can't imagine how it started either.
So; Visual and Auditory Hallucinations. Cool.
One of his doctors cut down the amount of narcotics he was getting, but as far as I saw it didn't help.
We're trying to figure out what is going on with this man--blood cultures, urine cultures, x-ray. Good times getting those. He jerked away from the phlebotomist, he tangled himself up in wires while I tried to help him get the urine specimen, and the x-ray is really where it went downhill. I accompanied him down to the x-ray department because I didn't have much faith in his mental stability, and when we returned from x-ray he surprisingly agreed to sit in the chair instead of going back to the bed.
Turns out that's because he 'saw' people in his bed. He became very upset when we avoided reinforcing this idea, telling us that we snuck other people into his room and out through the back wall. It was HIS room, and he thought it very rude of us to let other people use his room, and demanded that to make it fair, he should be able to sneak into THEIR room on the other side of the wall. When I told him there was a stairwell on the other side, he insisted that he be allowed to see it. [He backed down from that, although I had no problem with the idea.] It got to the point that we either had to agree there were people in his bed, or leave his room because we were giving him the "worst care ever." When I tried to give him an antipsychotic, telling him he was upset and that the pill would help him calm down, he agreed he was upset, but said he didn't trust me, especially not to give him medicine.
And that's when I called in Psychiatry.
Case for Pleasant:
My shift started with one of my patients telling me that he was the hippest, grooviest patient.
Sure, I'll give you that. Normally I don't use those adjectives, so they are yours for the taking.
He asked me where I was from and if I had any children. This is very innocuous questioning, but when he asked me that for the third time that morning, I was suspicious.
He couldn't remember my name either (which was written on the board in his room...) and once pulled me aside to tell me he couldn't figure out what my role was. Your nurse, sir. It had been part of my introduction at the beginning of the shift, but memory was clearly questionable.
When I helped him walk to the bathroom, I noticed he would grab anything to steady himself: the bed, the wall, the doorframe. I asked if he used a walker at home, and he replied, "No, I play tennis!" And I wonder...how many years ago was that?
When I took him for a longer walk in the hallway (walking right behind him while holding onto a gait belt wrapped around his chest), he wobbled this way and that and told me that he was walking just fine, and reported to his wife that the walk had gone very well.
I repeatedly gave him safety cues, reminders, and directions, and by the afternoon he decided that I was indispensable; by end of shift he stated he wouldn't forget me.
I have my doubts, because he "forgot" me all morning.
It's hard to say which kind is more amusingly frustrating.
Case for Combative:
The night shift report was uneventful, so I was quite surprised to go in at start of shift and find that, although he is the only person in the room, he is talking to his wife--who is apparently in the bathroom wearing a helmet. And she must have been talking back, because every once in a while he would try to clarify something she said. Really not sure how that conversation continued. But then, I can't imagine how it started either.
So; Visual and Auditory Hallucinations. Cool.
One of his doctors cut down the amount of narcotics he was getting, but as far as I saw it didn't help.
We're trying to figure out what is going on with this man--blood cultures, urine cultures, x-ray. Good times getting those. He jerked away from the phlebotomist, he tangled himself up in wires while I tried to help him get the urine specimen, and the x-ray is really where it went downhill. I accompanied him down to the x-ray department because I didn't have much faith in his mental stability, and when we returned from x-ray he surprisingly agreed to sit in the chair instead of going back to the bed.
Turns out that's because he 'saw' people in his bed. He became very upset when we avoided reinforcing this idea, telling us that we snuck other people into his room and out through the back wall. It was HIS room, and he thought it very rude of us to let other people use his room, and demanded that to make it fair, he should be able to sneak into THEIR room on the other side of the wall. When I told him there was a stairwell on the other side, he insisted that he be allowed to see it. [He backed down from that, although I had no problem with the idea.] It got to the point that we either had to agree there were people in his bed, or leave his room because we were giving him the "worst care ever." When I tried to give him an antipsychotic, telling him he was upset and that the pill would help him calm down, he agreed he was upset, but said he didn't trust me, especially not to give him medicine.
And that's when I called in Psychiatry.
Case for Pleasant:
My shift started with one of my patients telling me that he was the hippest, grooviest patient.
Sure, I'll give you that. Normally I don't use those adjectives, so they are yours for the taking.
He asked me where I was from and if I had any children. This is very innocuous questioning, but when he asked me that for the third time that morning, I was suspicious.
He couldn't remember my name either (which was written on the board in his room...) and once pulled me aside to tell me he couldn't figure out what my role was. Your nurse, sir. It had been part of my introduction at the beginning of the shift, but memory was clearly questionable.
When I helped him walk to the bathroom, I noticed he would grab anything to steady himself: the bed, the wall, the doorframe. I asked if he used a walker at home, and he replied, "No, I play tennis!" And I wonder...how many years ago was that?
When I took him for a longer walk in the hallway (walking right behind him while holding onto a gait belt wrapped around his chest), he wobbled this way and that and told me that he was walking just fine, and reported to his wife that the walk had gone very well.
I repeatedly gave him safety cues, reminders, and directions, and by the afternoon he decided that I was indispensable; by end of shift he stated he wouldn't forget me.
I have my doubts, because he "forgot" me all morning.
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