October 24, 2009

Assault and battery by Gatorade

I knew it was bound to happen sooner or later:  a patient threw something at me.

I was back on stepdown the other night.  The report said that the patient was involuntary, psychotic, delusional, a pussycat in the AM but once it got dark out, she would get all worked up.  True to form, she did.  She started slamming doors, spitting in the hallway, and getting into it with her roommate who was otherwise peaceful all day but told me in no uncertain terms that if this patient got in her face again that she'd "fuck her up". 

So we separated the two, thinking that having a private room would help the agitated patient calm down.  But now it's the safety checks that were getting her agitated, and she started complaining, throwing things, getting into it with other patients, and slamming doors even more.  She was reprimanded several times, and even reminded that this behavior is not going to work in her favor at her court hearing, but she disregarded it.

I'm peacefully in the med room doing my med pass when she got me with the Gatorade.  I yelled, "Hey!" and it took all my willpower to keep my mouth shut after that. 

I went to my charge nurse, who thank God is on the ball.  She arranged for an immediate transfer for the patient to the intensive care unit.  Then she tells me to see if she has any PRNs that I can give the patient.  Sure enough, she does:  Ativan PO or IM.

"Should I offer it PO?" I ask.

"Do you think she'll take it PO?" says the charge nurse.   Both of us know how this is going to end.

I point to my wet head and shirt.  "Probably not."

"Draw it up."

"It would be my pleasure."

So I prepped the needle, and though we had one male tech on the floor, we called for another tech to come help me give it.  Thank God they found me the biggest one on duty.

Charge nurse sends our two techs in, and tells the patient that we've got medicine for her, and would she lie down.  She keeps saying, "I'll be quiet, I'll behave," but when she sees me and then the needle, she starts glaring daggers.  I stare back with no expression (I'm still fighting to keep my tongue holstered and succeeding).  They asked her if she wanted it in her arm or her thigh.  She didn't answer, so I said she'll get it in her arm.  She didn't fight it--the two techs weren't going to let her.

God help me for saying it, but giving her that IM injection felt so damn good.

In the five minutes between that and her transfer, she kept walking the hall and muttering threats at me.  I didn't flinch and I damn well didn't take my eyes off of her as she passed.  She kept telling the techs that she'd behave now but they told her "you had your chances, we offered to help you, you need to go."  So now she's over in the intensive care unit, where they take no crap from any patient.

Afterwards, I took a few minutes in the lounge to breathe, curse her out (to the amusement of the techs), and then write the incident up.  The techs were impressed and said I handled it all very well, better than they would have.  The charge nurse understood how I felt when I gave that IM--such things have happened more than once on this floor.

Unfortunately, because of all of this, I had forgotten to give one patient all of her meds--I was in the process of doing that when the Gatorade attack happened.  She refused the remaining two meds, so I had to square that away with the night nurse, and I might be written up for a med error.   Maybe I got lucky and the night nurse was able to persuade her to take them. 

Can't win them all.

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