Delirious pt

I was given a pt that was admitted with a query fractured femur post fall, after multiple tests it was cleared that they only had a fracture in their hip bone that was to be conservatively managed.

The pt required a companion all day as they were very confused, their past medical history being that of dementia, anxiety and depression. My pt required strapping to the bed during the 3 days tests were performed to determine the cause of the pain. This was the extent of their confusion, the pt could be heard screaming and yelling at nursing staff due to this delirium. On finally getting the go ahead by the orthos for conservative mx my supervisor and I went into try and start ambulating the pt.

The pt was lying in bed on arrival, despite seeming asleep the pt was fully aware of our presence and replied to all our questions. The pt refused to get up at all. Calling us names and telling us to "get out and leave them alone" The nursing staff suggested that even if we arent able to get them up then we could at least assist by rolling her to insert a suppository. Despite a huge protest from the pt the roll ended up into a SOEOB. The pt continued to protest even in this position, repeatedly telling us to "get out" "leave them alone" passing ractist comments (as both my supervisor and I happened to be asian) such as "dont you understand english, read my lions- go outside" "mind your own business". As we were unable to leave them SOEOB without supervision we attempted to return them to bed but again met with protests such as the above. At this the pt raised the hand to strike us and raised their voice to match it. I couldn't get out of the way as I was supporting them in sitting. Even though the pt did not strike either of us it gave us both a fright to be met with such hostility. We tried negotiations asking if we leave would they lie back into bed. every thing was refused. The nurse then realised that the p.m. meds werent administered which may have caused the confusion. This did not help as the pt refused to take the meds. After a long time debating what to do we came to the decision to leave the pt SOEOB (as they had good sitting balance) and wait it out.

No more than 5 minutes had passed after we had walked out the door than the nurse came into assist her to walk the pt to the toilet.

So despite the good ending it was a difficult situation for myself as a student to decide what is the morally as well as safe thing to do. Despite our essentially good intentions pts with delirium are difficult to treat due to their confusion and swinging moods. It is equally dangerous as well as disheartening to be refused and attacked for trying to help. Its an experience that most of us will go through, strategies to cope are not based on theory but rather the pt type and experimentation. I find that the nursing staff are a huge help in this situation and that leaving textbook theory on the bookshelf helps as well.

Hope this helps others, you arent the only one!