On Bondage

1 Jun

Back when I was a teenager, I would have loved to wear these pink bondage pants. I would still rock that belt with the rings and chains. I love the color pink and most of my clothes are black. I doubt I would like those shoes though, I would be tripping all over myself in those clod-hoppers.

This post is not about my history of dressing punk rock, nor is it about sexual bondage or hidden fantasies. It is about restraints, nursing and patients. I still do want that belt though.

Lately it seems that there have been a few patients admitted to the telemetry floor where I work. They are alcoholics, withdrawing. Now, I am not a detox nurse specialist, I do not know much about rehabilitating these patients. What I do know is that they need to be sedated or they will keep climbing out of bed, all shakes and delirious, trying to leave the hospital against medical advice.

They get admitted to telemetry, because well everyone gets admitted to telemetry, but seriously, usually these people have severe electrolyte imbalances, mostly low potassium levels, which we know is not good for the heart’s rhythm. Potassium is needed for neuro-muscle cells to be able to re-polarize energy, and yes the heart is a muscle we know, and severe low potassium can cause problems with cardiac conduction. Hypokalemia may also cause respiratory problems, muscle weakness, fatigue.

We all know the alcoholic with severe liver disease, that comes in all yellow, big belly, low platelets, anemia, bleeding, low blood pressures, with metabolic encephalopathy, pooping all over the bed from the lactulose you are giving every four hours. They are so sick, it is not so difficult to give them some sedatives, get their bellies drained with paracentisis, transfuse some FFP, and maybe get them better enough to go home for a while longer.

Last week, since I am so nosey and seem to know what is going on with everyone on the floor, I hear another nurse talking about her patient that is a probably aged in the 40s, withdrawing from alcohol, with a potassium level of 1.9. Yeah that is super low, at that low-level you might see a U wave, and flattened t waves on the ECG, I imagine. The patient did not look that sick, there were tremors, but no delirium, just extreme agitation. The patient wanted to leave and it was only 0730 in the morning.

I had to intervene, I reported my 2 cents to the nurse, encouraging more sedation. The Librium 50mg every 8 hours is just not enough. This patient needed something like IV Ativan every 3 hours, that might have worked out better. Unfortunately, the nurse did not take my advice and luckily I was on the other side of the floor, so I did not have to hear, see this patient cursing and threatening to punch someone.

The shift went with the nurse trying to give IV potassium infusion plus oral replacement. Of course, the IV potassium kept burning, infiltrating etc, exacerbating the agitation. The patient kept trying to get up with an unsteady gait. The patient was orientated and kept saying: my potassium is now replaced, let me leave.

Things whirled out of control and went way over the line. A psych evaluation was ordered to evaluate competency, the psych doctor never showed up. The nurse struggled all shift.

The end of the shift came, and the patient was still trying to leave, the potassium was rechecked, it was still low and the fearful attending would not discharge the patient naturally. So what does the nurse do? She calls the doctor and gets orders to put the patient in restraints!

I am holding 1 posey soft restraint in my hand, security is there, and this yappy, dramatic nurse, who is not the patients nurse, is over zealous to get this patient into 4 point restraints. I get to the room and I am thinking to myself, something about this just does not seem legal, I mean why can’t we just give this patient some drugs and knock the patient out with chemicals and put mittens on like we usually do. ¬†Here we are facing this 200 pound angry alcoholic, totally unsedated, who ripped out the IV access again.

Luckily, the night nurse who happens to work in a psychiatric facility was with us and I was amazed by her therapeutic communication. She came into the room with a big needle filled with Thorazine and I think Haldol too. The experienced psych nurse told the patient that she was going to help her get everything sorted out after she gives the patient an injection in the muscle with this medicine. The patient took the injection willingly, the night nurse got the patient out of her clothing, sent the valuables to security, and started IV access on the patient.

In the middle of all of this the neurotic restraint happy nurse tried to tell us: You have to restrain the patient now, the doctor’s order says so! I was like whispering shut up, because we were in the room with the patient and the order was a verbal order taken by the nurse, and we all know we do what is right, not always what is written, we clarify. I wanted to tell her to take the restraints home to her hubby if she is so desperate to use them!

I was very impressed. I was also irritated at the day nurse who failed to adequately make this patient comfortable, and I was extremely annoyed at the happy psycho nurse desperate to restrain an alert angry patient in withdrawal. Not only did it seem unethical and barbaric, we would have gotten hurt. The patient was not going to say: sure tie me to the bed you evil bitch nurses!

A few shifts later, I happened to notice that the patient was still hospitalized, happily zombified on psych medications, and transferring to a rehab facility for alcoholism. The patient was not agitated, tremors gone, and the battle was over.

Now, my potassium is not low, I am not a raging angry alcoholic in detox, but I might not mind the posey soft restraints.

6 Responses to “On Bondage”

  1. Wanderer June 1, 2010 at 16:05 #

    The biggest fix to all of this is simple: give them a beer.

    Now there are the exceptions to this, like the patient who is willingly admitted for detox, to them I just tell ‘em to cowboy up. But many others, they’re fighting pneumonia, or cellulitis, or COPD or any other innumerable things and just happen to be an alcoholic. So what do we do? We detox them, pretty much against their will. Now in addition to whatever medical problem brings them in, we’ve added detox on top.

    The place where I went to school did this for awhile. The patient got a beer with lunch and dinner. It wasn’t much, but it was usually enough to quell the demons until we 86′d them.

    The docs mean well, thinking they are giving the patient a chance to “clean up”, but they’re not the ones chasing them all night, getting swung at, cursed at, pissed on and generally abused like the bedside nurses. It’s a mental exercise for them, but for us it’s something much more.

    • seejanenurse June 18, 2010 at 11:26 #

      Yes, it is so difficult and it can turn abusive, they are often manipulative as well. There has to be a better way, and I go for the “more sedation” approach, let them sleep it off.

  2. my2ndheartbeat June 5, 2010 at 13:08 #

    I was in restraints for a while after my heart transplant. Apparently, I didn’t like the vent very well and kept trying to take it out. Soooo ….. I was tied down for a few days. I didn’t remember that part at all, but later when I was conscious (and calm) I asked about these odd looking marks on my wrists that appeared to be ligature marks …… that’s when I was informed that I had been a “bad boy”.

    • seejanenurse June 15, 2010 at 01:36 #

      You are not allowed to rip out any tubes or lines!

  3. Robert September 23, 2010 at 06:24 #

    I was taken to a psych hospital in Nigeria after I slapped my lady teacher in the face. They stripped all my clothes off in a locked room with the teacher present and told me to put a tee shirt and pajama on. I did as I was told when a nurse walked in with a medication tray with four syringes. I was scared and started to cry (I was 14). The teacher and the nurses held me down and one nurse rolled up my sleeve all the way up. She then administered a most painful injection in my upper arm. I cried as my arm was held tightly by the teacher and nurses. She then gave me another injection close to the first one. After that they dropped my pajama down and gave me the remaining two injections in my buttocks. My teacher enjoyed all this punishment she was giving me under her authority. I promised her to behave myself, but she arranged for an 8 hour stay with the nurses.
    I could never talk to her again.

Trackbacks/Pingbacks

  1. Nurse Bloggers Best! | The Millionaire Nurse Blog - June 20, 2010

    [...] See Jane Nurse writes about Bondage-now get your mind out of the gutter-not that kind of Bondage… well maybe not, you have to go read to find out. [...]

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