had a patient so fractious they would wake up agitated and stumble out into the hall trying to fight people. I noticed one time passing this room that the pt was gurgling in their sleep, (excess saliva being a side effect of all the antipsychotics they were getting for the punching). this turned out to be pretty common for them. They would then start coughing and sputtering, then wake up.
So you have a feedback loop: Choke on your own spit, wake up mad about it, punch a nurse, get more antipsychotics, pass out while making more spit to choke on and so on and so forth.
Now this pt did have sublingual atropine drops ordered that would stop the excess salivation, but there was no way to get them to willingly let me put them under their tongue…
…so I did it while they were still asleep. When I heard the gurgling I would have a coworker shine a light on the ceiling while I heel-toed in with the drops, very carefully dropped 4 as close to the bottom lip as I could manage, then toe-heeled my way back out. the gurgling would dry up and stop before the pt started choking.
no more overnight agitation. no more punching. no more shots. well none on my shifts anyways. everybody else was too scared. I figured I was being swung on either way I may as well actually try to fix it.
storytime:
had a patient so fractious they would wake up agitated and stumble out into the hall trying to fight people. I noticed one time passing this room that the pt was gurgling in their sleep, (excess saliva being a side effect of all the antipsychotics they were getting for the punching). this turned out to be pretty common for them. They would then start coughing and sputtering, then wake up.
So you have a feedback loop: Choke on your own spit, wake up mad about it, punch a nurse, get more antipsychotics, pass out while making more spit to choke on and so on and so forth.
Now this pt did have sublingual atropine drops ordered that would stop the excess salivation, but there was no way to get them to willingly let me put them under their tongue…
…so I did it while they were still asleep. When I heard the gurgling I would have a coworker shine a light on the ceiling while I heel-toed in with the drops, very carefully dropped 4 as close to the bottom lip as I could manage, then toe-heeled my way back out. the gurgling would dry up and stop before the pt started choking.
no more overnight agitation. no more punching. no more shots. well none on my shifts anyways. everybody else was too scared. I figured I was being swung on either way I may as well actually try to fix it.