Your least favorite patient. - page 4

Whats your least favorite type of patient to take care of in the ER..... Mine would have to be the drug over dose....had one on my last shift the treatment is pretty much the same What we normally... Read More

  1. by   curleysue
    Quote from blueinplaid
    Why demerol and not morphine or dilauded? I'm new to the ER and trying to learn to tell the difference between the drug seekers and real pain...
    Its kinda hard to learn the difference between drug seekers and the real pain cause as a nurse its hard in some cases cause sometimes you just cannot figure out which patients are just abusing the system to get their 'high'. I know a lot of nurses have been trained to keep their mouths shut and whatever the doctor orders the patient needs. I guess after a while working in the ER you learn who is the classic drug seekers and frequent flyers. I saw a TV show that had a frequent flyer who would fake seizure out of the hospital setting so that an ambulance would come and immediately give her valium or versed. But as soon as she would get the medication she would wake up like nothing happened. The paramedic caused it 'psuedo-seizures'. She would be so good at it she even wet herself. Finally after so many times doing it the ER caught onto it and the ER doc confronted her about it and she admitted she was trying to kick methamphetamines and that she needed help with the withdrawls. I think confronting patients who are drug seekers might get them to admit something. At least for a few people but not all. Some docs will, knowing the patient is a drug seeker, just say give her what she wants and get her out of here. But that isn't such a good solution.

    However, what if someday you are wrong and they are really in pain? That is the other issue with it. How can you really determine who is faking it and who isn't.

    Anyways, good luck in the ER. I loved working there as a paramedic and would love to do it when I am done with my BSN. Its exciting. Although the drug seeking behavior seems to be a huge topic in the ER nursing forum. It must be just a huge problem and frustrating for both the docs and nurses.

    Curleysue :uhoh21:
  2. by   acutecarenp
    Quote from snowfreeze
    Mine has to be the UTI obese female with 40 family members entourage along for the free ride. She expects food q1HR and they bring it and interrupt all aspects of the ER in the process. They ask for free bus passes, free lunch tickets, free parking passes even though they didn't drive you gather from the conversation. And she isn't in much pain, but is just a needy pain.
    People that work the system in general.
    I have 2 favorites:

    1. The drunk who comes in with cops in handcuffs....who, by some miracle of having come through the doors of the ED, no longer needs police custody...or handcuffs!
    2. The self proclamed "VIP" who works in the billing office and comes in with the 16 y/o daughter with a runny nose, and demands to be taken care of immediately.... when the Sh** is in the process of hitting the fan!...

    Hmm... this is Saturday night...Do you usually wear your hospital ID on your day off?
  3. by   tferdaise
    Well after working in a level 1 tramua ED for 4 yrs, I think I have seen them all, the homeless with the REALLY smelly socks that almost knocks all the patients out when thier shoes are taken off. The gang banger who comes in with his homies because he was beat up (err, I mean, he fell down) the GI bleeder, the Freq flyier who NEVER follows up with the Doc from thier last visit for the same thing and who is on welfare(NOW that is a whole different thread) or the Inmate who complains of chest pain 10 out of 10 pain, SOB, and stats he has a elephant on his chest..

    What really got me to think one day was seeing this women come in who was the same age(40) as I am, but looked like she was 20 yrs older. She lived a hard life of IVDing and came into the ED with this abcess that was the size of a softball that was on her (L) buttocks. Now, I usally don't feel sorry for these people, it's thier choice to live that lifestyle, but man, when I saw that abcess I was speechless...

    I guess I could go on, I do miss the ED a lot I shall return one day..


    Tony/PHX:angryfire
  4. by   wikiwicked
    Whats your least favorite type of patient to take care of in the ER.....

    Well for at least those patients, I am actually doing ER nursing. My least favorite complaint is that of back pain (chronic) - because while I am helping the RN who has that patient or someone is assisting me with a TRUE emergency reqardless if intentional, it is the patient with a problem that is non-life or limb threatening that feels as if his/her problem is more severe than that of anyone else in the ER. :angryfire
  5. by   RAD72
    Mine would be someone that calls for pain meds and just as your pulling them there calling again. Give me a chance to get them first! :flamesonb
  6. by   Nurse Bob
    "We are inbound to your facility with an 89-yr-old male, chief complaint is altered mental status, the staff reports he is always confused but just doesn't seem to be himself today...." Arrives with a full diaper, a couple skin tears on his forearms, a 2-3cm stage 2 decubitus on his coccyx, 18 medications to sort through, unable to give any history or assist in his care in any meaningful way, G-tube... After CT and septic work up, $6,000 later he goes back to "Vibrant Lifecare (or whereever)" because we couldn't find a good reason to send him for brain surgery or any new meds to shovel into the G-tube.
  7. by   vablueyes
    Mine is the 390-400 pounder who can't walk because his legs won't support him, and who can't wipe his hinney or find his penis to use the urinal. He comes in at least once a week to get "cleaned up", and it takes seven people to move him, can't turn over because he's too big for the stretcher, he smells to high heaven, and wants the phone, wants the ice water, wants you to move his leg, "can I have a urinal" (even though he cant' get his penis to pop up big enough to make it in TO the urinal), "will you order me a tray", and the whole time you have your seriously ill patients, who must not only endure the smell, but wait while you babysit this one. His attempt to use the urinal is like "Old Faithful" spurting all over the walls,floor, curtains, and me if I'm not quick enough. I always get stuck with this one, and my back is just killing me.....I think next time I get a report over the radio that he's on the way, I'll develop a migraine and go to the lounge until it's over...There has to be a better way to make a living.



    You have to do your own growing, no matter how tall your grandpa was.
  8. by   z's playa
    Quote from vablueyes
    Mine is the 390-400 pounder who can't walk because his legs won't support him, and who can't wipe his hinney or find his penis to use the urinal. He comes in at least once a week to get "cleaned up", and it takes seven people to move him, can't turn over because he's too big for the stretcher, he smells to high heaven, and wants the phone, wants the ice water, wants you to move his leg, "can I have a urinal" (even though he cant' get his penis to pop up big enough to make it in TO the urinal), "will you order me a tray", and the whole time you have your seriously ill patients, who must not only endure the smell, but wait while you babysit this one. His attempt to use the urinal is like "Old Faithful" spurting all over the walls,floor, curtains, and me if I'm not quick enough. I always get stuck with this one, and my back is just killing me.....I think next time I get a report over the radio that he's on the way, I'll develop a migraine and go to the lounge until it's over...There has to be a better way to make a living.



    You have to do your own growing, no matter how tall your grandpa was.

    How does he get the EMS to bring him in when they know what its for? Home care not an option? Does he make a cmplaint that can't be ignored to get his foot in the door? Maybe take that money the EMS spends by taking him in and get the fire department to go by once a week and hose him down ...

    ok ok.....that was mean but it really gets me mad to see people abuse the ER.
  9. by   mamanurse13
    Quote from blueinplaid
    Why demerol and not morphine or dilauded? I'm new to the ER and trying to learn to tell the difference between the drug seekers and real pain...
    Welcome to the wonderful world of "The EMERGENCY DEPARTMENT". You will be amused and confused daily. You'll learn to cope and recognize.
    Most of my "pain patients" would rather have Vitamin D than anything, other than Lortab or Oxies they can sell on the street. They seem to be allergic to everything in the PDR especially Toradol and Motrin.
    Toradol is a no-no for a seeker...it works on the pain NOT the brain. Why ease the pain where there is none.
    Keep your head up and your ears open. You'll learn much just by listening to conversations between the patient and family. Sorta like eavesdropping.
  10. by   RAD72
    Quote from vablueyes
    Mine is the 390-400 pounder who can't walk because his legs won't support him, and who can't wipe his hinney or find his penis to use the urinal. He comes in at least once a week to get "cleaned up", and it takes seven people to move him, can't turn over because he's too big for the stretcher, he smells to high heaven, and wants the phone, wants the ice water, wants you to move his leg, "can I have a urinal" (even though he cant' get his penis to pop up big enough to make it in TO the urinal), "will you order me a tray", and the whole time you have your seriously ill patients, who must not only endure the smell, but wait while you babysit this one. His attempt to use the urinal is like "Old Faithful" spurting all over the walls,floor, curtains, and me if I'm not quick enough. I always get stuck with this one, and my back is just killing me.....I think next time I get a report over the radio that he's on the way, I'll develop a migraine and go to the lounge until it's over...There has to be a better way to make a living.



    You have to do your own growing, no matter how tall your grandpa was.
    Now that's rough.
  11. by   RAD72
    Old Faithful is right!

    I'd be sitting in the lounge too.
  12. by   ERNurse678
    How about this one. Had a cardiac arrest the other night. Pt. was DOA, we pronounced it upon her arrival. The ER doc and I walked over to the family room where there is 50 family members. The doctor gives the news and then quietly exits the room as I am left to try and calm the family and support them however I can. Now, also let me mention that due to renovations in our ER the family room that we were in is not actually in the ER, you have to walk down the hallway away from the ER to get to it. So I am in the room with the 50 family members crammed into this little family room and the daughter "passes out" So I am trying to get her out of the middle of the floor and put a cool cloth on her head when the next thing I know the son is having a seizure. So here I am by myself climbing over the "passed out" daughter to get to the son who is having a seizure and whose airway is becoming non patent very quickly from all of the secretions. Would have to say that was my least favorite in a long time. Needless to say after getting him stable for a second I ran to the phone, called the ER told them to send me another nurse and a stretcher. The other nurse and I lifted this 230 lb man off the floor and onto a stretcher. He then starts seizing again. We run back over to the ER, get a line give him some ativan and eventually find out that he is supposed to be taking dilantin but hasn't taken it in months. Dilantin level is next to nothing. Sad to say, this was only in the first couple hours of my shift, any guesses on how the rest of the night went.
  13. by   creedyrn
    i'm an urban er nurse...my faves have to be the ones who call ems for either a toothache, or the std's...i have 70 year old women who won't call ems and wait hours for a family member to come home and bring them in when they are having chest pain, yet these 20-somethings will call ems just because 'i don't feel good'...talk about a difference in mind-set...were we raised that differently? probably the best was a homeless man, on a cold night, called ems c/o chest pain, when he got to our place, and realized we weren't going to do anything for him (when he stated he had no complaints), stated that he was going to kill himself because he had no place to go (we also have a psychiatric er, the only one in the city) do they know how to play the system or what?!
    Lee

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