"problem patient"

  1. Im having major issues right now with a patient that I do multiple 1:1's with. Heres the HX:

    Pt came in almost comotose from being noncompliant with his DM. He also has a HX of multiple heavy recreational drug use to the extent where his liver is shot and his mind is that of a teen (hes about 27). He is constantly hungery and extreemly verbal about his "misgivings" that the Dr.'s give him (the restrictions on what he can and cannot eat). He has been here since 2/11 and will stay here untill a custody hearing can be arranged and he can be admitted into an assisted living facility.

    The reason why he is a 1:1 is because he was constantly in the kitchens (we have 3 on the 65 bed unit) and is a flight risk.

    The Dr.'s have made compromise after compromise with him and he still is noncompliant. One of theses such compromises is that he can have as many tomatoes as he pleases, well he took advantage of this and had about 10 bowls of tomatoes delivered to his room per day in addition to his regular meals. well now he is having rectal issues due to the acidity. He refuses to take showers and keep himself clean and he constantly smells of fecal material despite the sitz baths that he does take.

    Many times he has tried to change his own diet and "trade" items on his tray. Of course I tell him he cannot do this showing him the long list of restrictions they have placed on his diet. Each time he curses me out and threatens to leave AMA.
    There are also been times where I or another nurse has turned around to do something and he slips out of his room only to be found in the kitchen again.

    Security has been called many times due to his actions.

    As you can imagine this is a very difficult patient and this is a very small picture of what we have to deal with on a daily basis...

    CAN SOMEONE PLEASE GIVE ME TIPS ON HOW TO DEAL WITH HIM AS I AM ALMOST CERTAIN THAT I WILL BE PUT WITH HIM AGAIN AND AGAIN UNTILL HE IS DISCHARGED?!?!?!
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  2. 37 Comments

  3. by   TazziRN
    Is there any way that a private sitter can be justified? Does not have to be a licensed person, just someone to keep him out of the kitchen, etc.

    The bathing......unfortunately he has the right to refuse a bath.
  4. by   elbo
    what are his blood sugars running? once stabilized the hunger should be decreasing... or is this behavioral? some suggestions, a conference with a dietician and the staff ; psych. consult to come up with a plan with the staff. Consistency will be key and giving him responsibility, good luck, elbo
  5. by   Nurse2bducky86
    I am the sitter! Uggh (thats the 1:1 part)
    We have tried the conferences with the dietary and the psych dpt. etc.
    His BG levels have been off the wall (today from 241 in the am at 0700 to 81 at 1000) but even when his BG are stable he still eats and eats and eats (we think it may be that one disease where people are unable to tell if they are full or not)

    I need tools that i realy dont have (Im on my 4th month of employment) on keeping his respect. Because he respects some nurses but not others.
    I try to be nice and constantly try to reinterate that we are only trying to help his situation.

    Are his actions possibly a result of his loss of mental capacity due to the extensive drug use??
  6. by   morte
    Quote from Nurseducky86
    Im having major issues right now with a patient that I do multiple 1:1's with. Heres the HX:

    Pt came in almost comotose from being noncompliant with his DM. He also has a HX of multiple heavy recreational drug use to the extent where his liver is shot and his mind is that of a teen (hes about 27). He is constantly hungery and extreemly verbal about his "misgivings" that the Dr.'s give him (the restrictions on what he can and cannot eat). He has been here since 2/11 and will stay here untill a custody hearing can be arranged and he can be admitted into an assisted living facility.

    The reason why he is a 1:1 is because he was constantly in the kitchens (we have 3 on the 65 bed unit) and is a flight risk.

    The Dr.'s have made compromise after compromise with him and he still is noncompliant. One of theses such compromises is that he can have as many tomatoes as he pleases, well he took advantage of this and had about 10 bowls of tomatoes delivered to his room per day in addition to his regular meals. well now he is having rectal issues due to the acidity. He refuses to take showers and keep himself clean and he constantly smells of fecal material despite the sitz baths that he does take.

    Many times he has tried to change his own diet and "trade" items on his tray. Of course I tell him he cannot do this showing him the long list of restrictions they have placed on his diet. Each time he curses me out and threatens to leave AMA.
    There are also been times where I or another nurse has turned around to do something and he slips out of his room only to be found in the kitchen again.

    Security has been called many times due to his actions.

    As you can imagine this is a very difficult patient and this is a very small picture of what we have to deal with on a daily basis...

    CAN SOMEONE PLEASE GIVE ME TIPS ON HOW TO DEAL WITH HIM AS I AM ALMOST CERTAIN THAT I WILL BE PUT WITH HIM AGAIN AND AGAIN UNTILL HE IS DISCHARGED?!?!?!
    i would ask for combination locks on the kitchens....and 1:1, means exactly that.....he has to be in your lne of vision at all times....and since there are "custody" issues...he is apparently not "his own person" and he may not have the rght to refuse tx of any kind....and i would stop compromising with him...he sounds like the classic addict.....keep things simple and direct.
  7. by   TazziRN
    No, I mean a sitter who does nothing but sit with him and makes sure he doesn't get into the kitchen. You are his 1:1 nurse, that's not the same thing. You have other things to do regarding his care that take you away from his bedside. Even 1:1 ICU pts do not have a nurse at the bedside every single second.
  8. by   pooker
    You could ask psych dept for advice. I've found our psych nurses a great resource with behavior problems.
  9. by   Nurse2bducky86
    Quote from TazziRN
    No, I mean a sitter who does nothing but sit with him and makes sure he doesn't get into the kitchen. You are his 1:1 nurse, that's not the same thing. You have other things to do regarding his care that take you away from his bedside. Even 1:1 ICU pts do not have a nurse at the bedside every single second.

    I AM THE 1:1 SITTER...ALL I DO IS SIT WITH HIM FOR MY 12 HOUR SHIFT I CANNOT LEAVE HIS BEDSIDE UNLESS THE CNA COMES TO RELEIVE ME!!
  10. by   firstyearstudent
    Has this patient had a pysch. consult. His eating is obviously compulsive. Maybe there is medication he can take.
  11. by   Nurse2bducky86
    Quote from firstyearstudent
    Has this patient had a pysch. consult. His eating is obviously compulsive. Maybe there is medication he can take.

    As I look through his HX there have been many psych consults. and many talks btwn him and the docs but still...
  12. by   TazziRN
    Quote from Nurseducky86



    I AM THE 1:1 SITTER...ALL I DO IS SIT WITH HIM FOR MY 12 HOUR SHIFT I CANNOT LEAVE HIS BEDSIDE UNLESS THE CNA COMES TO RELEIVE ME!!

    You don't have to shout.


    You did not make that clear.....if you're the sitter who can't leave his bedside then how is he getting to the kitchen??
  13. by   Cattitude
    Quote from Nurseducky86



    I AM THE 1:1 SITTER...ALL I DO IS SIT WITH HIM FOR MY 12 HOUR SHIFT I CANNOT LEAVE HIS BEDSIDE UNLESS THE CNA COMES TO RELEIVE ME!!
    I don't think it's clear to others reading this because your user name says NURSE and also you put "< 1yr exp. under nursing exp. People are going to assume you are a nurse not a tech or CNA. Usually members don't put Nurse in their user names unless they are one. Just an FYI.

    Quote from TazziRN
    You don't have to shout.


    You did not make that clear.....if you're the sitter who can't leave his bedside then how is he getting to the kitchen??
    Tazzi, she is a tech./CNA. I know with the username it's confusing.

    Now as far as the situation, I don't see how you can really take your eyes off him for a second unfortunately. He can't be trusted and that's the way it is.
  14. by   TazziRN
    Cat, she's asking for advice on how to deal with this pt who slips off to the kitchen whe no one's looking, then says she's at the bedside for 12 hours. Doesn't much matter what her title is, is she at the bedside constantly or isn't she?

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