Crohn's Disease P/t

  1. Hello,
    I had a 28 year old female patient admitted with a crohns disease flare. MD prescribed 1mg dilaudid every 4hrs prn and zofran. She was having diarrhea with rectal bleeding, vomiting, and low grade fever. MD completed a colonoscopy and EGD. Results showed gastritis, and biopsies were normal. MD changed dilaudid to every 6hrs prn, and add toradol. Patient was relieved but frustrated that she was still have terrible pain and the diarrhea with rectal bleeding. She was concerned she wouldn't be able to take care of her young children in her state. She asked the MD, what can be done about her crohns flare symptoms, but MD would continue to escalate her voice by saying, there's no crohns disease, this is not a flare! I don't need to give you dilaudid. And called for a psych and pain med consult. The patient was very distraught on how the MD was speaking to her. She asked, I'm sorry but are you giving me attitude? I'm very confused... all the while the MD talking over her. Patient started to cry and said she's very sensitive, and to have the MD judge her and automatically decide the patients pain level for her was very hurtful. Her emotional and physical well being was distressed with how this MD treated her. Personally I believe pain is subjective, and given that i physically saw her while she had painful bowel movements, pain, etc, the patient doesn't seem like. Drug seeker, she has genuine pain. Isn't there no cure for crohns? And even with the colonoscopy findings, it could very well still be a flare? Thoughts on how the doctor should have approached the situation? I felt so bad for this patient... anything I can do or recommend for her to do? Thanks!
    •  
  2. 15 Comments

  3. by   brownbook
    I love your post, but am drawing a blank on what a nurse can or should do. Or just have some vague...maybe.....ideas.
    Last edit by sirI on Sep 28
  4. by   sirI
    Welcome to allnurses.com

    We moved your thread to the General Nursing forum for more exposure.
  5. by   Meeshie
    If all her biopsy results were normal then ... ? Those biopsy results are the confirmation of Crone's. So if they're negative....... then the consults might very well be the best way to go. Or not. Who knows without knowing more. However, you can't control how a doctor speaks to a patient. You can advocate for that patient with the doctor and the patient can, of course, fire that doctor and have another if she feels that she is being ignored or mistreated. What you can't do is control how someone else acts.
  6. by   meanmaryjean
    Patient can also vote with her feet and see another doctor.
  7. by   MunoRN
    The first issue is that if the patient truly does have Crohn's, then opiates should generally not be given, the common view of the GI docs I work with is that they consider them to be contraindicated for Crohn's symptoms with only the exception of post-operative short term use.

    In this case where it's sounds like the patient doesn't actually have Crohn's, then it's still reasonable for the MD to determine that opiates are not indicated based on their assessment and diagnostics. We don't actually give people opiates simply based on what their pain is stated to be, we use their description of the severity of their pain to quantify the pain we have reason to believe is there.
  8. by   Sour Lemon
    Quote from Stephanie5160
    Hello,
    I had a 28 year old female patient admitted with a crohns disease flare. MD prescribed 1mg dilaudid every 4hrs prn and zofran. She was having diarrhea with rectal bleeding, vomiting, and low grade fever. MD completed a colonoscopy and EGD. Results showed gastritis, and biopsies were normal. MD changed dilaudid to every 6hrs prn, and add toradol. Patient was relieved but frustrated that she was still have terrible pain and the diarrhea with rectal bleeding. She was concerned she wouldn't be able to take care of her young children in her state. She asked the MD, what can be done about her crohns flare symptoms, but MD would continue to escalate her voice by saying, there's no crohns disease, this is not a flare! I don't need to give you dilaudid. And called for a psych and pain med consult. The patient was very distraught on how the MD was speaking to her. She asked, I'm sorry but are you giving me attitude? I'm very confused... all the while the MD talking over her. Patient started to cry and said she's very sensitive, and to have the MD judge her and automatically decide the patients pain level for her was very hurtful. Her emotional and physical well being was distressed with how this MD treated her. Personally I believe pain is subjective, and given that i physically saw her while she had painful bowel movements, pain, etc, the patient doesn't seem like. Drug seeker, she has genuine pain. Isn't there no cure for crohns? And even with the colonoscopy findings, it could very well still be a flare? Thoughts on how the doctor should have approached the situation? I felt so bad for this patient... anything I can do or recommend for her to do? Thanks!
    Are you a student or a nurse, Stephanie? I've actually had patients fake fevers, vomiting, pain, etc. to get what they need ...narcotics. One man even used to poor cranberry juice in his urine to make it look like blood ...and when he got caught, he started taking coumadin to make himself bleed, for real.
    A psych consult may be exactly what she needs.
    Drug seekers can have genuine pain, by the way. Sometimes withdrawal from the drug actually causes severe abdominal pain and nausea.
    The doctor gave her pain medication options and even a pain management consult. It sounds like he or she has taken care, to me.
  9. by   blondy2061h
    Quote from meanmaryjean
    Patient can also vote with her feet and see another doctor.
    That's hard, if not impossible, to do when you're hospitalized.
  10. by   blondy2061h
    I'm curious if the doctor involved is a general medicine doctor or GI specialist?
  11. by   brownbook
    Assuming the patient isn't faking anything. Is it appropriate for a nurse to give the patient a list of other gastroenterologist, or general medicine doctors, who have privileges at that hospital? Suggest she might consider seeing a different doctor?

    Even if the patient is drug seeking and needs a psych consult the doctor's bedside manner was inappropriate.
  12. by   meanmaryjean
    Quote from blondy2061h
    That's hard, if not impossible, to do when you're hospitalized.
    I beg to differ- I've seen it a lot in my 40 years of practice. I've done it myself.
  13. by   brownbook
    Quote from meanmaryjean
    I beg to differ- I've seen it a lot in my 40 years of practice. I've done it myself.
    I agree, but the average patient, myself included, might have a hard time. Not being assertive enough, not knowing how to fire their doctor while hospitalized, not knowing their doctor is being inappropriate, etc.
  14. by   SaltySarcasticSally
    As someone with Crohn's disease, some of these responses blow my mind a bit. I went undiagnosed for 10 years. Mainly because all of my biopsies were negative. This was due to the fact the part of my small bowel with Crohn's can't be reached with endoscopy or colonoscopy. It was until I went from 180 lbs to 130 lbs in 5 months that I was diagnosed by MRI.
    The patient's biopsies being negative does NOT mean she isn't having a flare.
    OP, I really appreciate you reaching out to better help your patient. I have zero drug abuse history. But I cannot tell you the amount of times I was treated as a drug seeker in the ER. I've had 3 large headed babies, the pain of labor has nothing on my Crohn's pain. I hate pain meds, they make me feel like I'm not in control of myself. But if I am hurting bad enough to go the ER, I don't care at that point, I just need relief. It is SO draining to be in extreme pain for days.
    I don't know what it is about GI Dr's, but the vast majority I've met are arrogant and have no bedside manner. The Dr that diagnosed me is the only Dr I have been able to trust because he doesn't talk to me like I am making my pain up.
    I've never heard opiates is contraindicated for Crohn's. Morphine IV is what I'm usually given in the rare times I do need emergent care. Usually that's when I'm so dehydrated I'm passing out. I do choose to not have an at home Rx for pain meds even though it was offered. I prefer to stick it out because 95% of the time, I can.
    Just advocate for her and let her know you do believe her. Let her know she has options for providers, even while in patient.
    Sorry for the novel but I'm just sick of the fact because there is a drug epidemic, anyone in severe pain that does not have a quick, visible cause is labelled a drug seeker.
    Crohn's is an auto immune disease. It doesn't not have a one size fits all progression and it may not always be the picture perfect description of it. That doesn't mean it isn't real or that a psych consult is indicated.

close