Faking It - page 4

the best, the worst......what's your experience with pt's faking illneses etc?......seems lately at my ER, seizures seem to be the malady of choice.....l have decided to earn my retirement writing a... Read More

  1. by   Allison S.
    Regarding RSD:

    I'm not being callous. We treat this all the time, and treat all cases as though they are real, even when the pain is the only symptom and even when the pain is only evident when we start talking about sending the child back to school or something like that.

    We do, however, have kdis who have made a life out of being comfortably ensconsed in the hospital.
  2. by   l.rae
    Originally posted by JNJ
    Not quite on topic, but it's quite a story:
    Close friend of mine, RN of many years pediatric experience, ends up taking a fragile looking child to the on-floor nurses room with her to lunch as he looked so sad as his mommy needed to leave the hospital for a while. Two-year-old is on TPN, with nothing by mouth related to long history of vomiting, no real Dx yet.

    During her lunch, the kid grabs a cracker and wolfs it down. My friend is alarmed - she's broken all the rules. (However, I'd trust her instincts over rules most days). Kid is smiling, asking for more. She's going off to confess, when suspicion strikes.

    To cut the story short, ipecac found in mother's bag after mother covertly observed to take something from her bag and give it to the child. Mother taken off by law enforcement, screaming at my friend. Kid now in foster care; huge legal trauma for my friend who started the (correct) procedure for dealing with such an incident.
    Horrible incident, but the RN probably saved the kid's life long term, and certainly his health. Took it's toll on my friend.

    Not sure if Munchausen by proxy - as this is officially called - is really a law enforcement matter. Seems to me the mother needs a psyche consult more than anything.

    JNJ...this brings back terrible memories for me...yrs ago l worked in a ped office....when l started the kid was about 18 mos old.....he had "problems"....ALL the time....ended up with a g/tube....and ended up coding at childrens hosp.....didn't make it..he was a couple of months shy of his 3d birthday when he died....autopsy showed ipicac poisening....GAWD, some of the posters that are worried about nurses being judgemental need to understand that we have seen so much of this kind of crap it is truely sickening.....and JNJ...you are right....it is Munchausen by proxy..............LR
  3. by   l.rae
    Originally posted by 3rdShiftGuy
    I know you are talking tongue in cheek as only nurses do, especially ER nurses.

    But people of "fake" seizures actually have an illness. Perhaps not "seizures". But they don't necessarily consciously say "Gee, I think I'll go to the ER and fake a seizure".


    I disagree somewhat with this statement....Many really DO intentionally arrive at ER with just this purpose.....sometimes they want to get at someone who has been perceived to have done them some kind of injustice or some may be Munchausen's....some want the ativan and valium......all different kinds of reasons......there is an element of your thoughts that l agree with though.....they are sick and there are some who truely believe they are having sz(few though).....you just have to be there though....I think its hard to relay your observations to someone who is not accustomed to and submitted to these conditions day after day without sounding harsh.......I really can't explain it........ you do develope a sixth sense sort of, But l believe good nurses know to question these feelings and look for anything that would prove otherwise, sometimes things are as obvious as the nose on your face and sometimes more subtle and always best to err on the side of caution always.......and BTW, the repeat offenders have RARELY f/u with pmd.....they save their performances for the ER............LR
  4. by   kaycee
    Our repeat seizure offender was after IV Valium and Ativan. And I would say yeah he did say I think I'll call 911 and go to the ER and fake a seizure for my nightly high. When we wouldn't give him any meds and would just watch him preform, he would eventually get off the stretcher and walk out AMA.
  5. by   Tweety
    Originally posted by l.rae
    I disagree somewhat with this statement....Many really DO intentionally arrive at ER with just this purpose.....sometimes they want to get at someone who has been perceived to have done them some kind of injustice or some may be Munchausen's....some want the ativan and valium......all different kinds of reasons......there is an element of your thoughts that l agree with though.....they are sick and there are some who truely believe they are having sz(few though).....you just have to be there though....I think its hard to relay your observations to someone who is not accustomed to and submitted to these conditions day after day without sounding harsh.......I really can't explain it........ you do develope a sixth sense sort of, But l believe good nurses know to question these feelings and look for anything that would prove otherwise, sometimes things are as obvious as the nose on your face and sometimes more subtle and always best to err on the side of caution always.......and BTW, the repeat offenders have RARELY f/u with pmd.....they save their performances for the ER............LR

    O.K. I think though nurses and MDs are often unaware that there is definately a difference between "psuedoseizure" disorder and drug seeking, or attention seeking.

    My expereince is in neuro, only with the patients the ER admits, so I don't see it on a day to day basis, in that respect. So I can't say most of the people who come to the ER consciously make the decision to get drugs and fake a seizure, (obviously you can and do, so it's not my place to agrue that point.)

    But like the nurse above who said they got a good laugh at the patient, after the laughter realize the patient is still ill.
  6. by   majrn
    Originally posted by regnursein99
    We used to have this frequent flier w numerous admits w CHF. However he would often fake it or c/o other things while admitted in order to stay in the hospital where he got "great food" (his words).

    We once found him laying on the floor in his room, rolling around and jerking. (He weighed over 350#...this was a real sight) A verteran RN on our floor had dealt w him many times and just yelled, "LOU! LOU! WHAT ARE YOU DOING?!!!" He honestly STOPPED the "seizure" looked up and said, "I am having a seizure!" and promptly started flipping around on the floor again! :roll

    :chuckle what a sight that must have been!!!
  7. by   howie122832
    We have a guy known as "Jimmy the fish". He goes into a bar, runs up a tab, and then fakes a seizure when it's time to cash out flops around like a fish all over the place, they call 911 and the paramedics take him to the hospital.... then he doesn't have to pay his tab! Haven't seen or heard of him lately, not since the last paramedic told him he was in "heart failure, and they were going to "shock" him..!!!! He immediately got up, and left!!
  8. by   hoolahan
    3rd shift guy, not to be a snot, but maybe you haven't seen this so much b/c our dear ER colleagues have already triaged or treated and streeted the fakers w all their assundry miraculous cures that I am learning about tonight.

    I did ICU for many years and I have to say I have NEVER seen a seizure faler admitted to ICU, so too alt ER nurses.... I bow to your humble wisdom!!! You guys do a great job.

    I have rarely ever even considered thinking of a pt as "faking" something...until I was doing worker's comp. You may ask WHY would someone WANT to have surgery when they have been told by 3 speacilaists that they don't need it?? Well, some people I learned, will do anything not to have to work. Some of the things I saw from the fakers almost turned me off of nursing completely!

    L Rae, I want a copy of the book too.
  9. by   rdhdnrs
    We had a pregnant girl who faked blindness!!! I guess she thought we'd deliver her for it. When her mom came, she was miraculously cured.
    Have had many pseudoseizure pts... when they're pregnant you have to really take it seriously...I guess they are mag addicts??
  10. by   Tweety
    Originally posted by hoolahan
    3rd shift guy, not to be a snot, but maybe you haven't seen this so much b/c our dear ER colleagues have already triaged or treated and streeted the fakers w all their assundry miraculous cures that I am learning about tonight.
    That's exactly what I was thinking. I hope I brought that point across. Sounds like the number of people who present to the ER with fake symptoms outnumber the ones with pysch illnesses who truly don't know they aren't actually sick.

    However, my point being that "faking seizures", not the ones who go "gee, I'll fake a seizure and get drugs"., but the one's that have spontaneous psuedoseizures is a condition. The same as "clinical depression" is.

    These people deserve to be treated with respect. Not laughed at, not talked about in the hallways that they are "fakers".

    The unit I just left had continuous video eeg monitors and we would get patients on a direct admit basis. People who have thought they've had seizures for many years. Whom even "fooled " ERs and doctors, being on anitseizure meds. (Because you don't have to flipflop and piss on yourself to have a seizure) (Sometimes, it's very obvious that a person isn't having a true seizure.) The monitors tell the truth. They are then sent for proper help, not sent on their way chastised for being "fakers", just for drugs and attention.

    I'll get off my soapbox. LOL
  11. by   perfectbluebuildings
    We had a lady once at this assisted living place who would pull out her fully inflated foley catheter to soak her just-put-on outfit if we didn't get there fast enough to change it to something she preferred, then would say it just slipped out... with only 3 cnas/ras and no other staff but the cook for 50 residents, that was annoying!!
  12. by   rachel h
    We have a patient who comes in the hospital all the time for "pain crisis"- last time I took care of him he was getting dilaudid q1-2h (and was on his light every hour on the hour), rating his pain 10/10. As I'm giving him dilaudid, he says to me " I wish the hospital had a weight room so I could go work out."
    Unbelievable... he was taking up all my time so he can get high while my other patients have to wait longer for what they need because he wants his drugs every hour...

    Last time he came in the docs wouldn't give him any IV meds and he left the next day...
  13. by   FullMoonMadness
    We have a frequent guest on our floor who has such sevr pain she states she can't eat.Routine orders are MS Conyin 80 TID with a little IV morphine for breakthrough pain. Last visit she was on maintenance fluids and NPO because of a new gastric complaint,
    " I cant eat it hurts my stomach,havent had anything in 3 days". I went in her room and thought she was bleeding from her mouth at first glance,head slumped over on chest.On closer exam,it turned out she had put a Snickers in her mouth and nodded off. The "blood" was melted chocolate!

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