pt was very upset about fluid restrictions - page 5

by anon456 10,004 Views | 51 Comments

I'm a student nurse-- not sure how to handle this I had a pt on a fluid restricted diet. This pt had been in hospital for at least a couple of weeks and the fluid restriction was nothing new. The tray came without liquids on... Read More


  1. 0
    I had a pt in ltc that was on a fluid restriction for eslf. He called his hospital at 2am trying to get a Dr. to make me give him some water. The operator wouldn't put him thru to an MD and gave me a call to give me a heads up. This pt called the ltc about an hour later asking for me, the charge and pretended to be his physician and giving an 'order' to let Mr. so and so have as much water as he wants. Pretty crafty. This pt stayed up all noc thinking up ways to get more water. I told him he could have as much as he wanted out of his faucet if he wanted to get up. That shut him up til morning. Thank god.
  2. 1
    I finally had the chance to talk to my instructor about this. She gave a good suggestion. She said to do a full assessment of the patient and talk about what I was looking for as I was doing it so pt can be aware of it. For example checking for edema, listening for lung crackles, checking the daily weight. If there are signs of fluid overload, tell this to the patient .Have them hear their own breath sounds. If those signs are there, the patient may have a greater understanding and more motivation for wanting to follow the fluid restriction. If they are free of these s/s praise them for keeping their health in check.

    If they still insist after all this, give them a small amt of liquids, call the doctor and tell them the findings of the assessment and tell them you are having a hard time keeping them on the restrictions. The doctor may decide to lift it if the pt is doing well. If they are doing poorly the doctor knows that you tried to talk to her, maybe doctor needs to talk to her, but in any case she's choosing to go against AMA on the fluid diet and the doctor knows about it.
    threelittlebirds likes this.
  3. 0
    Quote from platon20
    When patients pull this BS, the best way to handle it is to get the doctor to write a letter to their insurance company and notify them that the pt is refusing doctor's orders and will be discharged AMA. That way, the insurance will refuse to pay for the hospitalization and the patient will be charged the full bill. Lets see how they like disobeying orders when they have to pay $100,000 up front for their hospitalization!

    This is unfortunately a common misconception and is simply not true. The truth of the matter is that Medicare and virtually all private insurance companies will pay for any care up to the point of discharge. What may not be covered, depending on the specific insurance, is subsequent readmission for the same condition within a specific time period, i.e. 15 or 30 days, if the patient left on their own AMA.

    IMHO, any doctor or nurse that would make this type of statement to a patient is a fool. Regardless of how well intentioned you may be, attempting to compel a person to do something against their will by direct or implied threat is called coercion. It is a criminal act in all 50 states. Speaking of criminal acts, taking any possession of the patient (this would include food and beverages) without their permission is theft, and using force to do so if they resist may be either assault or strong-armed robbery.

    As others have correctly pointed out, the patient has the absolute right to refuse any treatment or procedure, including complying with any dietary or fluid restrictions, and they can do so without leaving AMA. You can't physically force them to comply.

    Teaching and documenting is about the best you can do - never threaten, deceive or outright lie to a patient to try to persuade them to comply.

    I think the suggestion by the OP's instructor is a good one, but after all is said and done, the bottom line is that the patient still has the final say.
  4. 0
    I am 'justavolunteer' & I have even gotten grief from pts. and families about fluid restriction, restricted diets, etc. Often the patient is 300 lbs.+, diabetic, on a restricted diet along with the FR. They seem to think the nurses should just wave a magic wand or something. Then they can be instantly cured & go back to wolfing cheeseburgers & whatever else got them to the hospital in the first place.
    I love being a volunteer and I am willing to do whatever I can to make people more comfortable. Most of the patients & families are extremely helpful & appreciative of my efforts. However, it amazes me that a few individuals seem to take absolutely no responsibility for themselves or their actions. If I tried a tenth of the shenanigans some so called grownups pull when I was a child, my parents would have skinned me!
  5. 0
    let them DROWN themselves just document that you informed pt/family and of course the MD b/c those little bastards will try to pin it on you, saying "the nurse never informed me". make the family get their love one the water or whatever he or she want to eat/drink.
  6. 1
    Quote from sharkdiver
    This is unfortunately a common misconception and is simply not true. The truth of the matter is that Medicare and virtually all private insurance companies will pay for any care up to the point of discharge. What may not be covered, depending on the specific insurance, is subsequent readmission for the same condition within a specific time period, i.e. 15 or 30 days, if the patient left on their own AMA.

    IMHO, any doctor or nurse that would make this type of statement to a patient is a fool. Regardless of how well intentioned you may be, attempting to compel a person to do something against their will by direct or implied threat is called coercion. It is a criminal act in all 50 states. Speaking of criminal acts, taking any possession of the patient (this would include food and beverages) without their permission is theft, and using force to do so if they resist may be either assault or strong-armed robbery.

    As others have correctly pointed out, the patient has the absolute right to refuse any treatment or procedure, including complying with any dietary or fluid restrictions, and they can do so without leaving AMA. You can't physically force them to comply.

    Teaching and documenting is about the best you can do - never threaten, deceive or outright lie to a patient to try to persuade them to comply.

    I think the suggestion by the OP's instructor is a good one, but after all is said and done, the bottom line is that the patient still has the final say.
    good post, shark.

    i need to point out that my insurance co has called me, verifying that i indeed, received said services...
    obviously they do not want to pay for services i never received.
    i have to wonder if insurance would cover services if pt is non compliant?
    it's actually not a bad idea, when you think about it:
    that ins co's need to enforce actual compliance in the hosp or they won't be covered.

    it would seemingly reduce the amt of litigation out there, for those notorious, pita pts/families.

    leslie
    kaliRN likes this.
  7. 1
    anon456,

    I find it helps to write a "countdown" of fluids and put it on the bulletin board where the pt can see it. So, you start out by writing "1200 mls - June 8th 0700" at the beginning of the shift, discuss the goal/limit with the pt, and then subtract as you go. The pt always knows how much they have left, and they feel they have some control over how much and when they choose to use that 1200 ml.
    3rdcareerRN likes this.
  8. 2
    Quote from goldenfire5
    anon456,

    i find it helps to write a "countdown" of fluids and put it on the bulletin board where the pt can see it. so, you start out by writing "1200 mls - june 8th 0700" at the beginning of the shift, discuss the goal/limit with the pt, and then subtract as you go. the pt always knows how much they have left, and they feel they have some control over how much and when they choose to use that 1200 ml.
    and when it's gone, it's gone. i can't force them to be compliant, but i'm not going to aid and abet their noncompliance, either.
    morte and VivaRN like this.
  9. 2
    Quote from ruby vee
    and when it's gone, it's gone. i can't force them to be compliant, but i'm not going to aid and abet their noncompliance, either.
    lol, i love it, but nope! just gave at least 4 pictures of ice and water plus many handfulls of saltine crackers to my non compliant hemo patient last night. know why? she demanded the supervisor be called because we initially refused and had her 'phone witness" and said she had 'rights as a patient and could refuse anything'.....

    think i was supported by the higher ups that are concerned with patient satisfaction scores and reimbursement with her welfare pay? nope...

    so i happily gave her non-compliant arese all she wanted, she threw it all up... gave her all her dilaudid, zofran and as much ice, water and saltines as she wanted and charted it all away..."despite health teaching on the importance of compliance, pt refuses to adhere to needed advice and with the supervisors support, demanded all that she could consume to her demise... provided pt. with her requests although re-iterating the importance of compliance to no avail. "

    why fight the battle? one patient complaint, i'm suspended, two i'm fired... drink up honey... i'll intubate your butt when you're in pulmonary edema....and keep my job in the process... you're an idiot and not worth loosing my job for.

    all the noobies... this is whats out there, get ready.
    wooh and RNTwin like this.
  10. 1
    Quote from Zookeeper3
    Why fight the battle? one patient complaint, i'm suspended, two I'm fired... drink up honey... I'll intubate your butt when you're in pulmonary edema....and keep my job in the process... you're an idiot and not worth loosing my job for.
    this is just so freaking unreal.
    no wonder you're stressed!!
    this has to be one of the most destructive policies i've ever heard, for employees AND pts.

    how would tptb react if it was one of their loved ones, demanding all this crap they weren't supposed to be having?

    zoo, respectfully, i hate your hospital.

    leslie
    wooh likes this.


Top