Pts who "Cry Wolf"

  1. OK...I'm soooo frustrated/mad/disgusted with this pt I have on med-surg. 82 y/o female with history of COPD,MI,Resp.Failure,& drug addiction..Mrs X is allergic to all pain meds EXCEPT Demerol(her drug of choice).She has actual medical problems, but throws a fit and c/o chest pain when her Demerol is decreased or d/c'd.Last night @ 9 she got Xanax .5 ,refused her Oxycontin 20 saying it made her 'sick' and opted for a Tylox..all was well til 2 am..she got another Xanax & Tylox for her chest pain..she refuses to even try NTG sayin it never helps..Ekg's/VS unchanged/sat 98-99% no s/s of any distress..3am I observe her sleeping well resp even/unlabored..310am i accidentally make a noise outside her room awakening her and she buzzes with c/o chestpain..holding her chest/hypervent'n..take note her Demerol has been dc'd for a total of one day..check vitals/ekg AGAIN..no changes..demanding shot of Demerol.."it's the only thing that will help".convince her to take Oxycontin and give her Dramamine to prevent nausea..pts daughter is at bedside and is aware of how she "clowns" to get what she wants..I tell her to give the meds time to work...on the buzzer every 5-10 minutes..cont to monitor vs,ect, with no changes..demands RT tx (knowing this raises her heartrate) oh yeah did I mention this pt is/was an RN ? I talk to the woman with daughter present telling her the MD would not order anything else knowing everything she has already recieved and to try to calm down and let meds work..pt observed @ 4 am snoring her butt off..cont to rest well on frequent roomchecks..resp even/no distress..had to awaken for am accucheck(bad as I hated to) sleeping one second..rubbing her chest when she sees me/hyperventing herself..her bloodsugar is fine..and I ignore her chest rubbing/and go about my business..prayin for 7am to come..I go back and check her 15 minutes later...sound asleep..breathing fine.......and, I'll have her AGAIN tonight!!! Lord help me!!!...I've had this woman soooo many time and she keeps doing this over and over..MD is aware and I think he's at his wits end with her too.The thing is she DOES have actual med issues..I'm just afraid one of these million times she "cries wolf" it will be real and NOBODY will believe her...........any of you had to deal with this?/ how dou YOU handle it???
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  2. 16 Comments

  3. by   Noney
    I feel for you Mandy. We all get these pt's. I just hope everyone stands their ground. The problem is that staff who aren't familar with these pt's will call mds, sometimes reaching on call staff that aren't familar with the pt's, they then order whatever the pt wants. Then your back the ground one. These pt's know if they ask enough times they will evenually get what they want.

    On the other hand hand I feel for the pt. Imagine a life where your convinced you need something (demerol) and your being told no. I'm sure that this pt has been getting the demerol for so long she's addicted (if only mentally). And who are we to say it's such a bad thing for an 82 year old pt to want the one drug she thinks works for her?
  4. by   Marie_LPN, RN
    Kind of strange how demerol is the ONLY thing that will help. Sounds like an addict to me. She needs treatment.

    I'd bet a million if you gave her a shot of something else and told her it was demerol, she'd be fine. No, no, no not suggesting that you do that, but she seems stuck on it.

    Only way we can deal with it at our facility is go to the nurse manager, and she contacts social services to talk with the patient.
    Seen way to many people come in that are miracuoulsy cured of anything once they get their demerol.
  5. by   Tweety
    Can you let the charge nurse know you are a bit burned out with her.

    We rotate problem patients at the nurses request. Why should you be stuck with her day after day. Those patients can be draining.
  6. by   ktwlpn
    She's 82 yrs old-crikey-should she go to a drug and alcohol rehab? The doc probably has accepted the fact that he can't fix her and just goes along.You won't have her in acute care long enough to really help her.Just give her what she has ordered and get out of the room to save your sanity.Maybe she should switch from nurse to nurse so no-one gets burned out on her.Why ever did the demerol get dc'd anyway? Our docs and our pharmacy don't recommend xanax for COPD'ers now....I have recently learned that oxycontin really does not last the full 12 hours that they advertise and often patients have sx of withdrawal that they mistake for side effects as the level of med drops .If she won't take it regularly I can see why she would get pain but I wonder what exactly this pain is? Is it pain at all or anxiety? Nothing worse then a nurse or doctor as patient.She's a train wreck and probably scared spitless........Don't get personal-By not getting personally involved I mean that you have no need to get frustrated or mad at her-she is just a patient in that bed and you have a shift to do and then you are done.Try to just go with the flow-without judgement..Don't get upset and beat your head against the wall-it's to no avail. It is easy to get impatient especially when you are running circles to keep up in med-surg but it is not worth wasting your positive energy in a negative way.Those patients that we know we truly can not help seem to really take more of a toll on us....Thank the lord that she is not your mother...and vent away here....Sounds like she really needs pillow therapy-stat
  7. by   flowerchild
    Agree with 3rdShiftGuy.
    I also would be firm with her and tell her you know what she's doing, why she's doing it, and that you know that she knows what she is doing..being a nurse herself. I would tell her to knock it off, get better, forget about the Demerol b/c she's not going to get it per the doc, and to quit crying wolf and why. Everyone, including family needs to reinterate this and stand firm. Once she knows she's not going to get away with the act, she'll probably try to find another doc and hospital to go to until they figure out what's up. She'll probaly ask for another nurse. Do it with unit and doc and nursing management support so as not to cause trouble for you. Call a case management meeting and make referral to psych. Good Luck!
  8. by   ratchit
    It's OK and natural to get frustrated with patients like thse.

    You cannot provide good, objective care to someone you are this frustrated with.

    Ask to change assignments- you are not helping you or her by continuing to take care of her.

    Perhaps a pain service evaluation might help? Or psych/addictions eval? These might be helpful in a nice ideal world. I also agree with another poster about the anxiety component here- perhaps an antidepressant might help.

    In the real world, though, this 82 year old RN seems to really *believe* that demerol is the only thing that will help. And as long as she believes it, that's the way it is. I doubt you're going to change her mind at this point.

    How about PO demerol? They make it, I've given it. If I recall correctly, it's poorly absorbed and doesn't give much pain control, but it doesn't have the side effects of the IM drug either. Might be worth a try, as long as you have other meds to offer her if her pain is real and uncontrolled.
  9. by   gwenith
    Some good advice here Mandy. I would talk to her and be honest with her and if you can find a 10 minute slot where she is NOT in pain and you are running around being reactive that would be best.

    So proactive management. Sit down with her and ask her what she wants in life. Does she want to get better and go home? Does she want to live without the pain etc. OK now you are showing you are on her side and not the "enemy nurse" holding her demerol hostage.

    Explain what it will be like if she continues with the Demerol. She probably already knows but it is wothwhile going over it with her to reinforce it and personalize it.

    As for her being an RN if she is 82 when and how!!! Did she do her trianing in the 1940's and never went back or what? Discount that she was an RN unless you know her work history chances are she has not been nursing for more than 20 years and will have forgotten most of what she originally knew.

    Contrary to popular belief the stamp that says "NURSE" does wear off after a little while
  10. by   healingtouchRN
    gosh I swear I know this woman, she must live in my mom in law's building & frequent the ER where I used to work!!! I am sure their one like her EVERYWHERE!
  11. by   bedpan
    I know I am just a student and don't know anything at all - but -

    She is 82 years old - maybe the demerol buzz is all she feels is worth living for now -

    Maybe as a former nurse she experienced LTC in a time that was much worse than it is today - and from my clinicals I have already decided I don't want to end my days like many I see -

    As has been said already, also as a nurse she has seen some very scary things that have now become her life - Even without that she is living at the end of her life's journey, scared and in pain

    I know I am still listening at this world of nursing through a rose colored stethoscope, but when I am working with a combative pt. in clinicals - Alzheimer's, dementia, incontinent - I can't help but look at them and see them when they were younger - Wondering what they were like with their bodies not twisted and full of strength, full of dreams.

    I look at them and see my grandparents, my parents - I look at them and even though I do not want to end my days like that see me some day - And I try my best to do my best for them, even though they don't know it nor care
  12. by   P_RN
    1. She's 82. She's GOING to get her way sooner or later.

    2. She's addicted/accustomed/habituated/dependent on Meperidine. SOME body started her on it. Why did they choose to cut her off this time?

    3. Demerol injections leave a taste of paint thinner, NaCl won't cut it.

    I'll bet her doc will relent and reorder it. I once had a patient who had been on Percocet for 20 years for post hysterectomy pain. We had to convince the doctor that percocet post op might not be enough for total hip pain.
  13. by   altomga
    Originally posted by 3rdShiftGuy
    Can you let the charge nurse know you are a bit burned out with her.

    We rotate problem patients at the nurses request. Why should you be stuck with her day after day. Those patients can be draining.

    I agree with you 3rdshiftguy....we have these type of pt's ALL THE TIME!!! I make sure to rotate them between the nurses and aids..they get someone so burned out. I hate it when a vent pt will deliberatly disconnect their vent b/c they know you HAVE to go in the room then....

    We lay down the law with them and even tell them they are going to be basically ignored b/c they continue to do it and do not need anything and one of these times something really will be wrong. (the ignored is lack of a better word)

    Of course they complain and then you're A$$ is in the sling with mgmgn't until they realize what type of strain you are under.

    These pt's are shared amongst us aren't they?? Sometimes you just want to do a little pillow therapy!!!
  14. by   ainz
    I would suggest rotating nurses to care for the patient.

    Perhaps a different perspective on the patient. I think ALL problems are "medical" problems as so many call it. I don't separate "mental" and "physical" or "real" versus the nurses' or doctors' perception of "not real or imagined."

    We know that all activities within the body, like heart rate and rhythm, autonomic activity, breathing and gas exchange, and so on, are physiologically based. Brain and nervous system activity are physiologically based. Behavior is a manifestation of physiologic activity, various chemical processes originating intracellularly, like any other function and activity of the body.

    Why is behavior seen differently? Behavior is merely a product of the brain, has a purpose, sustains life, like all other processes. An addicted person has an altered brain chemistry therefore the dysfunction. They may have "brought it on themselves" by using the drugs in the first place but essentially so did patients with advanced atherosclerotic disease through poor dietary habits, or smoking, sedentary lifestyle, perhaps noncompliance with medication regime or so forth. Why do we not condemn them and get frustrated with their care?

    I worked in psych for 7 years and always had a component of addictions nursing involved as well. These patients can be very challenging, especially in the actue care setting. She is simply withdrawing and suffering the effects of narcotic withdrawal. Perhaps the doctor could wean her with some sort of detox regime. But then again, if she is 82 and a complex medical patient, is it worth being aggressive.

    I do feel for you and the frustration.

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