Real or memorex?

  1. Lately I have had a few patients on the med/surg floor admitted with syncopal episodes. Many of these episodes appear to be very staged and timed, and many other subtle actions that are very questionable. All labs, MRI's CT's EEG's are normal. The doctor treats the dehydration issues, but confides that the patient is faking it. (The ones in question are usually young women with some kind of eating disorder as well.) What is some good advice in discussion of the patient "faking it" with a family member who has been snowed over by their behavior? Many of these family members are of course concerned, yet are naive to the real problem, and get defensive with any kind of discussion that they may be faking it or have an eating disorder. What is a good way to handle it?
    •  
  2. 8 Comments

  3. by   UM Review RN
    We often get syncopal patients and the syncope can have a cardiac or neuro or endocrine (thyroid) origin, if the patient doesn't have an infection of some kind. So I'd like to ask what kind of labs were done. Did the patient get a cardiac workup? An EKG? Anything like that?

    It's important to remember that eating disorders can lead to cardiac dysfunction and a host of other problems can follow. Of course, a psych consult wouldn't hurt, as the patient obviously has some emotional disorder underlying the food problem.

    This link might also help:

    http://mentalhealth.samhsa.gov/publi.../default.asp#4
    Last edit by UM Review RN on Mar 10, '07 : Reason: to add a thought and a link
  4. by   Daytonite
    one of the early lessons i had in nursing school was "don't be judgmental". it will never steer you wrong. you know, the doctor can come in and only be with the patient for a few moments. we nurses are with them for 8 or 12 hours shifts. tell someone, or give them the impression, i think they are faking their symptoms and any trust that might have been built between me and that patient and hope for cooperation from them in their care is gone out the window. we can think it, but i don't have to force the patient to admit that i suspect it.

    early in my career i worked on a medical unit that got alcohol detox patients. that somehow translated to every nut job being admitted to our unit. we got patients who were real whackos from faking seizures to one goofball who was actually punching herself until she got bruises. she had the docs baffled for days doing all kinds of tests looking for some kind of bleeding problem. the last thing we did with our detoxing alcoholics was to tell them that they shouldn't be drinking--unless they brought it up first. and, even then, we were instructed by the psychiatric nurse practitioner to just listen sympathetically and not impose or reinforce any judgments.

    therapeutic intervention is best left to nurses who specialized in counseling and treating that; not med/surg nurses on med/surg units. and, that's my view on it. it requires some specialized training in how to intervene with them and a basic nursing program just doesn't give you that training. what it does give you, however, is the basics in therapeutic communication skills. i can always converse with these people and give them the impression that i am in no way making any kind of judgment about what they are doing. i am sympathetic to their plight. any complaints or personal judgments i have about them are going to be said to my cats who won't repeat them to anyone else. above all else, be kind to people. that is what they will almost always remember most about the nurses who cared for them. confrontation of any type almost always is interpreted as an unwarranted attack, unkind, unasked for and will never be forgotten.

    http://www2.nemcc.edu/rlansdell/web/...iles/frame.htm - a really nice slide show on therapeutic communication. includes techniques, scenarios and blocks to communication.

    http://www.childbirths.com/euniversity/therapuetic.htm - therapeutic communication. a discussion about therapeutic communication that includes a nice listing of examples of appropriate open-ended responses to make to patients to get them to talk.

    http://academic.luzerne.edu/nfruscia...iles/frame.htm - a slide show on therapeutic communication. talks about the components, goals, therapeutic and non-therapeutic techniques.

    http://faculty.mc3.edu/rbenfiel/nur1...ion/sld001.htm - communication. a slide show (18 slides)

    http://www.education4skills.com/thecom/contents.html - therapeutic communication skills tutorial - page of links to subjects covered

    http://www.unc.edu/courses/2004fall/...ss6/index.html - therapeutic communication. some online information and practice modules from the university of north carolina chapel hill school of nursing. click on the links on the left side of the page to access activities.

    http://monsoon.he.net/~eri/realaudio...utic/thera.htm - a lecture series on therapeutic communication and the nursing process on cds that you can access at this website from education resources, inc. you need a real player to view the video.
  5. by   nservice
    This is a hard thing for nurses and that includes me. I know we are taught to be non-judgemental, but we are human and that is hard to do sometimes. As a new nurse, I once had a teenager admitted with seizures. In report I was told she was faking it. I was angry that these nurses were being so judgemental. As soon as report was over, the mother called me into the room. The patient said, "I'm going to have a seizure". Sure enough she had a seizure. Three times during the seizure, the patient told me she wasn't finished with her seizure yet. So, yes I believed she was faking. As a professional, I just charted what happened; what I saw and what the patient said. What's funny is, later during the shift, she called out again to "have a seizure". I asked if she could wait just a minute because I had to give a patient some pain medication. She waited for me and when I got back, she promptly had her seizure. I firmly believe that something was wrong with her, but seizure disorder wasn't the problem.
  6. by   wishtoprogress
    Thanks for your reply. If I remember them all, this pt. had been in 3 times previously the week before and had CMP, CBC, BNP, TSH, EKG, Lipid profile, and an iron panel for anemia. This time, because the spouse had found her on the kitchen floor, they ran another CBC and did a CT and MRI. The doctor did encourage a psychiatric visit, an lined them up with a cardiologist in a bigger city. All the labs, and the EKG were unremarkable. The pt. was definately dehydrated. Since this particular pt. had been seen frequently, the doctor told the spouse that he believed she was "checking out" at will and that the psychiatric visit was what was needed. Based on the spouses remarks, I don't know that will happen.


    Quote from Angie O'Plasty, RN
    We often get syncopal patients and the syncope can have a cardiac or neuro or endocrine (thyroid) origin, if the patient doesn't have an infection of some kind. So I'd like to ask what kind of labs were done. Did the patient get a cardiac workup? An EKG? Anything like that?

    It's important to remember that eating disorders can lead to cardiac dysfunction and a host of other problems can follow. Of course, a psych consult wouldn't hurt, as the patient obviously has some emotional disorder underlying the food problem.

    This link might also help:

    http://mentalhealth.samhsa.gov/publi.../default.asp#4
  7. by   UM Review RN
    It might be hard to maintain your nonjudgmental attitude with someone like that, but you know, she is headed for real medical problems with that eating disorder.

    I have seen people will themselves sick and I have seen people will themselves to die and succeed, so just be cautious with this type of patient and always play it like it's the real thing because one day, it will be.
  8. by   wishtoprogress
    i totally agree with you. trust may help open up that needed communication to be an advocate for the patient. thanks for your advice and the links! muchas gracias!

    Quote from daytonite
    one of the early lessons i had in nursing school was "don't be judgmental". it will never steer you wrong. you know, the doctor can come in and only be with the patient for a few moments. we nurses are with them for 8 or 12 hours shifts. tell someone, or give them the impression, i think they are faking their symptoms and any trust that might have been built between me and that patient and hope for cooperation from them in their care is gone out the window. we can think it, but i don't have to force the patient to admit that i suspect it.

    early in my career i worked on a medical unit that got alcohol detox patients. that somehow translated to every nut job being admitted to our unit. we got patients who were real whackos from faking seizures to one goofball who was actually punching herself until she got bruises. she had the docs baffled for days doing all kinds of tests looking for some kind of bleeding problem. the last thing we did with our detoxing alcoholics was to tell them that they shouldn't be drinking--unless they brought it up first. and, even then, we were instructed by the psychiatric nurse practitioner to just listen sympathetically and not impose or reinforce any judgments.

    therapeutic intervention is best left to nurses who specialized in counseling and treating that; not med/surg nurses on med/surg units. and, that's my view on it. it requires some specialized training in how to intervene with them and a basic nursing program just doesn't give you that training. what it does give you, however, is the basics in therapeutic communication skills. i can always converse with these people and give them the impression that i am in no way making any kind of judgment about what they are doing. i am sympathetic to their plight. any complaints or personal judgments i have about them are going to be said to my cats who won't repeat them to anyone else. above all else, be kind to people. that is what they will almost always remember most about the nurses who cared for them. confrontation of any type almost always is interpreted as an unwarranted attack, unkind, unasked for and will never be forgotten.

    http://www2.nemcc.edu/rlansdell/web/...iles/frame.htm - a really nice slide show on therapeutic communication. includes techniques, scenarios and blocks to communication.

    http://www.childbirths.com/euniversity/therapuetic.htm - therapeutic communication. a discussion about therapeutic communication that includes a nice listing of examples of appropriate open-ended responses to make to patients to get them to talk.

    http://academic.luzerne.edu/nfruscia...iles/frame.htm - a slide show on therapeutic communication. talks about the components, goals, therapeutic and non-therapeutic techniques.

    http://faculty.mc3.edu/rbenfiel/nur1...ion/sld001.htm - communication. a slide show (18 slides)

    http://www.education4skills.com/thecom/contents.html - therapeutic communication skills tutorial - page of links to subjects covered

    http://www.unc.edu/courses/2004fall/...ss6/index.html - therapeutic communication. some online information and practice modules from the university of north carolina chapel hill school of nursing. click on the links on the left side of the page to access activities.

    http://monsoon.he.net/~eri/realaudio...utic/thera.htm - a lecture series on therapeutic communication and the nursing process on cds that you can access at this website from education resources, inc. you need a real player to view the video.
  9. by   Daytonite
    Quote from nservice
    this is a hard thing for nurses and that includes me. i know we are taught to be non-judgemental, but we are human and that is hard to do sometimes. as a new nurse, i once had a teenager admitted with seizures. in report i was told she was faking it. i was angry that these nurses were being so judgemental. as soon as report was over, the mother called me into the room. the patient said, "i'm going to have a seizure". sure enough she had a seizure. three times during the seizure, the patient told me she wasn't finished with her seizure yet. so, yes i believed she was faking. as a professional, i just charted what happened; what i saw and what the patient said. what's funny is, later during the shift, she called out again to "have a seizure". i asked if she could wait just a minute because i had to give a patient some pain medication. she waited for me and when i got back, she promptly had her seizure. i firmly believe that something was wrong with her, but seizure disorder wasn't the problem.
    i had to chuckle at this. i think you did exactly the right thing. we had a young girl who was faking seizures. several of us were standing around the bed as she informed us a seizure was coming on and she started the bizarre thrashing that she did. she suddenly stopped, reached up for the bite block, grabbed it saying "you forgot this", put it in her mouth and proceeded to complete her seizure. i think afterward someone told her they were glad she remembered the bite block. that was her esteem booster for the day.
  10. by   canoehead
    Seizures are a great source or benzos and other sedating drugs, remember.

close