The one with the never-ending problems

I feel sort of bad, but not truly this morning. We have this resident at my facility who has a never-ending list of problems. He's been sent out to the ER more than a handful of times, and generally sent right back. To put it lightly, I'd rather have 15 of the most annoying little old ladies than this one man, and he's only in his 40's! (usually the younger ones are more tolerable).

He's known in the community as a chronic pill seeker. I don't know half the time if he is lying to me or not, I usually just give him his PRN meds when due and go along with my night. Sometimes he complains about "twitching," or intense jerking of the body, for which he has Valium PRN. Other times he complains about pain, for which he has MS Contin scheduled, and Demerol. More than a few episodes of nausea/vomiting/diarrhea have occurred, so he had a short-lived compazine order. He's had a foley cath in and then removed in the last two weeks, and has uncontrolled DM. Then tonight he started complaining about urinary retention to the 3-11 nurse. From what I understood, he said he hadn't voided since around 6pm. He's on a 2000ml/day fluid restriction currently, as well. So, I took the claim semi-seriously and when I began my shift at 11pm, I thought "okay, well it's only been 5 hours, think about when you sleep for a certain period of time for so long and don't need to pee, he should be okay." Every once in awhile he would c/o not being able to pee, and he'd ask me if I talked to the doctor yet about putting the catheter in. He'd then ask me for something for his ears, because his ears were so blocked up. And with the N/V/D, "don't you have a pill for that?"

The evening nurse had already called the covering to appease this man, to which the covering said "I don't feel comfortable giving that order after such a short period of time" - or something to that effect.

So, I let it ride through the night. Eventually this man dozed off and I could do my med pass for everyone else who wasn't getting the same amount of attention that he's been getting. So I'm counting off narcs with the day nurse, and I hear him saying her name, loudly. "I need that catheter STAT." Because he couldn't tolerate the two of us finishing count before the day nurse got the order to actually cath him, he went and immediately called his grandmother. No sooner than the nurse I was counting with get on the phone to reach the on-call, this man's grandmother called the other day nurse back. This nurse assured her that we were following up as they spoke and said that she would be in touch.

It's people like this that really are starting to bother me. He's friendly enough, but was even recently spoken to by our admin for overstepping boundaries with demented residents. He's just awkward, and there are just too many "problems" of his, that I can't handle him anymore.

So, I know the right thing to do was probably to call the on-call at 3am to get the order to straight cath and/or foley cath him, but it didn't seem like a pressing matter at the time. Just out of curiosity, have any of you had residents with urinary retention, and how long have you waited before calling the on-call MD to get the order to cath (who generally knows nothing about the other residents)?

Personally I think he's a closet perv who probably just wanted a hand on his junk, but that's just my opinion. I could be WAY off. I just don't want the **** to hit the fan today.

Sigh.