Have a case mgr with a frustrating situation. She has a pt w breast cancer. Pt nor family ever call the on call service. Nurse will call Monday, Wednesday, and Friday before visiting.... It isn't until nurse arrives n does her nursing assessment
that pt will say pain is a "7", and an acceptable level is less than or equal to "4". Pt went from 100-175 mcg fentanyl last week, she can have 6 lortab a day (she may take 2/day), and she has an ekit with morphine sulfate elixir 20mg/ml that she can have hourly if she needs it (she rarely takes). Also scheduled motrin was ordered last week (but she will only use prn).
Case mgr is at her wits end. Pt a&0x3, angry that she is ill. She won't let chaplain or social worker visit. She has a Dtr that visits daily. PTs sister moved in with her to help pt with her care. A Dtr in law committed suicide a few months ago. She needs Sw n chaplain involvement, but she n family are draining case mgr in that capacity. Case mgr spending 1.25-2hrs each visit.
Pt will state "slept all weekend", then report pain"7" all weekend n pain is 7 now. So, then pt will take a lortab n cm has to stay until pain less than or equal to 4.... Pt keeps up taking bp meds as scheduled but for the life of us we don't understand why pt isn't keeping up w her own prn meds. One weekend fam said pt "cried all weekend" bc she was I'm severe pain- yet no call to on call service to report.
Pt has Xanax for anxiety but stopped taking 2 weeks ago bc she was "sleeping" too much.
We just don't understAnd why pt isn't utilizing on call service or meds in the home. Cm has asked pt and she says "I don't know.". I'm believing her pain is more depression n pain related to family issues. It is frustrating for cm bc it looks like we aren't keeping her pain at a 4.
Thoughts? Thank you.