What is your least favorite kind of med-surg patient?

Specialties Med-Surg

Published

Mine definately would be the patient with pancreatitis. Although they have elevated levels of Amylase and Lipase and do belong in the hospital they always seem to be the most difficult patient for me to deal with. My favorite patients are surgical. I wish we had a surgical floor.valentinesdayavatar8jd.gif

HAPPY VALENTINES DAY TO ALL NURSES !!!!:blushkiss

Specializes in ortho/neuro/general surgery.

I don't like chest tube patients because I am constantly checking the chest tube to make sure the patient isn't lying on it or something else isn't going wrong with it. I don't like GI bleed patients because I can't stand the smell.

But I think my absolute most unfavorite is the "abdominal pain of unknown origin" patients. They tend to be non-compliant, on the light a lot, and tolerant of incredible amounts of narcotics. I had a patient who came in complaining of abdominal pain. They couldn't find anything abnormal on the CT scan, ERCP or UGI. No matter how much pain medicine we gave her, she constantly rang the light asking for more. She was getting 4 mg of Dilaudid every 2 hours and it wasn't touching her "pain". She came charging out to the nursing station yelling and accusing me of stealing her doses and giving her saline, so I started having other nurses witness when I gave her IVP pain med. Funny how she was in "so much pain" but had the energy to leap out of bed and come out of her room like that. She griped loudly each time because I didn't push her meds in fast enough (I'm a slowpoke with my pushes) or use the closest port to her IV site (I prefer to use distal ones). ARGH!!!

I am reminded of an acquaintance of mine who was an alcoholic with pancreatitis that would end up in the hospital at least once every 2 weeks. He knew all his meds and when he could have them etc. Unfortunately, I found him dead on the bathroom floor last week-so they do eventually die from the disease if they don't quit..

The pancreatitis patients or the respiratory patients? I would imagine the respiratory patients would be because of the secretions, coughing, hacking, etc.......

The pancreatitis patients always seems to be the most needy. Not all pancreatitis patients but the ones I get assigned to take care of......Constantly wanting to know when it's time for pain med, then phenergan, the doctors always seems to order one Q4 and the other Q 6. It would be so much easier to give them together. Many are alcoholics who are now dealing with DT's and then they want to know when their Ativan or Xanax is due. They have weird visitors, they constantly want "something". No one but "their" nurse will do. They frequently threaten AMA, don't have insurance anyway, and don't understand that AMA is no threat to the nurse. If only I would be so lucky that they would actually leave. Once the doctor says you're discharged they feel fine and want to flee out the door! They love that IV when they're patients, but that sucker has got to come out the minute the doctor says you're discharged. My favorite one was the patient who said I better keep this PICC line in just in case I have to come back sometime. The day before he was caught trying to push heroine through his PICC! Tried to sneak out the the hospital with his PICC in place !

I would have to agree with the Dutchgirl, as a matter of fact we seem to think alike on a lot of subjects. The pancreatitis pts. are the hardest and least appeciative of them all. I've got one now that has 3 different sliding scales depending on how she feels, sneaks potato chips, etc. I know I probably shouldn't but I just tell them I'll bring their PRN at the time due and then just treat it as a:rolleyes: routine med, saves me time and time saved is .....:rolleyes:

Specializes in ortho/neuro/general surgery.

Besides the abdominal pains :no: and the GI bleeds:barf01: , I really dislike caring for intracranial bleed patients. Frequently they are confused and aggressive.

I don't care for total cystectomy with ileo loop diversion patients, because on our floor something always goes wrong with them.

I don't mind all the many drains and tubes they have, but with all but one pt we've had since I started 16 mo ago, there's been serious complications- respiratory arrest, dehiscence and evisceration, rapid a fib, hypertensive emergency, bleeding out with hypovolemic shock, ileus... :uhoh21:

I hate taking care of the drunks. Had a pt. recently who got in a bar fight and ended up in ER. They thought it best that he sober up on med/surg. Wonderful. When I walked into work I could smell the sour alcohol. The pt. was 12 doors down!!! He put on his light and asked in this order: I want an ice pack(stitches in head), morphine, and a wheelchair to go smoke. Told him if he was getting morphine he wasn't going through those doors. Alright, he said and asked me to help him to the br. Wouldn't want a drunk pushing an IV pole. Before we got to the br he whips Mr. Winky out and pees on my leg. I was way beyond angry. He had to have done that on purpose. Should've shoved that IV you know where. If we weren't in a hospital I probably would've slugged the guy.

pts with CBI

Hepatic Encepathoy r/t ETOH abuse and non-compliance. If I can vote twice then its the detoxing non-compliant IVDA w/ HIV.

Specializes in Med-Surg, Geriatric, Behavioral Health.

Have to agree with you there...IV heroin addicts who feel entitled to any meds...no, make that ALL meds...just because they made it through the admit door. I'd take three raging Borderline patients to one demanding IV heroin user.

Oooops, showing my bias.

Sorry

Specializes in LTC, skilled nursing, Med-Surg.
Definately the abdominal pain with intractable nausea and vomiting. Labs all within normal limits and the intractable nausea/vomiting is gone once they hit the floor and get pain med of choice every hour or two of course with some phenergan too. We have a couple with no expendable organs, GB, appy but they are still having this mysterious abdominal pain that is only cured when the discharge planner looks at the doc and says no more, send them home.

I know this post is 3 years old, but as a nursing student and also a patient with "mysterious" abdominal pain and nausea, I want to add a comment. This is in no way intended to be rude, I just want to give another point of view. I'm sure this post was a rant about those who are 'drug seekers' -- but how exactly can you discern a drug seeker from someone in pain who just wants relief? In school we are constantly taught that a patient's pain is what he/she says it is, not what we think it is, and pain needs to be adequately managed. I am one of those abdominal pain and nausea patients whose labs, almost all of them, were 'normal'. Except for lipase, which was high. But I tend to think of myself as a human being and not just numbers on a lab test. I have been having severe upper right quadrant abdominal pain and only have had 2 different tests to check for gallstones and gallbladder functioning. Sometimes, gallstones are too small to be visualized. My GB function isn't 100% either, but it is apparently 'acceptable'. Now the pain has spread to my left side and so bad I had to go into urgent care since my PCP couldn't see me. I hate going to urgent care and being looked at like "well, most of your labs are normal so you must be a drug seeker." I got told I wasn't bad enough 'yet' to be hospitalized. Nor do I want to be hospitalized, I just want a doctor to actually listen to me, help find out what is wrong, and correct it. Since the pain going to my left side was so sudden and acute, and since I have been running a fever (albeit "low-grade"), I know something is wrong. I am praying that it is not pancreatitis. I know that sometimes undetected gallstones can travel and get stuck in the pancreatic duct. I guess I'm not what they think is the 'typical' pancreatitis or gallbladder patient since I'm only 26, not fat and not an alcoholic. Needless to say, after being told all my labs were 'normal' except a 'slightly elevated' lipase, and peered at like I was an idiot, I was sent home, told to f/u with my doc and given an Rx for Percocet. Which is not what I went in there for. Do I have to be projectile-vomiting and have my lipase levels have to go sky high in order to be taken seriously?

I know that some people will do anything to get narcotic pain medication, including faking any number of symptoms. That also gives those of us with mysterious abdominal pain (or any other idiopathic pain) a bad name, and we tend to get written off as drug-seekers. From my personal experience, just because a patient's labs are 'normal', does not mean there is nothing wrong.

Thank you, and sorry if it seemed as though I was rambling.

nevermind

Specializes in Home Health, MedSurg, Post Partum, SCU.

My least favorite med-surg patients have got to be the frequent flyers who came to our floor - and were NURSES. My two "favorites" happened to be EX nurses. They both came to us with abdominal pain every couple of months. They've each had every test or lab out there but they always got admitted with plain 'ol abdominal pain, the doc never could give any other dx. These two ladies were SOOOOOOOOOO demanding. I guess I would have expected that since they once worked the field they would surely know that we cannot be at their bedside our entire 12 hour shift. And that no, contrary to THEIR popular belief, they are NOT our one and only patient. Honestly, it was unreal. For one of them, we would give HOURLY Dilaudid pushes until the doc finally let us start a PCA. Don't forget the routine Phenergan and Ativan. I can't tell you how many times I fluffed the EIGHT pillows one of them had to have on her bed at all times - and let me tell you, she WOULD call me if one happened to fall off the bed. So I'd grab a new pillow case and just smile and gently hand her the pillow...sometimes for the third or fourth time. And while I was in there "I can't find my remote, do you see it?" Then came the ripping apart of the blankets and pillows - only to find the remote burried in her belongings on the bedside table. ARRRRGGGGG. I easily toasted a loaf of bread each shift between the two of them. And after I slathered them all with peanut butter and jelly I'd run down the hall to deliver them while they were still hot OR ELSE. I always loved how we had to put cans of tomato juice in the freezer for one of them and get them out just before they froze...because they had to "just be a little slushy". Or else she wouldn't drink them and we had to start over again. Oh...and don't forget to take her down 20 pepper packs for her juice. Amazing. We only had one CNA on our 7P-7A shift so I was doing it all. Sure hope my patient's who needed to have blood hung or their night time meds were able to fend for themselves while I was tending the "The Queens". :uhoh21:

"Lord, if I'm ever a patient, please do not let me run my nurse ragged...and please do not let me jump up out of bed and run to the door (tubes and all) when a friend comes to visit me...and be able to sit in my bed and work on my scrapbooks or play games on my laptop, but need the assist of 2 to help me out of bed and stand next to me while I go to the bathroom and wipe my *** because I just can't do it . AMEN."

Cally

Specializes in med surg.

my least favorite procedures on patients are trachs and arteriograms, the patient is different from the diagnosis and most of my patients are very interesting and appreciative.

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