What's a "difficult pt" to you?

vintagemother, BSN, CNA, LVN, RN · Jun 23, 2014

My most difficult ones...a stroke victim who also had cognition issues R/T drug use. She was mostly immobile but could still kick with one weak leg. She kicked me on the stomach, but I wasn't hurt. She also spit on nurses who tried to give her meds and called her CNAs racial epithets.

And a person with a psychiatric illness who also always states she has chest pains, lady partsl pains, headaches, anxiety, etcetera, and also uses racial epithets toward the nurses.

BrnEyedGirl, BSN, MSN, RN, APRN · Jun 23, 2014

I work in a Level I trauma center,....when I think of difficult patients I think of those patients who make it difficult to care for them, similar to the previous posts,..patients who are rude and demanding, beyond the expected irritation of being ill and being in the ED. Patients who continue to return to the ED for vague complaints that are never diagnosed, or patients who seem to think that the ED is a magical place that will fix all their ailments. It is frustrating to try to explain to a patient that while I understand they are having abdominal pain, that has been going on for months, the ED isn't the place to get the full assessment and diagnostics that they require to find answers. We rule out the really bad stuff that needs emergent treatment, beyond that you need a good report with pcp or GI doctor to further investigate, many people don't understand that.

Anyone who is on the call light 3-4 times an hour for 'non-medical" requests makes my job difficult,.ie another warm blanket, can I use the phone, can I have a sandwich, can I have ice?, can I run to my car real quick, how much longer will it be I have to pick my kids up from...... etc. This takes me away from giving medications, looking up lab results, discharging patients etc.

Cuddleswithpuddles · Jun 23, 2014

My definition of a difficult patient is one who is a constant threat to him/herself. This could mean a withdrawing addict who attempts to get out of bed, pull at lines, spit out meds etc. A person who has brain injuries due to a gang-banging life constantly wiggling and slumping down despite having a ventriculostomy. A noncompliant COPDer in respiratory failure refusing to calm down during weaning attempts and tries to extubate him/herself.

Psychologically, I can take the idea that someone wants to hurt me. A lot of the things I do to patients hurt and, in a time of confusion and high stress, I cannot blame someone for hating me in the moment. But what I cannot fathom is willful self-destruction.

I think a lot of these behaviors stem from denial or despair. They do not believe their actions will cause them harm and, if they do understand it causes them harm, they just do not care anymore.

That is hard for me to see and deal with.

Caffeine_IV · Jun 23, 2014

Dementia patient that refuses to stay in bed but is unsteady, will not take any meds and combative.

Fresh post op will pain control issues or unstable vitals or any type of complication.

Patients that are super needy and nothing satisfies them. Literally nothing you do is enough. They hate where their IV is but they don't want another stick. NONE of the prns work yet they want a med for every single symptom. Food is bad, room temp not right no matter what. And they have an OCD family member there 24/7

sharpeimom · Jun 23, 2014

As far as I'm concerned, someone who's detoxing, coming down, who doesn't want to take his meds, or participate in mandated groups once he gets there, isn't really the kind of difficult that drives me bonkers, because that's part of the diagnosis that landed them in the state psych hospital in the first place.

A difficult patient is one who is in danger of falling because they're adjusting to a life without alcohol, pills, or whatever illicit drugs. A difficult patient is one who hurls a mixture of cheap red wine and a bunch of cheap burritos when I'm wearing a new pair of walking shoes.

A difficult patient is one whose mother intervenes frequently when her forty-?? still single son, who has never moved out, with an almost constant barrage of just plain dumb stupid demands. "Does he have to be served lima beans wen you know he hates them?

Couldn't the kitchen just substitute? I know the rule is lights out at 9:30, but he never goes to bed before 1:00 am at home. Your sheets are so rough that his skin breaks out. May I bring in his sheets from home? Uh...No!

A difficult patient is one who is dying from liver failure because she drank far too much and used drugs for too many years. She has been a model patient. She's very likeable, participates in her groups, is going regularly to her twelve step programs, but she is in and out of the hospital due to deep depression and anxiety for a variety of reasons.

melosa08 · Jun 23, 2014

Confused, combative, and or non-compliant pts with over bearing family while being tripled. Anybody who rides their call light. I use to work in ICU. The above always seem to guarantee you a long, exhaustive night with little charting done timely.

I didn't mind the pts on the vents, multiple gtts, etc at all.

chrisrn24 · Jun 23, 2014

Whiny and needy...has perfectly working hands and can use a call light but can't pull their covers up or reach over and get some water.

I'm happy to help people if they need it but c'mon...

kiszi, RN · Jun 24, 2014

Lately, it's been the A&O pt with no psych hx who throws a temper tantrum every time someone comes in his room, be it for a finger stick, meds, what have you. Threw a med cup across the room while yelling an expletive the other day. At least he took the meds in it first. :cheeky:

I just smile and comment "Well I'm happy to see you too!"

OKNurse2be · Jun 24, 2014

For me, I think a "difficult" pt is a pt who makes unreasonable demands, or is mean to me, on the call light every 5 minutes for the same thing etc while fully cognitive. At least with a pt who has some type of cognitive impairment (dementia or stroke for example), I can tell myself that this person is not totally in control of themselves (which may or may not be true, but it helps me to be more patient). We had a pt this past week, for example, with CHF exacerbation who had a fluid restriction who was constantly on the call light for more ice and trying to push his fluid restriction. If he didn't get what he wanted, he would get verbally abusive towards staff. It's sad when everyone breathes a collective sigh of relief when the pt is discharged.

Jillybean48 · Jun 24, 2014

I work in pediatric home care at the moment and currently take care of a teenager. This is my difficult patient: Before I decide to sit down to eat a quick bite, I make sure she has everything she needs and ask her repeatedly if she needs anything else. She answers with a NO. But of course, as soon as I bring the first bite of food to my mouth, she always needs something; and I don't mean something life threatening, I mean "can you put my socks on" or "can you wash my face". Here is the other difficult patient: also a teenager, also a girl, refuses to let me change her brief for anywhere from 8 to 12 hours at a time and then gosh I don't know why your butt is red, I just have no idea. Can we please change it BEFORE the entire bed is soaked??? :arghh: GRRRRR...... teenagers!!

stickit34 · Jun 24, 2014

The confused combative dementia whose family has dumped in the ER because they don't want to take care of anymore and don't feel bad when they beat you up. Basically any patient who attempts to hit me, because one day I know I will lose it and actually defend myself. Not allowed at my hospital apparently.

The patient who drank/did drugs/didn't move a day in their life who demands to be cured and have all of their needs met within two seconds of request.