Frustrated, need to vent!!!!

[at your cervix]

Help!!!! I am so frustrated!!! Tell me how you would handle this patient (the pt that I had last night!) Pt comes in and walks up to the nurses station and says-with a smile on her face- "Hi, I am in labor", she is 36 1/2 weeks. Monitors on, SVE, cervix is 1 cm maybe 50%, -3 station (at least), can barely reach presenting part but it is very ballotable, cervix is a hard as a rock! No contractions on monitor, can't feel any contractions on palpation. I tell the pt that it doesn't look like real labor at this point but will continue to monitor and see if uc's pick up. Come back in 15 min, pt is now hyperventilating, crying, writhing in bed. Still no contractions seen or palpated. I leave the room to go call MD but I notice that the crying stops when I get out to the hall so, I leave the door open, curtain inside the door is pulled most of the way. I wait 10 min, then quietly come back in the room but stand behind the curtain, I can see pt, she can't see me. She is reading a book in bed, breathing normally, doesn't appear to be hurting at all! I proceed into the room and as soon as she sees me, she drops the book, starts with the crying, screaming, rolling around in bed thing again. I asked her about uc's, she says that she is now in constant pain, says that the contractions are 1 min apart and they hurt even worse now-pain is now a 6 on 0-10 scale, was 4 when she came in! So, I reposition toco (again!) and tell her that I will recheck cervix in 30 min. I leave the room-crying stops, so I tried this "test" 2 more times, every time I leave the room, she stops, as soon as I walk in, she starts in again. I recheck cervix, and no change (surprise, surprise). Pt becomes irrate with me, says "I have never hurt this bad even when I was close to delivery with my other babies and I never got past 1 cm until they broke my water and started me on pitocin." I wanted so bad to say, well then I guess we don't have to worry about your baby being born before 40 weeks then do we? MD came in to see pt, SVE, no change, MD writes discharge order, go in to dc pt, offer her ambien, she refuses, gets up to get dressed, starts throwing things around and says "that is just fine, if you won't believe me, then I just won't come in to the hospital anymore-I'll just have this baby at home!" I am thinking-yeah right I thought you didn't dialate until you had pit, do you have some at home? So she leaves screaming and holding her abdomen as she walks down the hall, 10 min later, her mother calls in to check on her. I tell her mom that she went home, she gets rude with me and says "Why did you send her home? She was in labor. I explain to her that the doctor has talked to her daughter and if she needs to know any info about her daughter's condition, she will need to call and talk to her. She then starts yelling at me about how her daughter will just be back in an hour unless she has the baby at home first!!!" I had to bite my tongue to prevent myself from saying "Oh no, that won't happen, she needs to have pitocin to dilate past 1 cm-oh yeah or maybe some real contractions!"

[ShandyLynnRN, BSN, RN]

I love those kind of patients. What can you do???? I always tell them that the definition of labor is dilation of the cervix. it irkes me even more when the doc makes up some excuse to induce them the next day. Really makes the nurses look bad!!!

[canoehead, BSN, RN]

Ding bat. I would almost want to confront her gently and let her know I'm onto her games, also that labor is cervical changes, though we could do a lot of painful tests o find the cause of abd pain , start with a cath urine...

[SmilingBluEyes]

We all have patients like that. I just give them a very detailed discharge sheet clearly outlining what LABOR IS and what IT IS NOT....I tell them i am sorry for their discomfort and remind them what the goal is...healthy mom and BABY (these manipulative and immature types often forget that part)..And I wish them well...all w/o emotion or feeding their hysteria. They WILL be back, trust me.

[RN always, BSN, RN]

WOW! OB nursing is so different from medical nursing but in a way it is just the same. We get the IV Drug users, ETOH patients. These are the kind of people who we call frequent flyers. We fix them up and they come back in a few months with the same problems. There are some really strange people out there! Thanks for sharing your story! You were a saint for having all those patience with her!

[SmilingBluEyes]

these ARE our "frequent flyers", Rn always!

[trixie]

I am always tempted to give our frequent flyers a punch card like they do at some sub shops----for example Buy 12 subs get 1 free. Only their card would say--come in for 12 visits for no reason and get one visit free! Only then I would have to see them again...

[moz]

:roll LOL Trixie I LOVE it!

You can hope that she is so disappointed she will go to another facility to deliver...just imagine how she will be in actual labor. Sounds like she would be demanding & manipulative after delivery also.

[shay]

I would inform the OB of exactly what I saw, then call the Screen Actor's Guild and ask them about an honorary membership for her.

Then I'd bust her and tell her exactly what I saw. But I'm evil like that.

[at your cervix]

I also get so upset when I dc a pt such as the above mentioned one and 30 min later, I get a call from the hospital in the next town asking for a copy of her medical record because she left us and went straight to them. As if we are stupid and don't know how to diagnose labor!

[MelissaCT]

I had a patient like that; she only cried when I was in the room.

I left the room but didn't close the door all the way, and she was perfectly quiet without me in there!

So I did my charting and stayed out of her way.

[indynurse]

Instead of a free visit punch card, how about telling the frequent flyers that for each punch on the card, their epidural is delayed a centimeter of dilation. Ten punches and no epidural for you when you really are in labor. I bet the next time we saw many of them they would be in active labor.

Kim