Why do they bother coming in anyway??

Specialties Ob/Gyn

Published

I work in a fairly small hospital Birth Center. Our patients are usually compliant with docs orders etc.. But twice in the last week, I had patients that were absolutely refusing treatment. The first was preterm labor (34+ weeks) throwing up, contracting and couldn't keep her PO terbutaline down. Got orders for a liter of IV fluids, zofran and SQ terb. She refused, up one side and down the other - wanted to leave, yada yada yada. Her boyfriend convinced her after about an hour to take the meds and IV, but she told me I had to have someone come and hold her arm down because she "gave a doctor a black eye the last time I had an IV".

Last night I get a 17y/o married but separated with a boyfriend, G2P0 (37 week demise a year ago), cocaine + with lady partsl bleeding at 18 6/7 weeks. She had left ER AMA about 12 hours earlier and came back for treatment when she could get someone to come in with her. She spent the whole time with the room phone in one ear and her cell phone in the other, screaming and yelling, cussing up a storm and left AMA about 4 hours after she got there.

What is with people?!?!?!?

Our other patients, should be 'normal' have been rude, snippy, refusing to allow us to do regular post-partum tummy checks, etc...

Sorry, just ranting!!!:confused: :confused: :confused:

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Specializes in L&D.

Welcome to the wonderful attitude of "do what I want, NOW!" I can't tell you how many times I've had preterm pts who refuse tocolysis because "my cousin/sister/best friend/neighbor had her baby at X weeks and it was just fine!" All you can do is educate them as much as possible, and if they still refuse treatment, smile, and hand them the AMA form to sign.

What I would *really* like to do is drag them through the NICU to see what horrible things we have to put their severely preterm babies through to keep them alive.

Then again, they would probably just coo and say how cute the 1-2 lb babies are. :rolleyes:

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Specializes in Perinatal, Education.

We had a 27 weeker who signed her AMA with a little smiley face in the dot of her i. There should be prerequisites for pregnancy.

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When an OB pt. signs AMA...does the doctor drop them as a patient? I work med/surg and some of our doctors do indeed drop those patients (of course some don't). I was just wondering.

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I once had a pt come in for c/o PIH symptoms. She refused to have labs done and refused the IV on the advice of her friend who then convinced her to get "just the heplock" and no fluids.....why???? She eventually left AMA.

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Specializes in LTC, Home Health, L&D, Nsy, PP.
Welcome to the wonderful attitude of "do what I want, NOW!" I can't tell you how many times I've had preterm pts who refuse tocolysis because "my cousin/sister/best friend/neighbor had her baby at X weeks and it was just fine!" All you can do is educate them as much as possible, and if they still refuse treatment, smile, and hand them the AMA form to sign.

What I would *really* like to do is drag them through the NICU to see what horrible things we have to put their severely preterm babies through to keep them alive.

Then again, they would probably just coo and say how cute the 1-2 lb babies are. :rolleyes:

I know what you mean! I have one who takes the cake though ... a while back we had a frequent flyer who had previously been one of our nursery nurses. She was 33 weeks with twins and we were fighting so hard to keep the babies in a little longer. The last time I saw her she was trying to talk the MD into letting her deliver because she had a "feeling" that she was closer to term than the Dr thought! I was soooo angry with her. She, of all people, should have known! :angryfire

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Specializes in Long Term Care.
We had a 27 weeker who signed her AMA with a little smiley face in the dot of her i. There should be prerequisites for pregnancy.

I agree completely. unfortunately, reproductive rights are protected by the constitution.

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All you can do is educate them, and if they chose not to listen or comply then that's their right. You will get burned out worrying about all the noncompliant patients out there.

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ok so is there an automatid referal to the dept of children to check on these children that are being born to these ladies..

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We had a 27 weeker who signed her AMA with a little smiley face in the dot of her i. There should be prerequisites for pregnancy.

Had a 14 yr old mom not too long ago in the NICU. Needed a signature on some paperwork. She asked, 'In cursive? I hope not. I hate cursive.'

I think the problem is this: When the powers that be created things like patient self-determination, I don't think they were envisioning the mental giants that we frequently deal with. Just gotta try your best, document, and keep on going.

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What is with people?!?!?!?

Our other patients, should be 'normal' have been rude, snippy, refusing to allow us to do regular post-partum tummy checks, etc...

Sorry, just ranting!!!:confused: :confused: :confused:

We get that too. I don't think you can apply "normal" logic to their behavior (i.e., "If you don't want treatment, why are you here?") I just try to be omni-nurse and be therapeutic for their behavioral and psychological issues as well as for their OB issues. There's definitely a lot of eye rolling in the staff room where I work, though.

Altalorraine

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Specializes in MICU.
Had a 14 yr old mom not too long ago in the NICU. Needed a signature on some paperwork. She asked, 'In cursive? I hope not. I hate cursive.'

:eek:

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