Just thought I'd share some of the stupid things I had to deal with yesterday!
I'm a wound care nurse. Patient number one has wound between toes, it has cultured out MRSA. However, pt will not allow the silver gel we ordered (which hits MRSA) because it "stings". Also won't allow gauze or anything else between toes. Also won't allow me to touch toes, in order to separate toes to look at wound.
Patient one then explains that he needs an antifungal cream. I explain that MRSA (and Pseudomonas, which also cultured out) is a bacteria. He doesn't care, he said that in the past he has had this, and an antifungal cured it. Fine. Whatever. I tell him I will call his doc to see what doc wants to do. BTW, the doc had discontinued our order, but said, "Continue wound care". How??? We can't touch the patient!!!!!
Doc, of course, never returns call, and office staff sends me all over telephone hell everytime I call them. I finally fax the doc, chart all the attempts to contact doc and patients refusals, and move on.
Patient number two's wife gets upset because I won't rip the dry gauze out of her husbands wound (toe amp site). Instead, I use some saline to moisten in order to minimize pain and not destroy any new tissue that might be growing (of course, there is no new tissue). She says that "Dr. Quack at St. Elsewhere says we have to rip it out to get out the dead tissue". She also says that Dr. Quack at St. Elsewhere has some crazy
orders to do wet to dry on one day and Silvadene on the other day. I explain that
wet to dry is old school. She gets upset, whips out her notebook (always a bad sign),
writes furiously, and tries to get Dr. Quack, the vascular surgeon, on the phone to discuss. Of course, Dr. Quack is not available. All I can think is, Why don't you go back to St. Elsewhere?
Patient number three is in the ICU. Despite her serious pnemonia, urosepsis, and
subsequent hypotension, the granddaughter is mostly concerned about a few wounds. There are about 8 people in the room, one who is in a wheelchair, about half of them deaf. Granddaughter also has a notebook. And a camera phone, which she used to photograph grandma's wounds. Another relative is holding the patient's hand, looking morose and sounding weepy. Grandma looks like she just wants to take a nap, or maybe shoot everybody in there who won't leave her alone. I put a wound vac on large hip wound, with granddaughter "helping".
For patient #1: bring in a picture of a severe MRSA skin infection and ask him if he thought the "picture" of the infection would "sting" more than the "sting" he felt with the silver gel. If he says the gel would sting more than the large infection, let him know you'll be following up in a week to see if his growing infection does now indeed hurt less than when the gel was previously applied.
For patient #2: tell the wife that you moisten the dressing first because if you just "rip" it, pus and blood will squirt everywhere -and you didn't want to ruin her nice white sweater. Tell her the "ripping" action aerosolizes the strong odor, and the odor will become permanently embedded in her clothing.
For patient #3: assign jobs to each person ("sir: you tear the tape; ma'am: you hold the gauze; daughter: you guard the door; son: you hold these q-tips; grandaughter: plug in the machine when I say GO"). Make it seem like its a top-secret mission of most utter importance. Pretend you wouldn't have been able to get the job done had they not been there ("oh wow, what would I do if you ALL weren't here to help me?").
Sorry, couldn't help myself
hee hee, Probably the best advice I could get! For patient number 3, I could also have the music from "Mission Impossible" running in the background!
I work at a city hospital where the majority of the patients have no insurance. We fee scale self pay patients to pay as low as $20 and this includes most diagnostic tests (except MRIs-those are $150) and labs. One new patient comes to our clinic and due to alcoholism, diabetes and cardiovascular problems, he has a boatload of referrals. I did a great deal of patient teaching regarding alcholism, complications of diabetes, medication reconciliation, HTN, and the reasons for his referrals. He says to me "I come here for one thing and I have all of these referrals. How am I going to be compensated for having to come for all of these appointments? The least you can do is pay my carfare. " I almost passed out from frustration, but I explained to him that he can see the financial counselor for the fee scale AND, if he cannot afford to pay the $20 for each of those visits, he will STILL be seen. Also explained that car fare is paid by the hospital once he receives Medicaid, but I would refer him to a social worker in case this is a problem for him. He then says that he doesn't want 'nosey*****" in his business and told me to kiss his ***.
Yeah, he really made my day...
I would have been tempted to tell him not to let the door hit him where the good Lord split him on the way out. :angryfire
oldiebutgoodie, RN
643 Posts
hee hee, Probably the best advice I could get! For patient number 3, I could also have the music from "Mission Impossible" running in the background!
Thanks for the laugh,
Oldiebutgoodie