how can you tell a drama queen?

[purse]

:banghead:We have this lady at my work (LTC) who is known to be a drama queen, she is always in some kind of pain, ANYTHING you can think of she has it. Anyways, she has had 3 strokes in her lifetime which is why she is there, (she is fairly young in her 70s) BUT, she is ALWAYS saying she is having a stroke! Everyone else just 'knows' she is a drama queen and just ignore her, but for some reason, I always think "well what if she really is having a stroke and I just ignore her like everyone else"

I always take her vitals, and they are normally fine, I even sent her to the hospital once just 'because' she thought she needed to go, she was on the call light every 5 minutes, so i just sent her.

So does anyone have any tips of how to deal with the drama queens out there?!

She is constantly crying and in so much 'pain', and always wants to go to the hospital, but then she gets sent back the same day!

UGH its driving me nuts, because she does have health problems, and there is going to be tha one time noone does anything and there really is something wrong!

[kool-aide, RN]

Kinda sounds like something I've been studying in abnormal psychology... Somatoform Disorders. Google it and see what you think. Maybe ask the MD for a psych eval since these "Sx" are disrupting her normal activity?

[lawandaluxnurse, ADN, BSN]

Does she have any memory issues? Strokes can effect this. Maybe just fear since she has had 3 strokes already...

[bubblymom373]

Ahh yes, the lovely Drama Queen. They are a challenge aren't they? I think every LTC has at least one of those.

If she was my resident I would do several things. I would start temporary care plans to monitor behavior and pain. This way each shift would record how she acts on their shift and if she has c/o pain and where it is. I would also offer prn medication if resident has any and also chart effectiveness if given. This way you have solid documentation forthe MD to see. Personally I would do this for about one week and then send all information to the MD.

This type of behavior could be depression, anxiety, boredom or ?? It could also be pain related and resident just isn't expressing it.

[systoly]

What makes her think she's having a stroke? Why does she want to go to the hospital/what is different at the hospital or what does she expect the hospital staff to do different? Of course I don't know this patient, but sometimes, provided the answers to the above questions are vague and evasive, you can just bluntly ask, "what do you really want?"

[Nurse_Ziba]

Hmmm.. try to put yourself in her position. You don't have your family with you, you have three history of stroke, your in pain, and no one seems to care. How would you react?

Trust should have been established. I would be anxious and paranoid too if no one is taking me seriously. This patient is obviously not coping well with her current situation. What makes it worst is no one is there to process things with her.

Pain is subjective. It doesn't have to be in physical form. I think that your patient is having emotional pain. Maybe crying can be a sign of depression, but it can also just mean that she have some feelings that have to be let out.

Talk to her. Find out what's causing her behaviour. Maybe she just needs someone to listen/address her concerns. If you think she needs to be evaluated, then I guess you can refer her to a psychologist.

Kudos to you for taking the time to explore ways to help her. :redbeathe

[psu_213, BSN, RN]

I worked as a CNA in LTC. Had a resident who always said she was having a heart attack...not the pains, SOB associated with them, she just said she was. You would ask her how she was doing and she would say "better now that I am over the heart attack I had earlier the evening." She also "accused" (and I use the term lightly) one of the night shift aids and night shift LPNs of coming in during the night and giving her a heart transplant (considering her frequent heart attacks one would think this would have made her happy!). We found it quite interesting when she revoked her DNR and there was a new advanced directive for CPR and full resusitation. I started by saying "I, XXX, being of sound mind...." Interesting to say the least.

Also, to the OP, sorry to be rude about this...you are going to make some people very upset if you sent this pt to the hospital because she was on the bell every 5 minutes. If, based on physical assessment, you suspect stroke, by all means, send her! Otherwise, sending her because she rings her bell often and demands to be sent out...not a good enough reason. That being said, good luck, keep up the hard work, I know this is a tough situation.

[morte, LPN, LVN]

I worked as a CNA in LTC. Had a resident who always said she was having a heart attack...not the pains, SOB associated with them, she just said she was. You would ask her how she was doing and she would say "better now that I am over the heart attack I had earlier the evening." She also "accused" (and I use the term lightly) one of the night shift aids and night shift LPNs of coming in during the night and giving her a heart transplant (considering her frequent heart attacks one would think this would have made her happy!). We found it quite interesting when she revoked her DNR and there was a new advanced directive for CPR and full resusitation. I started by saying "I, XXX, being of sound mind...." Interesting to say the least.

Also, to the OP, sorry to be rude about this...you are going to make some people very upset if you sent this pt to the hospital because she was on the bell every 5 minutes. If, based on physical assessment, you suspect stroke, by all means, send her! Otherwise, sending her because she rings her bell often and demands to be sent out...not a good enough reason. That being said, good luck, keep up the hard work, I know this is a tough situation.

inre: the above bold......if she has not been declared mentally incompetent it is her right to go to the ED.

[gentlegiver, ASN, LPN, RN]

What can I say, Drama Queens are everywhere! We have one who cries like a baby if you don't drop everything your doing to get her what she wants. She did this to me because I placed her glass of water on her tray table, which was right next to her. She just burst out crying, woke up pts in the 4 rooms next to hers with her crying, it took 5 minutes to find out that she wanted the water on the right side of the table not the left. She has no impairment to either arm, she could have easily moved the cup herself, she just wants everything where she wants it and she wants it NOW! Just give up, you can't please a Drama Queen, you just have to go with the flow.

[kakamegamama]

"There but for the grace of God, go I" someone wise once said. Sounds like she's terrified. Has anyone called a social services consult on her? Does she have family who offer support (doesn't sound like it). Has anyone ever asked why she thinks she's having a stroke? Again, it sounds like she's really scared & needs some attentions/redirection.

[jollydogg_RN, ADN, BSN]

inre: the above bold......if she has not been declared mentally incompetent it is her right to go to the ED.

I'm not sure. If she has no family and has a conservator, it usually required an order to go to the ED at the LTC facility I worked at. "Just wanting to go" even if not mentally incompetent wasn't a reason to go unless accompanied by signs and/or symptoms of something that warranted a trip to the ED.

Strokes do weird, weird things to people. We had a couple of people always on the call light, and to be honest, I just learned to deal with people. I work in psych now and we have a few guys who ALWAYS complain. We basically go through the motions: sit them down, quick assessment of area of complaint, take vitals, tell them that their vitals are normal, they aren't exhibiting signs of what they are complaining about, and that's it.

Does she have any PRNs for anxiety? What are her normal medications? Not really enough information. Sounds like you all have work to do in your administrations next care plan meeting.

[jollydogg_RN, ADN, BSN]

I worked as a CNA in LTC. Had a resident who always said she was having a heart attack...not the pains, SOB associated with them, she just said she was. You would ask her how she was doing and she would say "better now that I am over the heart attack I had earlier the evening." She also "accused" (and I use the term lightly) one of the night shift aids and night shift LPNs of coming in during the night and giving her a heart transplant (considering her frequent heart attacks one would think this would have made her happy!). We found it quite interesting when she revoked her DNR and there was a new advanced directive for CPR and full resusitation. I started by saying "I, XXX, being of sound mind...." Interesting to say the least.

Also, to the OP, sorry to be rude about this...you are going to make some people very upset if you sent this pt to the hospital because she was on the bell every 5 minutes. If, based on physical assessment, you suspect stroke, by all means, send her! Otherwise, sending her because she rings her bell often and demands to be sent out...not a good enough reason. That being said, good luck, keep up the hard work, I know this is a tough situation.

I agree completely. It's playing into the patient's desires, which will only reinforce the behavior. (Just my opinion. Like you said, if there are signs/symptoms found, then by all means, send away.)