Real vs fake chest pain - page 2

I am relatively new to working in corrections and am at a county jail. One of the big problems I am having is discerning who is lying and who is not.......particularly about chest pain. I am... Read More

  1. by   Mapam
    You were right on the money! I gained more insight from your response and try to post this(emphaise try as i just lost my orginal respone to u) for my peers to read- Nursing check #1. Assesment right on
  2. by   MassagetoRN
    I work at an acute care hospital that has a locked down DOC floor, where the inmates are sent when they are shipped out. We know the ones that are fakers:
    1. Frequent flyers with negative work-ups (over and over and over)
    2. They are "allergic" to morphine, ASA, NSAIDS, demerol (even though they don't know that we don't use it anymore). They just want Dialudid or say that 2mg of morphine won't touch them (even though 2mg is the chest pain dose...)
    3. They throw a fit and want to leave AMA when they see that we have no TV, clock, and that they're 2 pointed to the bed behind a locked door. They get 3 hots and a cot. We aren't waitresses to provide snacks, juice, coffee, etc. all night long. Also, they usually want AMA when they see that they aren't going to see the Dr until he rounds later in the morning (I work nights, when most admits happen). We see alot of miraculous healings!!

    Inmates are slick, they talk and they know what to say and how to act to fake an MI. And they know that we have the check out chest pain seriously. Some will even not take their KOP meds or take other's KOPs in order to get to medical. Once they realize how strict we've gotten at the hospital, the fakers have really subsided..... Now if we could just cut down on the abcesses from skin popping and dirty needles..... but I digress....
  3. by   sirI
    All true about some fakers, but we have to remain ever vigilant as one day, the "faker" will not be faking and will present with subtle s/s of crisis that could be dismissed.

    Just pointing out the obvious.
  4. by   Munch
    One of my good friend works in the locked corrections unit in our hospital. The stories she tells me..If I had a nickle for every inmate turned patient that was as healthy as a horse, I'd quite my job and move to the Bahamas. Granted some of the inmates ARE sick on the unit, they just had or are going to have surgery, they are cancer patients, pneumonia patients, she even told me they get patients that eat things that aren't edible just so they can go to the hospital to get them fished out(when then in turn makes them a real patient). She did say that the patients that are genuinely sick usually aren't much of a problem and the ones who are malingering(the percentage who are liars are about 60%) are full of demands, needs and wants. The medications that are notorious among the locked corrections unit(which is the proper name for the unit, everyone calls it the jail ward) among sick and malingering patients alike happen to be: Morphine, Fentanyl TDS, Dilaudid, PCA's, IV Tranquilizers(most of them want everything by IV which the exception of a small amount of genuinely ill inmates who are recovering addicts and maintaining sobriety is very important to them, they won't even take a tylenol 3 for post surgical pain). Sleeping pills are popular too. My friend says that if these inmates don't get what they want medication wise she gets threats(and then they get threats by the guards), she also gets threats because like MassagetoRN said there are no TV's, newspapers, phones(only a call button) no entertainment. They get their three meals a day(which they don't get to choose like the rest of he hospital..though I am told by my friend the inmates like the food at the hospital better than at jail/prison). The only inmates on the unit that get pain medication are post op, have chest pain(that after a work up shows it's genuine), organ failure and pretty much anything else that would warrant pain medication. They get toradol and morphine(not high doses like they want..they only inmates that get high doses would be the oncology and organ failure inmates).
  5. by   nursechris1
    We have a 37 yo inmate who had a cardiac event (after running from police) 2 days prior to entering our facility. Troponin levels elevated. Tox screen negative. Heart cath negative. He has been with us 5 weeks and we have sent him out twice with c/o chest and left arm pain. He returned both times within hours with the ER doc stating nothing was wrong with him. I noticed on his mar that the day before his last episode was his last dose of tranxene. I realized I hadn't had a complaint in days from him while on the tranxene. His bp is always low, so I don't take much stock in that. The other night he said he had a severe headache, he was having dry heaves. Chest pain. We gave him tylenol, something for nausea, and put on oxygen. I had him see mental health earlier that day and was instructed on deep breathing. We practiced that with him. He recovered quickly. So hard to know the right thing to do. Like others have said, I can't keep sending him to the ER.
  6. by   cchezem15
    I really loved [COLOR=#003366]libran84's [COLOR=#003366]post! Definitely going to help when I start working!!!!
  7. by   angelkay
    I work in prison and as for chest pains, I have to say that some fake it to get out to the hospital etc (some inmates ahve told me they would fake chest pains becasue they dont get what they want but there will be one that you think is faking and it turns out to be real) ... But I think that the vital signs give clues too. Use your judgement and intuition. and cover your self. If in doubt, send them to your "emergency area", better safe than sorry. This is just from my own experience and I have been dealing with jails and prisons for over 4 years now.
  8. by   OldcootRN
    I've been a correctional nurse in a state prison for better than 8 years and CCHC nurse so I do understand your situation. Our protocal is to do an EKG on ANYONE incarcerated that c/o chest pain. So what if security gives you "the stink eye" when you do obtain a EKG? YOU are the health care professional, not them and it's YOUR license that is on the line. Your job security comes from giving good care not from the bullies with a badge. If this continues, go see your HSA and report the officers in question. Your license could depend on it.
  9. by   Gretchitect
    Ive learned that a very short conversation can help weed out the fakers : basically in my institution "faking" results in a ticket and loss of privileges. Also IMs are charged for medical services 5$ (which is not charged if the complaint is real). So after chest pain complaint I might say "ok, I will bring you to the ER and do an EKG, if its normal you will be charged 5$ and get a ticket. You would not believe how many of them sign the "refusal of medical services" form I always have handy. If they really have chest pain, they will not care about the charge, etc. Our protocol for any chest pain complaint starts with an EKG, so I always give them the option of saying no its not chest pain, and signing refusal on the way to the ER.. that way I am not delaying care if they are not faking. If they are faking but willing to be charged, there is very little you can do - you have to provide care. Thats the nature of correctional nursing .... your patients are criminals. If security interferes, just document the hell out of it.
  10. by   chulada77
    As an agency nurse that fluctuates units I tend to get TONS (up to 10) reported Chest pain cases during the first day of my rotation. The inmates know what s/s to say they are experiencing. I tend to go cellside and do an observation/assessment and go from there. Many of them want a conversation by a new face. Of course I work in a facility right now that is a 24 hour lockdown, one nurse, no provider, and up until now the nurse has been male or elderly.
    A person experiencing a true MI or cardiac emergency are fairly easy to spot. Diaphoretic, vitals abnormal, demeanor off, EKG abnormality, guarding, etc. Usually I have a baseline EKG for comparison so that helps too. If you are familiar with your patient it helps as you can tell if they are in distress and not their "normal" selves.
  11. by   Pranqster
    I look at the big picture, including histroy. Is this a 18yo athletic male vs 55yo obese diabetic male s/p CABG? I always run an ECG on c/o CP. If V/S are normal and ECG neg, I tell them that everything looks good so far. That often weeds out the legit cases.
  12. by   Orca
    Quote from Multicollinearity
    Just screening vital signs sounds negligent to me. I do a lot of EKGs. I also look at the overall picture. Is the patient diaphoretic? Skin color? Is the inmate just off the daily transport bus, coming out of protective seg. and afraid? Is the inmate displaying signs of using medical to avoid being somewhere else? Does it look like he wants out of the cell block or off the yard?

    We cannot just ship everyone out who claims chest pain, and we've got to walk a fine line. You are absolutely correct that you would be fired if you shipped out all inmates who claim chest pain. A lot of their chest pain is muscular (non-cardiac), from excessive exercise. If it does not appear to be a classic MI which requires an emergency response and MONA, gather all your observations and evidence, call your on-call provider, and let them decide the disposition (i.e. back to cell, follow up with HCP, or ED, etc).
    If you don't have a protocol (which is a severe deficiency if you don't), this post gives you some of the best screening advice you will find. About the only thing I would add is to ask the inmate to describe the pain, and to show you exactly where it is. A lot of inmates point to the esophageal area or somewhere else along the midline, indicating a GI cause. Others describe almost any pain between the belt line and the neck as "chest pain" because they know that it will get a swift reaction.

    Vital signs alone are not enough to rule out an MI. While BP, pulse and respiratory rate should logically be elevated if one is occurring, there are exceptions. Same thing with a depressed O2 sat. In a situation like this, I had rather be accused of doing too much. In addition to vital signs and a physical assessment, we review the chart for any prior cardiac history and run an EKG, then call the provider (if it occurs when there is not one on the premises). Most of our providers have fax machines at home, so they can directly view the EKG and the other assessment findings. before making a decision.
  13. by   adgesmeraldiamond
    As everyone else has said follow protocol. At a minimum gather VS, auscultate, feel the pulse and do the EKG. You're documentation needs to show as much objective data as possible to CYA. Ignore security and their eye-rolling. 99 times out of 100 it'll be malingering but do not chance that 1 person all due to security. Ultimately you are responsible for their care, you hold the license, and you will be the one in court. Not security. Also because of the court bit, make sure to exclude any subjective data like "appeared to be faking." I wouldn't just go handing out aspiring and nitro... unless it's ordered for that inmate. But if you feel you need to give it then you likely need to contact a provider and/or send out to ER.