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Demanding resident-vent

Geriatric   (3,626 Views 16 Comments)

NurseLoveJoy88 has 6 years experience as a ASN, RN and specializes in LTC.

31,831 Profile Views; 3,959 Posts

We have a resident in our LTC facility that is so demanding. I normally have the patience of an angel when it comes to nasty, demanding residents but for some reason this resident really gets under my skin. She loves to take ativan, tylenol, and ultram. I know pain is whatever a patient says it is and I completely agree with that, but don't tell me at 4pm ( when I'm currently giving you your pain meds) that you will need your PRN pain meds at 9pm! How does she know she will be in pain four hours later?

Tonight she received her once daily dose of ativan PRN. She requested another dose even though we don't have an order. She throws a fit ! I notified the supervisor who is in house and she said to call the doc. I call the doc and get a one time dose of ativan. By time I get to her room she is knocked out asleep. I watched her sleep for a few minutes and debated whether to wake her up. I did decide to wake her up because I knew if I didn't she would eventually wake up and call me to give her her meds.I have tried to do non-pharmalogical techniques with her, doesn't go for it. We got psych involved and that hasn't helped. We ruled out any other underlying medical issue. I expect my supervisor to back me up but that was a no go. Just so sick of it sometimes.:sniff:

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Brea LPN has 5 years experience and specializes in LTC.

143 Posts; 3,750 Profile Views

Residents can be very demanding to say the least. I just have to walk away for a few minutes to keep my cool. I have a resident that sets her alarm clock to get her next dose of PRN pain medicine. If she is asleep, she can't be hurting as bad as she makes seem.

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Thedreamer has 4 years experience and specializes in PCU/Hospice/Oncology.

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Some people are just nasty and miserable. Im very understanding and I dont hold it against them. Some patients have just had miserable lives and they are ending them alone in a home someplace a thousand miles from their family.

If they want to complain and be demanding and needy, i say go for it. At the end of the day, you get to go home to your family and happy life, she will still be miserable there. :/

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wee_oneRN has 1 years experience and specializes in NICU/Subacute/MDS.

120 Posts; 2,756 Profile Views

Residents can be very demanding to say the least. I just have to walk away for a few minutes to keep my cool. I have a resident that sets her alarm clock to get her next dose of PRN pain medicine. If she is asleep, she can't be hurting as bad as she makes seem.

Yes and no. Pain medication takes time to work, esp PO pain pills. If you wait until your pain level is 6-7 to ask for the pill, you know it won't be as effective and you will be in tears before it truly gives relief. When I feel a migraine coming on, I immediately take a break, take some Tylenol and see if I can rearrange my schedule when the pain is still mild to moderate. I know that if I don't, if I just keep pushing through, I will end up unable to open my eyes, unable to think straight, throwing up and ready to bash my head into walls. At that point, all the Tylenol in the world won't work on me and I end up in bed for 2 days, miserable.

I just try to remember that when I am giving a pain medication to someone in LTC who is still smiling. These people have felt pain I have never had to deal with, and I don't see any of them running to the corner to get their 'fix'. It's not like working with drug-addicts in the ER.

Also, if someone is setting an alarm clock for a prn pain pill, why not just have the order changed?

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Brea LPN has 5 years experience and specializes in LTC.

143 Posts; 3,750 Profile Views

Yes and no. Pain medication takes time to work, esp PO pain pills. If you wait until your pain level is 6-7 to ask for the pill, you know it won't be as effective and you will be in tears before it truly gives relief. When I feel a migraine coming on, I immediately take a break, take some Tylenol and see if I can rearrange my schedule when the pain is still mild to moderate. I know that if I don't, if I just keep pushing through, I will end up unable to open my eyes, unable to think straight, throwing up and ready to bash my head into walls. At that point, all the Tylenol in the world won't work on me and I end up in bed for 2 days, miserable.

I just try to remember that when I am giving a pain medication to someone in LTC who is still smiling. These people have felt pain I have never had to deal with, and I don't see any of them running to the corner to get their 'fix'. It's not like working with drug-addicts in the ER.

Also, if someone is setting an alarm clock for a prn pain pill, why not just have the order changed?

The person sets alarm clock after getting say 12 am dose for 4 am to get another one, not knowing if she will even need it. No need to change order because she doesn't do it every night just. You don't think LTC residents can be addicts? I have seen residents run to the corner to get their fix.

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AngelicDarkness has 7 years experience and specializes in geriatrics, IV, Nurse management.

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The person sets alarm clock after getting say 12 am dose for 4 am to get another one, not knowing if she will even need it. No need to change order because she doesn't do it every night just. You don't think LTC residents can be addicts? I have seen residents run to the corner to get their fix.

Oh I've seen plenty of addicts to ativan, tylenol, heck even gravol. I understand where you're coming from Brea, I had a similar resident to yours, and if they didn't get their dose they wanted (even if they just took a dose), they would make you call an ambulance for them because they were going straight to emerg. Emerg doctors got to know my resident on a first name basis from paramedic reports, and just signed her a prescription the minute she entered emerg doors.

*hugs* Just think of the positive ones that make your job so rewarding. Demanding ones are always a challenge, but keeps our jobs interesting;)

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NurseLoveJoy88 has 6 years experience as a ASN, RN and specializes in LTC.

3,959 Posts; 31,831 Profile Views

Sounds like the lady has chronic pain that isn't being adequately managed.

I feel the same way. I have called the doc many times to address this. She has had her pain meds changed but then there was a point where it was doing more harm than good, so they changed the dose. Next time I work there I'm going to suggest a narcotic. Maybe that will help, then again she is a fall risk. :confused:

I have discussed this with the DON as well. I feel as though all the nurses are doing false documentation when we put pain med or ativan med effective when its clearly not.

I was so fustrated with her that I had to walk away for a few minutes and come back. She threatens me and always say " the other nurses give me extra doses" or she wants to speak to the head boss which I have no problem telling my boss so she can deal with it. :uhoh3:

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Forever Sunshine has 7 years experience as a ASN, RN and specializes in LTC.

1,261 Posts; 16,139 Profile Views

I recently had a resident who had an order for percocet PRN. The doctor refused to give her anything else and the resident swore up and down it wasn't working for her. but kept taking it.. and kept asking for it.. and refused all other types of analgesics.

She once grilled me because I didn't bring her a pain pill which she wanted at 7pm. Mind you, she didn't tell anyone she wanted it, not me, not the CNA, didn't even ring the call light. I was not disappointed that she was discharged lol.

Make sure you document this behavior.

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heron has 40 years experience as a ASN, RN and specializes in Hospice.

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There also needs to be a major inservice effort in pain management. I don't want to put anyone on the spot, because I think all your frustration is legitimate. Therefore, I'm not quoting anyone or trying to hijack the thread.

However ... a couple of statements made so far in this thread are just plain false. Stating that fact does not, unfortunately, address the frustration folks are feeling, so I'll leave the lecture for another time.

The behaviors you all are describing could indicate addiction or they could indicate pseudo-addiction.

Furthermore, some of them are perfectly reasonable ... without knowing the specifics of the situation, the pt who's setting the alarm clock is doing what she's supposed to do if she expects the available medication to adequately control her pain.

Run a search here on "pain", "pain management", "drug seekers" and you'll definitely get an eyeful.

Meanwhile ... just breathe ... try to set limits and get them careplanned so that staff can be consistent ... and give yourself hugs, a hot foot soak and a cup of cocoa when you get home. Nothing makes drug-seeking or perceived drug seeking easy to tolerate.

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tewdles has 31 years experience as a RN and specializes in PICU, NICU, L&D, Public Health, Hospice.

3,156 Posts; 30,759 Profile Views

Thank you heron...

I agree that our patients with chronic pain MUST be watchful for the timing of their doses. This is THEIR responsibility first, not the nurses'. To somehow disable the alarm clock to interfere with this is wrong...even when the behavior is frustrating.

It is imperative that they know what works and what does not. They should know the names and doses of their meds. They should know what time they take it and when they take it next.

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