OK- so we all have patients who completely deny that they have any medical conditions or problems, yet appear chronically ill or are taking a boatload of meds. But last week I had a guy who took the cake. As I was taking his PMH he advised me that he has had almost 20 stents. A few questions later, he revealed that he smoked 3 packs a day. To which I say "No wonder you have had 20 stents." With a complete straight face he says..."Oh, mine is hereditary. My smoking has nothing to do with it." Huh?
And then the lady who adamantly denied she had diabetes. She was taking metformin so I asked her why she was taking metformin (thinking she could be taking it for PCOS). So she tells me "My pancreas does not produce insulin, so I have to take this medication so my pancreas makes insulin." When I informed her that is almost a textbook definition of diabetes, she still insisted that her doctor said she did NOT have diabetes. I really did try to educate this lady in my brief time with her, but who knows how effective it was. And the bad thing is-I believe her when she says her physician told her she did not have diabetes.
Regarding allergy to Cogentin and Haldol - one of our primary docs told me once that if you get a patient with a huge list of med allergies, there's a very good chance there's a psych component in there somewhere.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
I wasn't offended. It's fine.
Regarding allergy to Cogentin and Haldol - one of our primary docs told me once that if you get a patient with a huge list of med allergies, there's a very good chance there's a psych component in there somewhere.
An amusing side note...the vast majority of patients I encounter with a laundry list of drug allergies are COPD patients, and very "type A" people...controlling, anxious, and inflexible. Even more curious, when I reflect on these cases they are predominantly women. The things that make you go hhhmmm...
An amusing side note...the vast majority of patients I encounter with a laundry list of drug allergies are COPD patients, and very "type A" people...controlling, anxious, and inflexible. Even more curious, when I reflect on these cases they are predominantly women. The things that make you go hhhmmm...
Yeah, I can see where not ever being able to breathe may make you a little controlling, anxious, and inflexible.
I hate lungers, can not do a thing to help them... they are so sick and so miserable, and get absolutely no relief ever...as long as they are alive. Even taking a breathe wears them out. So sad!
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Yeah, I can see where not ever being able to breathe may make you a little controlling, anxious, and inflexible.
I hate lungers, can not do a thing to help them... they are so sick and so miserable, and get absolutely no relief ever...as long as they are alive. Even taking a breathe wears them out. So sad!
ya...we can't, by and large cure them...but we can help them. Opioids for pain and dyspnea, anxiety meds, and sleep aids go a really long way to help these people be comfortable.
My mom was a COPD patient for many years. She was the poster child for many of these patients...resistant to comfort meds, inflexible, very opinionated about what was and wasn't going to be done (type A and RN). It was odd to me that although she had plenty of pain, she was not on a physician ordered pain med, although she had frequent nausea she had no orders for antiemtics or similar, although she rarely slept more than 3 hours continuously she had no sleep aid, she had no orders for anxiety (she tried to treat self with vodka for a spell).
The last couple of years she was in and out of the hospital several times. She always got plenty of theophylline and IV fluids, antibiotics, etc, but never came home with a plan to control or improve her symptoms.
I wish I could say that her case is unusual...but, sadly, it seems that this is sort of the standard for these folks. It appears that many times, unless the person is deemed hospice appropriate, they really get no attention to palliating symptoms...to making them FEEL more comfortable.
This, I think, is a failure of our health system. Some of these people suffer for quite a period of time before they enter that magical "6 month" window for hospice eligibility. I would encourage you, I_LOVE_TRAUMA;4231220, to advocate for aggressive palliation of the symptoms when these poor folks come breathlessly into your ER. You would be as an angel to these patients if you are successful...
JulieCVICURN, BSN, RN
443 Posts
I wasn't offended. It's fine.
Regarding allergy to Cogentin and Haldol - one of our primary docs told me once that if you get a patient with a huge list of med allergies, there's a very good chance there's a psych component in there somewhere.