Difficult resident

lovingtheunloved, ASN, RN · Nov 30, 2004

Hide 'em.

Nurse Ratched, RN · Nov 30, 2004

First, I might ask if the resident really needs all those pills. Is there any way to cut down on the number or at least the frequency? So many things come in extended release now - at least then it decreases the number of times you have to play this game.

Second - refuse to play the game. Hold this resident's meds until very last. No sense her keeping other willing pt's from their pills. Then offer once, and if the game starts, walk away. An A&O pt has the right to refuse meds. You are not obliged to cajole anyone. Clearly she is getting secondary gain from this. As long as she does, the game will continue.

harleytx · Nov 30, 2004

Similar situation, I was fed up with trying to get her meds down. I think she just wanted the extra attention and I too was told "that's just how she is". After two weeks, I had enough. She didn't want them I explained to her that your doctor has ordered these medications for you, if you do not want to take them I can not and will not even try to make you, I explained the importance of her medications and then threw all of them into her trash, tied up her trash bag and took it out of the room with me, documented that patient refused and that I preformed patient teaching of how important her medications were, called her doctor and responsible party, filled out an incident report. At 5p med pass she took them without ANY problem, I never had another problem again with her. Although every one else did.

kae rn · Nov 30, 2004

Depends if she is competent or not. If she is competent, she has the right to refuse. Go ahead and chart it as such. If she isn't, then hide them. If it becomes a really big problem--such as blood pressure meds, heart meds,.... then whoever is designated power of those decisions, will need to decide on alternative measures to get her the meds--peg tube, ng...

Fiona59 · Nov 30, 2004

What do you mean hide them? In food?

I had to try three times and then mark Refused.

dekatn · Nov 30, 2004

Thanks for the feedback. Pt. is on bp meds, dig, plavix and numerous vitamins.There are some cognitive deficits, but others that have known her for awhile say she was like this before the CVA. From what I can tell she has always been a difficult person to deal with, gets aggressive at times with other pt. and staff. Thanks for letting me vent.

meownsmile, BSN, RN · Nov 30, 2004

Unfortunately its a control issue. This poor woman has lost control over most every aspect of her life, and was probly very in control and desisive prior to her move to the LTC. The NH schedule/staff tell her when to get up, when to eat, when to shower, when she can watch tv, take a nap, and when she can pee via everyone's "schedule" of tasks for the day. She still has control over when and how she takes her medication. Maybe tell her when she is ready for them,, come find you and ask you for them. Maybe she would be willing to do it on HER schedule. It might surprise you.

tiroka03, LPN · Nov 30, 2004

If they are alert and playing games with me, I will tell them what the med is for, and they can take it, or refuse it if they wish. If they deciede they want to play more games, I say, sorry, but I need to give another person pain pills. Call me if you change your mind. About 75 percent of the time, the person has a sudden change of heart and now wants to take their pills really badly. OK, so then I give them, if they don't OK too, they can always call. Usually one or two times of this, and they will take them like clockwork. While I am sorry that pts feel they need to assert themselves as everything is being taken away, I have other pts who do want meds and care. I also have a job and very real time constraints, I honestly don't have time to play these games. I have walked into a room were a 40 yo man is having a tantrum, and bouncing on his bed demanding this and that and all kinds of strange things. I told him, when he is finished with his little display, I would come back. I try to be careful not to become emotional emeshed into the pts games or tantrums, just don't have enough time or emotional stamina. But again this 40 yo man never had a tantrum for me again, but continued with everyone else to have them on a consistant basis.

What I do then have time for is to comfort a dying or frightened pt because of the time saved in playing games. Or time to do a deeper assessment on someone and help identify and/or allivate something they would have had to live with, as my time was spend with playing a a pawn in someone else's game.

UM Review RN, ASN, RN · Nov 30, 2004

An A&O pt has the right to refuse meds. You are not obliged to cajole anyone. Clearly she is getting secondary gain from this. As long as she does, the game will continue

I have to agree with this. I used to have one like that. I would hold up each pill and say the appropriate reason to take it, for ex., with Dig I would say, "This keeps your heart from going too fast" or whatever the case may be with that patient.

Some pills she took fine after my explanation, some she refused.

If she's A&O, she has the right. Just be sure to let the doc know what she's refusing on a steady basis, so he can adjust accordingly.

CoffeeRTC, BSN, RN · Nov 30, 2004

I'd try to get the pills reduced. Cardiac meds are more important than the MVIs. Explain the reason for the meds. Ask why she doesn't want them. Don't sit around and play the game.. try to find out when she "will" take them. Ask family for imput. Notify the doc. Maybe a psych consult. Document everything. If she is A and O X3 not much you can do..she has every right. It is very frustrating esp when you have 20+ other residents to medicate + tube feedings + IVs +++++ other things to do.

Blackcat99 · Nov 30, 2004

At LTC's there is no time to play these "games." I chart refused and when those residents see me again they sometimes take their meds because they know I'm not going to play their silly games.