my drug-seeking nurse patient

[chenoaspirit, ASN, RN]

Ok, do you guys remember the patient I had who crushed her percocet and pushed it thru her port-a-cath and occluded it? If not, here is a copy of the thread...

https://allnurses.com/forums/f8/getting-percocet-thru-port-cath-285794.html

Well, she is back and with a vengeance! First thing as Im coming onto my shift, she rings the callbell 3 TIMES before I am able to get to her room...wanting pain medicine. She is a nurse who lost her license due to narcotic abuse. She knew it was change of shift, and as a fellow nurse she should have known not to act that way. We, as nurses, know not to act that way because we know and understand how shift change is hectic. :grn:Well later, she claimed she had a seizure. I walked into her room and she was awake, alert, watching tv, no signs of any seizure activity at all. She claimed she did though. :icon_roll She also claimed she had been vomitting, but keeps forgetting to save it...flushes it everytime. She claims there is blood in her urine, but refuses to show us any of her urine. She refused to give a urine sample in the ER until they threatened her with an I/O cath to obtain a sample..then all of a sudden she could pee...no blood in it by the way. All this after chasing my orifice taking her Dilaudid IV and Phenergan IV all day around the clock. :smackingf Well, I didnt call the doc when she claimed to have had a seizure...what exactly would I tell him? She was fine, had just painted her toenails and asked me if I liked the color, she had eaten a ton and drank a ton of pop, chocolate milk, etc. But yet she needed her Phenergan. grrrr. Well, anyway, when the doc comes to the floor he is upset with me that I hadnt called over her "seizure" and I assured him that I had seen NO seizure activity. So he ordered an EEG stat. Of course it showed nothing. She even told me it would show nothing.."it never shows anything." Then to top it all off, I go into her room and she has picked the dressing off her port and as Im re-dressing it and adding IV extension tubing, she starts fluttering her eyes, she wont answer me for about 10 seconds, and then looks at me and says "what are you waiting for". I took her vitals, all WNL, made dang sure that I called the doc. He comes to see her. She tells the doc that I told her she had a seizure, I said NO SUCH THING. He assessed her, tells me she is crazy and leaves. I felt like :selfbonk: by the end of the shift. I ran out of that place as fast as I could. Its people like that who make me HATE my job.

[antidote]

Oh goodness! Good luck dealing with this gal. I'd talk to my manager and get the heck off of her case. I wouldn't want anything to do with her crazy actions.

Why is she being admitted? If there is no good reason for her to be there in the hospital why doesn't she get discharged?

[Kunzieo]

That's Terrible!

Use your CNAs. That's what I used to do with my nurses, when there was a demanding / drug-seeking patient. The nurse would let me know about the patient and then I would always answer the light, not the nurse, and only get the nurse when absolutely necessary. I could relay messages about how "your nurse says it's not time yet" or "your nurse is busy, she says she'll be in shortly." Also, would go in with the nurses and do vitals and straighten the room as they assessed/gave meds/answered questions...that way there were two sets of eyes watching the patient.

We caught one lady this way...she was getting po Percocet, and only taking 1 tablet (when she was given 2) and hiding the other one...and then occassionally taking 5-6 AT A TIME! and having periods of "un-responsiveness" once or twice a day for 2 days(after she had taken all the meds)

Nurses suspected, but couldn't prove anything... after we started going in 2 at a time and watching her, she had to take both pills at once...and she never had another "episode"

[classicdame, MSN, EdD]

Try to think of her as a psych patient who is manipulating her world, versus an ornery old nurse. When you change your expectations it will make the situation easier to contend with - won't change much except your attitude. Sometimes that is the best we can hope for.

[chenoaspirit, ASN, RN]

I just cant believe someone who has been in our position would be one of our WORST patients. I have been in the hospital many times and would only use my callbell when/if necessary. The saddest part is that some of the docs over her care KNOW what she is doing and continue to cater to her. If I were her, I would be ashamed of myself. ALL of her tests have negative results. They cant find anything wrong with her, but the fact that she doubles over and cries and insists something is wrong, they wont release her and continue to add more narcs to her list of candy we can give her. grrrrrrrr

[sissiesmama, ASN, RN]

All I can say is OMG!!!!! How did I miss that last thread about that patient????? I did have a patient one time who was an RN and worked at this same facility in the ICU. She did not like LPNs, med surg nurses, and on and on. She still had ICU nurse "RN itis" or something. This nurse told me later that she didn't think we would catch on to what she had been doing since we were "just med surg nurses".

She had one of the MDS that will give them anything but the kitchen sink, narcotics wise. She had been bringing home needles and syringes from work. She began to inject her thighs with urine and feces and make abcesses. She told me about some of this after she was d/ced and her dh had her committed for a psych hold. One nasty thing about her situation was that the urine she injected into her thighs was her urine, but the feces actually belonged to HER DOG!!!!! OMG! Let's just say I didn't eat supper that night after she told me what she had been doing with the doggie poo.

One sad thing was that the MD said that he knew what kind of crap she had been doing and he just kept putting her back in the hospital with a "all you can take" buffet of po, im, ivp pain meds, ect. The last straw with the MD was when he entered her room without knocking, just to check up on her and caught her in the sharps container to see what she could reach. When she got out of the psych hold, it was right back to what she had been doing, she just added doctor hopping to her list of things to do.

Anne, RNC:banghead:

[Mulan]

wow, I didn't know you could crush percocet and push it through a port a cath

:roll

[Karynica, RN]

she lost her nursing license due to narcotic abuse and she is being a pain in the orifice? She sounds like someone who is jealous of nurses and wants to make everyone around her miserable because of her own undoing.

I would personally want to tell her a few choice words, but of course being the professionals that we are, we cannot do that.

Again, I believe she is being a pain just because of the fact SHE CAN.. She probably would be this way to any nurse, not just you, but I know it must be a pain to put up with such a patient. Makes a nurse want to cuss!

[leslie :-D]

i work inpt hospice, so my pts never get discharged.

so what i'm asking, is when do these type pts eventually get discharged?

what if they're still displaying their symptoms, even in spite of all negative tests?

and i agree about treating her as a psych pt...

limit setting, limit setting, limit setting.

leslie

[RN1982]

I love the ones who juat want some ativan. I had a girl fake a seizure. Of course it happened in front of three other nurses, so as I am walking half way down the hall to get to a phone, one nurse steps out and says that she is fully awake and asking for ativan and pain medicine. So I go back to her room sure enough, she's awake as if nothing ever happened. Her mom is in the room by the way. So again I leave and call the doc who says "she's faking her seizures, i've known this patient for such and such time. Her EEGs are all normal and she's NOT getting ativan". Ok fine.

I go back down to the patient's room and tell her everything her doctor told me including the faking her seizures bit. She never bothered me again all night. I felt bad cuz I knew it really wasn't my place to say that but I wasn't messing around with this girl. When she arrived to the unit, she said she couldn't breath. She was faking stridor. We did ABGs and they were all perfectly normal.

Patients that come in and fake their symptoms just waste a bunch of money and get on my nerves.

[chenoaspirit, ASN, RN]

Well, they eventually get d/c'ed when they can no longer do anymore tests and insurance wont pay for their stay any longer but usually they get transferred to a bigger hospital for more sophisticated testing. They end up right back in our hospital once they are d/c'ed from the other facility. Its a vicious cycle and I get so tired of it. This patient went to take a shower after her "seizure" and unhooked her tubing and draped it over her shoulder! I told her "oh no" and unhooked it from the huber needle and fixed it right. Then when she came back to her room, she hooked it all back together with NO alcohol cleansing. The next time I caught her trying to hook up her tubing I told her how germy that is and it needs to be cleaned with alcohol first, she said "I know". Well, then why are you trying to contaminate yourself!?!?

[Batman24]

When patients are known to be faking seizures do you call a psych consult?! I've never had this happen as of yet so just wondering.

I would try and make sure that all the nurses have to take a turn with her as patients like this are exhausting.