my drug-seeking nurse patient

Nurses General Nursing

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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! :banghead: 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.

Specializes in Medical.

In theory all our patients who have unexplained seizures have neuropsych consults - partly because they can be physical manifestations of psychosocial stressors (and therefore we try to work out better coping mechanisms). In practice that only happens if they come in under neuro.

I've currently got a patient who was admitted with (unwitnessed) haemoptysis and haematuria (sputum and urine came back NAD) who's now reporting collapses. The unit want neuro obs and a medical review whenever he reports one, even though he came up to the ward the other day and said he'd collapsed in the hospital cafeteria - anything like that outside a clinical area and they call a Code Blue but if he said it happened...

Manipulative patients can be the most frustrating, and former nurses and often the hardest to manage. I think whoever suggested letting go of any idea of her as a nurse was right - all that means is that she knows better how to push buttons, like when the absolutely worst time to buzz is.

Good luck

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

Well, that's easy...when you are an addict, you don't care about anything but the drugs.

The drug issue is going to get more and more complicated in heathcare with this shift to pain management.

What they are teaching us in school as well as a brand-spankin' new hospital orientation, is that it's not up to us to decide if someone is a drug seeker or not, it's only our business to communicate it to the physician, because ultimately, he is the one writing the prescription, and to treat addiction like any other chronic illness.

I can easily see, just from the posts, how aggrevating a drug seeker can be when you are overloaded with patients that DO need attention and are having real issues vs someone who doesn't have any. Along that same line, they are more prone to injure themselves to "prove their pain", take things they have brought from home, or even worse, what someone else has brought them to the hospital, and if you ignore them and something happens to them, they'll nail the nurse to the wall for it.

Specializes in ICU/Critical Care.

I think my patient was manipulative. I'm sure she has some psych issues along with it. I forgot the diagnosis the psych doc gave it, but basically to describe it, it was having neurological disease symptoms without there being any presense of a neuro disease. The girl told me that she couldn't walk and that I would have to lift her to the commode. Mind you, she's wiggling around in bed to get herself comfy. I told her flat out no. I pointed to the commode which was only a foot away from the bed, and said " i am not lifting you, you are moving your legs just fine".

She got herself to the commode all night without my or an aide's help. I think she realized that I was the nurse that would not deal with her manipulation all night. I can tell you that the day nurse got a run for her money. They almost intubated the girl because she was faking "respiratory distress". She wouldn't get up to the commode and had the day shift nurse straight cath her. I don't think the day shift nurse had as strong a personality as me because I would not put up with that.

We've gotten several patients who fake their seizures. The doctors just think its because of stress. Sometimes I think they should come out and say "we know you are faking, knock it off".

Specializes in Med/Surg, Home Health.

Has anyone ever told a patient that you suspect they are faking it? I mean, sometimes I feel like saying "I know you are faking, knock it off" But I guess I could get into trouble if I did. I have a hard time dealing with patients like this because I have to act concerned when Im not. I have to call the doc and bother them, just to cover my butt. They waste my valuable time and energy that I need to get other stuff done.

Specializes in med-surg, telemetry,geriatrics.
Specializes in ICU/Critical Care.
Has anyone ever told a patient that you suspect they are faking it? I mean, sometimes I feel like saying "I know you are faking, knock it off" But I guess I could get into trouble if I did. I have a hard time dealing with patients like this because I have to act concerned when Im not. I have to call the doc and bother them, just to cover my butt. They waste my valuable time and energy that I need to get other stuff done.

Had another patient who faked her seizures and she would make this whining noise when she was putting her show on. So when I and another nurse were in the room watching her "have her seizure", I said, "I've never heard seizure patients make noise before". After I said that she stopped making that noise.

When I worked inpatient psych we would have this one guy who would come to the nurses' station every night around 8 and fake a seizure...he would get up after a few minutes and ask 'What did I do wrong?' LOL:bugeyes:

Like anyone would tell him. That would just make him smarter. (Perhaps someone could tell him about this "rare seizure disorder" that causes people to do lots of pushups really, really fast for 15 minutes.)

:chuckle:bugeyes::lol_hitti

Has anyone ever told a patient that you suspect they are faking it? I mean, sometimes I feel like saying "I know you are faking, knock it off" But I guess I could get into trouble if I did. I have a hard time dealing with patients like this because I have to act concerned when Im not. I have to call the doc and bother them, just to cover my butt. They waste my valuable time and energy that I need to get other stuff done.

Maybe that's why they manipulate, because they can play on the concerns. There has been a few times in my life when I didn't act concerned for various reasons, and I think it saved me from a lot of "drama". One of my friends had a jerk of a boyfriend play on her concerns for all it was worth, and it caused her a lot of worries, until she burned out and didn't care about what he did anymore. Then it stopped.

Specializes in ICU/Critical Care.

Cheno, you have to do what I do. When you have a manipulative patient like the one I had who was faking her seizures, you just have to be very calm. When I have a patient like this, I am almost expression-less. I take the patient's vitals, tell them I'm calling the doctor and leave the room. They are waiting to see your reaction. The more of a reaction you show them, the more of a show they are going to put on. You need to be straightforward and tell them what you will not put up with. I have a good story for you to read...

My friend works contingent in psych so he's well experienced with disorders. He worked at his full-time job which is on a progressive care unit. He received report from ER about a patient he was getting. When the patient arrived, he could tell something was a miss about the patient. Anyhow, he's up at the desk and the aide comes to him and says "your patient's I.V. came out". He says ok, goes to the room, places another I.V. then goes back to the desk.

30 minutes later the aide comes to the desk and says "your patient's I.V. came out". He says ok, goes to the patient's room, places another I.V. Forgot to mention, this patient is alert and oriented x3 and acting as if everything is dandy. So my friend tapes down this new I.V. really really good, then goes back to the desk to finish his paperwork. 30 minutes later the aide is at the desk "Now don't kill the messenger, but your patient's I.V. came out again."

It suddenly occurs to my friend that his patient possibly has borderline personality disorder. So he and the aide go down to the room, sure enough, I.V. is out. He asks the patient "how did your I.V. come out", patient says "It just came out"..My friend looks at the aide and tells her to leave the room and shut the door. My friend approaches the patient and says, "listen I know you are pulling out your I.V.s. They DON'T just come out. Now knock it off". Patient has this wide eyed look on his face and for the rest of the night he behaved.

Specializes in ER, TRAUMA, MED-SURG.
Has anyone ever told a patient that you suspect they are faking it? I mean, sometimes I feel like saying "I know you are faking, knock it off" But I guess I could get into trouble if I did. I have a hard time dealing with patients like this because I have to act concerned when Im not. I have to call the doc and bother them, just to cover my butt. They waste my valuable time and energy that I need to get other stuff done.

Hey- yes, I used to work with a charge nurse on a med-surg unit that was a "no nonsense, no BS" kind of woman. We had a 30 yr. old woman that was a frequent flyer and just about every nurse has had their turn taking care of her many complaints.

Her sister in law had started having seizures after being dz with brain tumors and she had told our star patient what they gave her for the seizures. About 30 minutes after the visitor left, she hit the call light and said "I think I am having a seizure!" We went right down to assess her and found her lying on the floor, positioned on her side, with her pillow UNDER HER HEAD!! Her eyes were closed, and the CN went into the hall to get the dynamapp to check vitals. I was very quiet and she thought the CN was the only one there and for the moment she didn't have an audience for her "performance". She opened one eye and looked around and saw me standing next to her watching her. The CN came back in and saw what wasgoing on. She did the "droppsie test" with the patient's hand and she failed. The the CN said, "Most of my seizure patients are incontinent. She hasn't urinated, has she?" Then, almost on command, we saw a small pool of yellow urine seeping away from her on the floor. Then the CN stated "-------, you might as well give this up. We don't give narcotics after a patient has a seizure.(Of course, that was not the truth.). That means you won't get your pain medicines (Demerol IVP) or sleeping pills. It's your choice." The patient opened her eyes stood up, and asked for a towel. She cleaned up her own urine off the floor and got back into bed. We didn't hear another complaint from her all shift.

Pitiful, isn't it!

Anne, RNC:D

I am a CNA on a unit and I always go in with the RN's in the problem patients' rooms. The 'clock watchers' will get a very polite 'the nurse said it's not time for your pain medication yet' or 'your nurse has an emergency in the next room but as soon as that's under control, she'll be in with your pain meds.' yea...the next room is the break room and the emergency is that the RN's chinese food is getting cold! Why should my nurse delay her lunch for a drug seeker???? I'm in nursing school and I'm terrified of these crazy drug addicted patients!

Gosh, I just can't imagine what kind of miserable life a person must lead to do these kinds of things.

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