expert opinions please

nancykday · Sep 26, 2007

I am well aware of the games inmates play in regards to "fake" chest pain and "fake " seizures. These being the most common. I am relatively new to corrections, and am setteling in very well, very quickly... now, when a signal is called in a pod..what signs do you assess and look for to determine if their condition is real or fake??.. I would hate to miss a legitamate diagnosis, if in fact it is real. Most of my co-workers have the attitude that 'they are all fakers, trying to get a trip to the ER." I agree there are many who would love a trip to the ER (ie: better food, TV (which our jail does not have) I have good assessment skils, but these inmates are very very good at making a medical emergency appear to be really real. Please educate me on how to know the real deal. I would hate to have an inmate suffer gravely becauseI missed something essentially important.
Thanks for your time to reply :)

It took a good 6 - 12 months before I was comfortable being able to tell if any I/M was scamming me. I had worked ICU for 20 years before going to corrections. So chest pain was a life threatening emergency to me.

Over time I noticed a pattern in the I/M complaints. They most always occurred prior to medline being call, just before s/c started, the I/M's girlfriend was admitted to the ward, or the I/m was on D/C custody and bored with being held in cells. I/M are impatient and hate to be kept waiting in line.

As far as chest pain, I would always review the med record for risk factors, previous c/o chest pains and what else was going on. If you are able to palpate the ICS and reproduce the chest pain and make it worse, they've had the chest pain all day. All week or all year and it's worse today or NOW. If the I/M has no other s/s ie n/v, diaphoresis, abnormal VS, normal EKG, chances are they are looking for a ride to the ER. And a day at the hospital Hilton.

Faux seizures, boy are they fun. After responding to multiple sz calls in the unit and finding all the CO's on the block, down by the seizing I/m's room and finding the I/m beautifully placed on the floor, with their head rested on their arm or a pillow, if their aura was to throw a pillow on the floor, I began to wonder, what else was going on in the block. Seizures happened at all the times chest pain happen, but also during count, when the CO's are on the floors. The I/M's, after a grand mal sz, were never incontinent, " popped " out of a post ictal status with a ammonia inhalent, or helsd their breath when it was held under their nose, or were sitting up on their cot eating cheetos when medical responded. We began drawind CPK,s imm after a grand mal seizure, and if the MM bamds were not elevated, we issued misconducts for lying to staff. This combined with lay in the I/m from yard, phone calls, charginh the I/m an emergency charge and a medicine charge for the ammonia inhalent, decreased faux seizures, by 85%. there is still the occ. Faux seizure by newbees, but word travels fast.

It is easier for us a a state facility, rather than a county, to see patterns. Our I/m have a much longer sentence. You will with time and experience be able to " cull the wheat from the shaft"

Good luck.

VegRN · Sep 26, 2007

Wow NancyKday, you are good!

My tips for fake unconsciousness are.....sternal rub followed by nailbed pressure followed by opening eyes and blowing or touching q -tip. If they pass that, try an arm drop over their head. If the hand magically drops anywhere but their face, they are faking. If they are faking unconscious, they will always protect their face.

Also, be very familiar with what "should" be there in a diagnosis. throw in things that shouldn't be there (for a positive dx) and see what kind of answer you get. Inmates often know what should be there but don't know what shouldn't be there.

Again, nancykday, I am very impressed with your assessment tips AND also the way you handle the fakers.

nancykday · Sep 26, 2007

Wow NancyKday, you are good!
My tips for fake unconsciousness are.....sternal rub followed by nailbed pressure followed by opening eyes and blowing or touching q -tip. If they pass that, try an arm drop over their head. If the hand magically drops anywhere but their face, they are faking. If they are faking unconscious, they will always protect their face.
Also, be very familiar with what "should" be there in a diagnosis. throw in things that shouldn't be there (for a positive dx) and see what kind of answer you get. Inmates often know what should be there but don't know what shouldn't be there.
Again, nancykday, I am very impressed with your assessment tips AND also the way you handle the fakers.

Yes I agree with all the above, I have also asked the i/m if they have "itching behind their eyeballs" and almost 100% they have replied yes and my reply to this usually is get out of here you're wasting my time.

one time an i/m was feigning unconsciousness for 12 hours, she had normal vs hand dropped over head would fall gracefully to her side, I wispered in her ear that she would be more convincing and would probably be sent to the ER but her hand had to hit her face. OMG next time I let here arm drop, shet let it down slowly to here face, go figure.

suecdnp2b · Sep 26, 2007

i am no expert in faking illness, i would send the im to a triage rn quicker than you can say nstemi, but should we be discussing this here? maybe private messages? is it paranoia if its true? seriously, i am very impressed with everyone trying to hone assessment skills so please help out a fellow learner by attending my online wound class for correctional nurses! here is the link to begin, good luck, i only need around 15 more correctional nurses to complete this so i can finish college (its taken almost 30 years)!! thank you!

www.allnurses.com/forums/f11/help-dnp-student-looking-correctional-nurses-242888.html#post2351458

nancykday · Sep 26, 2007

i am no expert in faking illness, i would send the im to a triage rn quicker than you can say nstemi, but should we be discussing this here? maybe private messages? is it paranoia if its true? seriously, i am very impressed with everyone trying to hone assessment skills so please help out a fellow learner by attending my online wound class for correctional nurses! here is the link to begin, good luck, i only need around 15 more correctional nurses to complete this so i can finish college (its taken almost 30 years)!! thank you!
www.allnurses.com/forums/f11/help-dnp-student-looking-correctional-nurses-242888.html#post2351458

whay is nstemi? unfamiliar with the anacronysm

suecdnp2b · Sep 27, 2007

Non ST elevation MI (more common than I would like)

texascowgirl · Sep 27, 2007

whatever you do, do not ever let a CO walk away from an I/M in a "supposed" post-ictal state. the ONLY time i ever was in danger, was when this happened-i kept telling the CO that the I/M was faking it. he didn't believe me-he walked away to help another CO do head count. as soon as he did and was away from view, the I/M miraculously aroused from his "post-ictal" state and all i saw was a HUGE I/M in a violent rage come after me threatening to kill me. luckily, with years of experience, i knew NEVER to back myself into a corner of a room and i had been standing at the doorway and was able to make a quick exit and summons help. gotta admit it was the only time i was ever scared for my life. but this happened in Georgia, where i found the correctional system much more "lax" than Texas.....

nancykday · Sep 27, 2007

Non ST elevation MI (more common than I would like)

OOPS:smackingf Wasn't even thinking medical term. I'm embarassed. I was trying to come up with a prison term.

BSNinTX · Sep 27, 2007

My favorite for testing fake seizures:

Yes, sternal rub works, nail bed pressure works, arm drop works, ammonia inhalant works...but have some fun while you're at it...NIPPLE TWIST. If it's a fake, they'll come off the ground QUICK.

As for MI, you need good assessment skills and an ability to do and read a 12-lead EKG if you think there might be some validity.

gina gina · Sep 28, 2007

hi ,if u witness a seizure,let's say gran mal,people usually change color in the face and they yell out first.one guy i heard of faking was jerking no color change and his head stayed on the blanket.cum on now,if u r having a seizure,your head will b off the blanket!! real seizure r not controlled .the other day an inmate stated he had a high b/p with headache.the nurse i shadowed took his b/p and it was 110/78 and he started smiling.i was pissed at him for her.i would look at pt dx, hx at beginning of shift,there should be a mandatory "GO IN THE HOLE FOR FAKERS"and that would cut down on a lot of non sense!!

BSNinTX · Sep 28, 2007

My favorite for testing fake seizures:
Yes, sternal rub works, nail bed pressure works, arm drop works, ammonia inhalant works...but have some fun while you're at it...NIPPLE TWIST. If it's a fake, they'll come off the ground QUICK.
As for MI, you need good assessment skills and an ability to do and read a 12-lead EKG if you think there might be some validity.

To amend my earlier post, there is another way to check seizures for faking. As with the nipple twist, but reach lower (works for males, maybe not females). Now remember, the idea is to GRAB and TWIST. Again, if the seizure is fake, you'll have your answer pretty quick.