Faking It

kaycee · Feb 22, 2003

Hey no problem 3rdShiftGuy. It's easy to get misunderstood on a bulletin board. I do understand where your coming from and you don't need to be on the defensive. Never doubted you are fun to work with as are I'm sure, alot on this board, including me. I enjoy your posts and especially your sig line. Take care.

Tweety, BSN, RN · Feb 22, 2003

Thanks for understanding Kaycee. (Sometimes it is very hard for me to make myself clear and understood and I will beat a dead horse into the ground to make myself at least understood, not necessarily agreed with.)

NOTE: I did edit my post to say "the patients are NOT the one's seeking drugs"....

So, I'll let it go now. LOL

gauge14iv, MSN, APRN, NP · Feb 22, 2003

Heh these are great - I have seen many fake seizures/paralyasis/unconciousness cases over the years...

But here is one from my traveling days that still makes me shake my head -

Patient was on high doses of IV Aminophylline and Floxin for respiratory infection and asthma (clue #1) - was told in report she had been diagnosed with psychosis and that she was acting up to impress her family and she was refusing to talk to anyone or make eye contact with the nurses so she must be faking it.

She was having continuous (real) seizures and had been for DAYS!!!!

Called small town doc in the middle of the night to discuss this with her and she replied "Oh - Seizures???? REALLY??? Are you SURE?............what should I do?"

:eek:

Had one case of a woman claiming to be paralyzed from her neck down after a fall at her first day at her new waitressing job - we left her the bedpan and when we returned she had filled it with pee and set it on the chair next to the bed - with no assist!!!!

:roll

Flynurse · Mar 5, 2003

Wow! There must have been a seminar in January called "How to fake a seizure and win an Oscar for it."

Early this AM the unit I was on today had a patient admitted from the ER with Dx of uncontrolled Seizures. Okay....First thing patient asks me for is "my Demerol 50 and Visteral 50"

"Hmmmm!" I think....she just got her last dose at 0530 and its only 0830. She then says I feel funny....I think I'm going to have a seizure.

0930....gave pt her pain meds...says she feels hazy...and she might have a seizure. Hmmmmm????

Of course its Ash Wednesday and there are nuns/preists all over the hospital (Catholic Hospital) giving communion and blessings with the ash. Its 1030 and First seizure comes just as the nun is finishing the blessing....She's thrashing around in the bed, making grunting noises, her eyes open and close.

Neurologist, Nurse manager, and two other nurses witness the seizure. After the seizure is "finished" she opens her eyes and says "Did I have another seizure?" Almost everyone had to walk out of that room at that point. Neurologist examines. Writes progress note: Pseudoseizure witnessed this AM. Please do CAT scan, MRI, and Psychological eval."

Second seizure happens at lunch 1200. Aide witnesses....walks out in the hall and grabs me....I time the seizure and another nurse says "Does she have food in her mouth?" .....The food comes flying out of pt's mouth. Don't need to try to get it out now. Seizure stops and pt says "Oh my God, I had another seizure. I'm so sorry!" What for I think????

Explain to patient of all the tests and medications we will be doing, but do not go into detail. "The doctor will explain!" I say....since 1300 she did not have another seizure. Asked for pain meds again an hour before they were due....back hurts a little.....doc was just in to increase the dose to 75mg.

And she just can't stop shaking and having sharp jerking spams.

She needs a muscle relaxant she says....but doc says "no way" Spams get worse immediately.

Hmmmm....Pseudoseizure for Dx on this one....along with Drug addict, DT's, and possible abusive situations at home.

Flynurse · Mar 5, 2003

BTW....did I mention the Neurologist had just visited her before the first seizure......AND none of the meds any of her docs put her on helped....AT ALL!

red606 · Mar 6, 2003

Lots of experience with psuedoseizures....ha ha. The ones who have spontaneous seizures when they dont recieve the narcs they request. The ones who fight with spouse or significant other...and has psuedoseizure (real MD diagnosis) to pay them back for what ever they did to upset them in the first place...real dramatic. Some are pretty good some are not. Like the teen who stopped seizing long enough for us to drag him out of the car and put him on a stretcher, then start seizing again when we put the bedrails up.

Or the patient who is faking it and you ask "what are you doing?" The patient replies with a puzzled look on their face "I'm having a seizure" They are disappointed you didnt recognize it.

mrh1953 · Mar 6, 2003

>What happened to the good ol' days when all docs

>thought everything was "in your head"?

I have tried this approach to my own "complaints" (assuming that, as a nurse, I'm inventing stuff I know too much about!). It can backfire, though (and has). Sometimes the woes are truly real and need to be dealt with.

A faker in the hospital may not have a valid physical complaint, or it may not be the presenting problem (as he or she states it), but it could be real, nonetheless. And probably does need treating, if only in a psych setting at times.

I may not appreciate the faker's "wasting my time" but I do try to understand what motivates such folks. No one does something for no reason at all... (It's hard, though, when you have to wade through a lot of distracting s/s to find the real problem at the root of it all.)

I think we have to find a happy medium between all-in-the-head and not all-in-the-head.

sigh...

hogan4736, BSN, RN · Mar 6, 2003

3rd shifter...

you stated (and quoted):"But when there are comments from a nurse like brefni's "I don't understand what the attraction is..." it bothers me. There is no attraction, there is no though process "gee, I think I'll fake seizures to get into the hospital and get some attention, drugs, or to perform". As I said before, it's a pysch illness same as depression, or phychosis, amnesia etc. "

I genuinely believe that some actually premeditate about how they'll pull their act off, for whichever "chronic" (exacerbation of) illness (seizures, pain, etc)...Is there a psych component there? OF COURSE...but I've got to be concerned about true life-threatening conditions in my patients, or actual pain, etc...

Maybe this is a stretch, but , should career criminals receive lesser sentences, because of abuse/neglect in their past. ..

Look, patients w/ psych histories, that consciously make symptoms up for attention, take care away from those that really need it, and it frustrates us all here...If someone calls 911 for what is later to be found a "pseudoseizure", and does it monthly, then, in my world, let's hand him an ambulance transport bill ALONG WITH his therapy...

sean

hogan4736, BSN, RN · Mar 6, 2003

My point is that people should be held accountable for their actions (except some severe cases of mental illness), and we are outraged that patients do this...

I worked in a long term/residential pediatric psych facility for 10 years...The patients could get into a funk for continually focusing on/blaming current behaviors on past events...Should the past be discounted? NO, NO, NO...BUT, the past should never be used as an excuse for current behaviors, rather to shed light on them...

Coldfoot · Mar 6, 2003

When I was in the Army I worked ER on a training post. We got a lot of kids that decided that the military life wasn't for them and a medical discharge was the way to go. (Sadly a lot thought suicide attempts with nasty stuff like Tylenol was the best way out.) We had one troupie that like to fake a siezure in the PX. The first time she did it and got the full workup and then her paperwork was forwarded to the Medical Board. Any time she felt the discharge paperwork was taking too long, she'd go to the PX and "sieze". When one of the new MS4's went into interview her (not knowing what the rest of us did) her responce to the "Do you have any meical problems?" question was "Oh yah, I have psuedoseizures." Don't people research their DX's? She did progressivly get better (at acting) to the point that she would wet herself. She never did get the post-ictal thing down or realize she shouldn't follow any commands.

Tilleycs · Mar 6, 2003

You mean people are actually trying to GO to the hospital or doctor? Yuck. I avoid them like the plague.

gizzy76 · Mar 7, 2003

Thought I'd add my two cents in here...I've only encountered one person so far in my nursing career that I have thought (as well as others) was a faker.

A middle aged man came in with abdominal pain. He was given many tests and would sit at the bedside holding his side, rocking back and forth and moaning and groaning. The minute you'd leave the room, there wasn't a peep to be heard. He would walk down the hallway as if he were you or I (with no obvious distress). He'd call approximately 1/2 hr before his pain meds were due saying that he was in great pain and needed something for it. He also called the nursing desk at one point and was making gagging throwing up sounds. I went to see him and he had some phlegm in the basin at his bedside and went on to tell me that he was dry heaving and nauseaus and in so much pain. I left to get him the Buscopan that was ordered and snuck back up to his room. I quickled walked around the corner and found him sitting at the beside with his fingers down his throat trying to make himself puke. I can't describe the surprise on his face! He was speechless. Needless to say, his abdominal pain and nausea quickly subsided to a much lesser evil at that point!