a patient who things she's in a hotel

[uscstu4lfe]

I just wanted to get your opinion on a patient that my floor often gets. The diagnosis is intractable abdominal pain, which she states is a 10 out of a 10 on the pain scale. She has been in and out of the hopsital several times so far, each visit lasting usually a week or more. Our hospital is the only one that will admit her. This patient is fully ambulatory, walks up and down the hallways without any trouble, smiles, giggles, laughs, passes notes to the nurses, talks on the phone, finds ways to criticize our policies. She leaves the floor and goes down to the entrance area and outside to smoke - at least every hour (for which a doctor has written an order). Without fail, she hunts down the nurse every hour for her dilaudid IVP (yes, dilaudid every hour!) for her "10 out of 10" pain. I'm not saying she isn't in pain, I just find it hard to believe. Apparently we are the only hospital that will admit her (she said she has tried all others). This patient is driving all of the nurses crazy!

[MIcrunchyRN]

I try really hard not to judge people's pain.... really hard (lol sometimes not so effectively).

But why or who is admitting her? Maybe they know a bit more about her and how she handles pain? Me personally you wouldn't know I was in pain because in front of others I totally attempt to hide it. I also know people who in midst of having a baby (crowning and drug free) are joking around and seemingly pain free (and we all know better).

Ok so now that's i've showed my "nonjudgemental" side...

Who is this doctor??! Is it someone that you suspect is a friend of this person? Why exactly is she being admitted for so long? Consults to a pain clinic? Alternative therapies for pain (accupuncture, meditation, massage etc?)

I dunno maybe you can make some suggestions to doc or patient about pain clinic or alternative therapies. If she's admitted via ER maybe you could go higher up the chain to discuss how many times she's been admitted and a plan of care for her? ..good luck

[Gr8Dane]

Ah a seeker. They often have the advanced medical knowledge of causing gallblader attacks/pancreatitis by drinking alcohol in excess or other methods they have not been known to share publically with us.

They often enjoy dilaudid, 2-3 MG Q2 hours IVP, and they are very consistant on the time schedules. They are known to be friendly at times, but do not dare to be late on their dilaudid! They become quite a troll. Often they are kind enough to give us 15 minute notice upon when they want their dilaudid (Generally 20-30 minutes prior to it being due).

They enjoy lavish meals, and numerous snacks/drinks inbetween.

[rph3664]

I have a relative who, when she was married to her first husband, would find a way to get admitted to a hospital for surgery at least once a year. After they divorced, I asked our mutual relative if maybe she did this because her husband was a pervert and she wanted to have a legitimate excuse to fend him off (long story as to why I asked this, and yes, I have heard of women doing this). But if you just wanted a break from your husband and kids, wouldn't a spa be less expensive, not to mention less painful? I can assure you that she does not have Munchausen's Syndrome.

BTW, I've mentioned this elsewhere, but her ex-husband had to pay the kids' medical bills and she found ways to take them to doctors constantly, and the ER too, just to soak him.

[Dolce, RN]

Its unfortunate that many abuse the healthcare system in this way. Yes, she may have legitimate pain, but is the hospital setting the best place to address it? If I were her physician I would not allow ANY smoking.

[RN1982]

You're too nice...If it was me I would say "Wow, your pain must be better because you look happy and you are smiling and laughing"...I can't STAND drug-seekers. And about coming late with their meds, when they start that "You were suppose to bring it five minutes ago", I say "Well, not everything can be on time. This is a hospital and I have other patients besides you". I'm not going to interrupt my care of another patient just to get a drug seeker their pain meds on time.

[morte, LPN, LVN]

have you noticed, is it typically the last week of the month?

[RN1982]

have you noticed, is it typically the last week of the month?

Yep and they come in on the weekend.

[psalm51]

I want HER INSURANCE!

[Bortaz, MSN, RN]

That's a pretty expensive hotel.

[uscstu4lfe]

The reason she gets an admission is because she nags, nags, nags about her intractable abdominal pain. It is easier for the doctor to just admit her. Every time a doctor discharges her, she ends up coming back and says her pain has gotten worse (all while laughing, passing notes, walking everywhere in the hospital, etc.). If she's in chronic pain, then perhaps she should go see a pain doctor. Dilaudid every hour while in the hospital isn't going to last forever (well, maybe in this case it will!)

On my unit we have this older 4 foot something small framed asian RN who packs a whole lot of attitude (but she's a good nurse). Anyway, during shift report this patient called her into the room and said it was urgent (dilaudid was due). The RN said no, i can't get you the medication right now, i'm in the middle of shift report (she was already aware of the multiple hospitalizations, dilaudid every hour, etc). The patient said "no, I NEED MY PAIN MEDICATION RIGHT NOW!".. the RN said "I said no!" and the patient said "I'M IN F'ING PAIN AND YOU'RE DENYING ME MY PAIN MEDICATION!!" and then the RN left the room. Well, she came storming out of her room and demanded she have her pain medication. Long story short, the charge switched nurses and she got her pain medication and then dozed off for a few minutes. Sadly, i think most of the doctors/nurses find it easier just to give her the medication for her "pain" than it is to have her nag, nag, nag.

[RN1982]

why not just put them on a PCA?