Crohn's Disease P/t

[Stephanie5160]

Hello,

I had a 28 year old female patient admitted with a crohns disease flare. MD prescribed 1mg dilaudid every 4hrs prn and zofran. She was having diarrhea with rectal bleeding, vomiting, and low grade fever. MD completed a colonoscopy and EGD. Results showed gastritis, and biopsies were normal. MD changed dilaudid to every 6hrs prn, and add toradol. Patient was relieved but frustrated that she was still have terrible pain and the diarrhea with rectal bleeding. She was concerned she wouldn't be able to take care of her young children in her state. She asked the MD, what can be done about her crohns flare symptoms, but MD would continue to escalate her voice by saying, there's no crohns disease, this is not a flare! I don't need to give you dilaudid. And called for a psych and pain med consult. The patient was very distraught on how the MD was speaking to her. She asked, I'm sorry but are you giving me attitude? I'm very confused... all the while the MD talking over her. Patient started to cry and said she's very sensitive, and to have the MD judge her and automatically decide the patients pain level for her was very hurtful. Her emotional and physical well being was distressed with how this MD treated her. Personally I believe pain is subjective, and given that i physically saw her while she had painful bowel movements, pain, etc, the patient doesn't seem like. Drug seeker, she has genuine pain. Isn't there no cure for crohns? And even with the colonoscopy findings, it could very well still be a flare? Thoughts on how the doctor should have approached the situation? I felt so bad for this patient... anything I can do or recommend for her to do? Thanks!

[brownbook]

I love your post, but am drawing a blank on what a nurse can or should do. Or just have some vague...maybe.....ideas.

[sirI, MSN, APRN, NP]

Welcome to allnurses.com

We moved your thread to the General Nursing forum for more exposure.

[Meeshie]

If all her biopsy results were normal then ... ? Those biopsy results are the confirmation of Crone's. So if they're negative....... then the consults might very well be the best way to go. Or not. Who knows without knowing more. However, you can't control how a doctor speaks to a patient. You can advocate for that patient with the doctor and the patient can, of course, fire that doctor and have another if she feels that she is being ignored or mistreated. What you can't do is control how someone else acts.

[meanmaryjean, DNP, RN]

Patient can also vote with her feet and see another doctor.

[MunoRN, RN]

The first issue is that if the patient truly does have Crohn's, then opiates should generally not be given, the common view of the GI docs I work with is that they consider them to be contraindicated for Crohn's symptoms with only the exception of post-operative short term use.

In this case where it's sounds like the patient doesn't actually have Crohn's, then it's still reasonable for the MD to determine that opiates are not indicated based on their assessment and diagnostics. We don't actually give people opiates simply based on what their pain is stated to be, we use their description of the severity of their pain to quantify the pain we have reason to believe is there.

[Sour Lemon]

Hello,

I had a 28 year old female patient admitted with a crohns disease flare. MD prescribed 1mg dilaudid every 4hrs prn and zofran. She was having diarrhea with rectal bleeding, vomiting, and low grade fever. MD completed a colonoscopy and EGD. Results showed gastritis, and biopsies were normal. MD changed dilaudid to every 6hrs prn, and add toradol. Patient was relieved but frustrated that she was still have terrible pain and the diarrhea with rectal bleeding. She was concerned she wouldn't be able to take care of her young children in her state. She asked the MD, what can be done about her crohns flare symptoms, but MD would continue to escalate her voice by saying, there's no crohns disease, this is not a flare! I don't need to give you dilaudid. And called for a psych and pain med consult. The patient was very distraught on how the MD was speaking to her. She asked, I'm sorry but are you giving me attitude? I'm very confused... all the while the MD talking over her. Patient started to cry and said she's very sensitive, and to have the MD judge her and automatically decide the patients pain level for her was very hurtful. Her emotional and physical well being was distressed with how this MD treated her. Personally I believe pain is subjective, and given that i physically saw her while she had painful bowel movements, pain, etc, the patient doesn't seem like. Drug seeker, she has genuine pain. Isn't there no cure for crohns? And even with the colonoscopy findings, it could very well still be a flare? Thoughts on how the doctor should have approached the situation? I felt so bad for this patient... anything I can do or recommend for her to do? Thanks!

Are you a student or a nurse, Stephanie? I've actually had patients fake fevers, vomiting, pain, etc. to get what they need ...narcotics. One man even used to poor cranberry juice in his urine to make it look like blood ...and when he got caught, he started taking coumadin to make himself bleed, for real.

A psych consult may be exactly what she needs.

Drug seekers can have genuine pain, by the way. Sometimes withdrawal from the drug actually causes severe abdominal pain and nausea.

The doctor gave her pain medication options and even a pain management consult. It sounds like he or she has taken care, to me.

[blondy2061h, MSN, RN]

Patient can also vote with her feet and see another doctor.

That's hard, if not impossible, to do when you're hospitalized.

[blondy2061h, MSN, RN]

I'm curious if the doctor involved is a general medicine doctor or GI specialist?

[brownbook]

Assuming the patient isn't faking anything. Is it appropriate for a nurse to give the patient a list of other gastroenterologist, or general medicine doctors, who have privileges at that hospital? Suggest she might consider seeing a different doctor?

Even if the patient is drug seeking and needs a psych consult the doctor's bedside manner was inappropriate.

[meanmaryjean, DNP, RN]

That's hard, if not impossible, to do when you're hospitalized.

I beg to differ- I've seen it a lot in my 40 years of practice. I've done it myself.

[brownbook]

I beg to differ- I've seen it a lot in my 40 years of practice. I've done it myself.

I agree, but the average patient, myself included, might have a hard time. Not being assertive enough, not knowing how to fire their doctor while hospitalized, not knowing their doctor is being inappropriate, etc.