Drug seeking patients

[Art_Vandelay]

The patient had a history of drug seeking behavior, but he also had a cardiac history and was taking cardiac meds.

So, one day he presents to me with c/o chest pain on the left side of his chest that is not radiating anywhere. Vitals are taken and all are WNL. He says he has had heart attacks before, but none felt like this and he "wasn't sure" so he "wanted to tell" me. He has no other symptoms. Assessment is normal. My gut tells me over and over he is lying. I give him ordered PO narcs and call the doctor and ask for a callback. He has no nitro ordered. The doctor doesn't call me back right away and the patient presents to me again, stating "it's radiating to my neck now." I call 911. The paramedics arrive and assess him and --what a shock!-- their assessment findings are all WNL. And voila!, his pain is not radiating to his neck anymore. Oh, and he is not sure about his pain location now, it might be in his ribs. "I told you I wasn't sure." Meanwhile, the paramedics are looking at me like, "Why did you call us? This patient is perfectly fine." Nevertheless, by this point I had talked to the doc and received the order to send the patient to the ER. I am still so irritated about it. I knew the patient was lying from the start, but I didn't trust myself. And here I am looking like the fool. It makes me so resentful toward these types of patients!!!!!! Just wondering how other nurses would have handled the situation...

Oh, and by the way, the patient came back that day with EKG and labs normal. Gasp!

[amarilla, RN]

The problem, I'd wager, that most nurses have with drug seeking patients (at least this is my problem with them) is the absolute time-suck they become. The whine, they cry, they're manipulative, they engage in staff-splitting, they're on the call bell every 3 minutes. They take away time from patients that are actually having a medical emergency.

I'll medicate you if I have an order, but only after all my other patients who have immediate needs are tended to.

Echo this. Fribblet, did I ever mention how much I tend to agree with your posts? Thanks for being here!

[Art_Vandelay]

Dealing with addictive behaviors in a textbook is very different from facing it over and over again on the job.

The exasperated, angry and cynical posts I read about "drug seekers" are a normal response to being manipulated. It's easy to get pulled into the contest over whether the junky gets his fix...

I fully believe that there needs to be a forum similar to al-anon for nurses dealing with drug abusers - we're the ones taking it on the chin day after day. Ignoring the damage done by this is setting us up for precisely the kind of polarization we see over and over in these threads.

It is not our pts' job to take care of our feelings ... and that's what power struggles over whether a pt is "really" in pain is really about, IMHO.

I could not have stated my resentment better than the above excerpt.

Did I mention the patient wheeled himself back to his room(albeit in a motorized WC) after having c/o radiating CP? If it were me and I was having "radiating CP" I would be at the front door waving a sign to the parametics. "Hello, I'm here!" And for the symptoms to drastically change by the time the parametics arrived. Sheesh, it was only 4 minutes! And now I only feel pain in my "ribs". I also didn't mention that the patient had a history of illegal drug use and that facility where I work treats a high majority of addicts. Oh, and did I mention that another patient mocked: "Oh, I'm in chest pain (smile)."

Yes, I feel "exasperated, angry, and cynical". I am a nurse there to help the patient, not be treated like a tool. They teach in school that "pain is what the patient says it is" and I always practice to those standards, but like hherrn stated, that is a gross oversimplification of the problem. There are other nurses at the facility that will ignore CP, give a narc, notify the doc, and reassess later because these are addicts. That scares me because what if I were wrong? At the point when the patient uses the term "radiating," I am calling the paramedics. It is endlessly frustrating though! In nursing school, it is "la de da" medicate as your patient states how he feels. In the real world, the patient has no outword signs of pain or fear and is having radiating chest pain while wheeling himself around the facility. Come on.

p.s. great feedback and discussion

[Art_Vandelay]

I meant to say that there are nurses that will not notify the MD of the CP. Just medicate for pain and monitor because of the drug history.

[Fribblet]

Echo this. Fribblet, did I ever mention how much I tend to agree with your posts? Thanks for being here!

Thanks!

I think you're one of the very few, though.