How do u deal with patients who make their condition worse?
4 moths ago we had a patient ( cardiac floor) with slight problems. At 82 she did wonderful with a cath. She had no other major health problems, besides intestinal polyps, which were also taken care of.
I realise she was anxious and needy, but what she ended up doing was refusing to care for herself (she asked US to brush HER teeth), she made a problem out of every meal time, she didn't comply with physical therapist, so by the time her hospital stay was over, she was not able to walk even to the bathroom.
As a result, she was not allowed to go home and was taken to a nursing home.
Another woman, who i really liked, was heavy, with many problems - cardiac, diabetes, etc, was doing pretty good. Was released to go home. 3 months lated she came back and i just could not believe it was the same person.
She is now on MRSA isolation (bedsores), she is swallen and her hands shake pretty bad. Every time I see her husband he is coming back to her room with food: icecream, fried shrimp, candy, juice, sandwiches (on top of dinner), potato chips.
I can see that maybe they are older, depressed and just don't care, but is this really they way people want to die?
I had another woman who was almost 90. She blew through seceral cardiac procedures without complaining and abusing the staff, she made EVERY effort to start getting out of bed and excercising. She was so determined to get on with it, that she eventually got out to the rehab and moved on with her life, however much there is left.
All 3 of these women have no children, but what a difference in the way they approach their life and death.
What do u do with patients like that? Do u just try your best to make them comfortable, regadless of how distructive they are or do u make an effort to get on their case and try to get them to listen?