Pts who "Cry Wolf"

[MandyInMS]

OK...I'm soooo frustrated/mad/disgusted with this pt I have on med-surg. 82 y/o female with history of COPD,MI,Resp.Failure,& drug addiction..Mrs X is allergic to all pain meds EXCEPT Demerol(her drug of choice).She has actual medical problems, but throws a fit and c/o chest pain when her Demerol is decreased or d/c'd.Last night @ 9 she got Xanax .5 ,refused her Oxycontin 20 saying it made her 'sick' and opted for a Tylox..all was well til 2 am..she got another Xanax & Tylox for her chest pain..she refuses to even try NTG sayin it never helps..Ekg's/VS unchanged/sat 98-99% no s/s of any distress..3am I observe her sleeping well resp even/unlabored..310am i accidentally make a noise outside her room awakening her and she buzzes with c/o chestpain..holding her chest/hypervent'n..take note her Demerol has been dc'd for a total of one day..check vitals/ekg AGAIN..no changes..demanding shot of Demerol.."it's the only thing that will help".convince her to take Oxycontin and give her Dramamine to prevent nausea..pts daughter is at bedside and is aware of how she "clowns" to get what she wants..I tell her to give the meds time to work...on the buzzer every 5-10 minutes..cont to monitor vs,ect, with no changes..demands RT tx (knowing this raises her heartrate) oh yeah did I mention this pt is/was an RN ? I talk to the woman with daughter present telling her the MD would not order anything else knowing everything she has already recieved and to try to calm down and let meds work..pt observed @ 4 am snoring her butt off..cont to rest well on frequent roomchecks..resp even/no distress..had to awaken for am accucheck(bad as I hated to) sleeping one second..rubbing her chest when she sees me/hyperventing herself..her bloodsugar is fine..and I ignore her chest rubbing/and go about my business..prayin for 7am to come..I go back and check her 15 minutes later...sound asleep..breathing fine.......and, I'll have her AGAIN tonight!!! Lord help me!!!...I've had this woman soooo many time and she keeps doing this over and over..MD is aware and I think he's at his wits end with her too.The thing is she DOES have actual med issues..I'm just afraid one of these million times she "cries wolf" it will be real and NOBODY will believe her...........any of you had to deal with this?/ how dou YOU handle it???

[ainz]

I would suggest rotating nurses to care for the patient.

Perhaps a different perspective on the patient. I think ALL problems are "medical" problems as so many call it. I don't separate "mental" and "physical" or "real" versus the nurses' or doctors' perception of "not real or imagined."

We know that all activities within the body, like heart rate and rhythm, autonomic activity, breathing and gas exchange, and so on, are physiologically based. Brain and nervous system activity are physiologically based. Behavior is a manifestation of physiologic activity, various chemical processes originating intracellularly, like any other function and activity of the body.

Why is behavior seen differently? Behavior is merely a product of the brain, has a purpose, sustains life, like all other processes. An addicted person has an altered brain chemistry therefore the dysfunction. They may have "brought it on themselves" by using the drugs in the first place but essentially so did patients with advanced atherosclerotic disease through poor dietary habits, or smoking, sedentary lifestyle, perhaps noncompliance with medication regime or so forth. Why do we not condemn them and get frustrated with their care?

I worked in psych for 7 years and always had a component of addictions nursing involved as well. These patients can be very challenging, especially in the actue care setting. She is simply withdrawing and suffering the effects of narcotic withdrawal. Perhaps the doctor could wean her with some sort of detox regime. But then again, if she is 82 and a complex medical patient, is it worth being aggressive.

I do feel for you and the frustration.

[caroladybelle, BSN, RN]

Is anyone else worried about the toxic metabolites that accumulate from Demerol use, especially in the elderly?

[kids]

Originally posted by caroladybelle

Is anyone else worried about the toxic metabolites that accumulate from Demerol use, especially in the elderly?

My thoughts also...then again, maybe she is used to all of that toxic crap in her system and doesn't feel right without it. If she has been on it for a long time she may be habituated to the point where she's not getting a buzz.

Ditto the turpentine taste.

Demerol sucks. period. I'll be glad when it is off the market.

And as a not so interesting asside: it does for pain in me, unless I am drugged to the point of respiratory depression (I've had it happen, then got Narcan'd with a big ol' belly wound, 4 hrs post-op), however, it does make me feel stupid which in turn makes me angry AND agressive.

[bagladyrn, RN]

I've got to say that if at 82, someone where to try to deny my needs, tell me that my nursing knowlege is no longer relevant because I received my RN too many years ago, then tell me they planned to ignore me, I would raise such commotion that it would make this lady seem like "Miss Congeniality". Yes, she's being demanding, maybe she is addicted (at 82, does it really matter if it makes life bearable?), but what happened to "Pain is what the patient says it is?". Some of these suggestions border on elder abuse.

By all means, rotate this pt. between people so no one reaches the level of frustration to treat her this way!

[MandyInMS]

Thanks for all the advice/replies all....

As for rotating pts..we do..we have ALL had her many many times..multiple admits over the last few years...it was just my turn this admission..I worked CCU last night and was glad for the break..it was MUCH needed.

MrsX got her Demerol reordered 75 mg q4 IV..along with increasing her Oxycontin to 40mg q 12..along with Tylox q3 prn..and Xanax q 4 prn..and she is taking in all she can get ,every chance she can get it..she could barely talk(slurred speech), or stand, or even go to the bathroom..as she did before r/t all the meds she taking...and still called for her Demerol after an hour or so of recieving it..not even remembering she had it...I'm not an uncaring or abusive nurse..and by all means if somebody is hurting give them something...this lady was put on a vent