I'm stuck w/ a LTC patient who has Munchausen's

Specialties Geriatric

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I am a CNA working in a long term care facility, or nursing home, and have one patient in particular who has really been irking the hell out of me lately. I've been working with her for about a year and have determined for myself that she is a posterchild for Munchausen's Syndrome even though her chart doesn't identify her as such, and if she is already diagnosed, none of my nurses have ever shared that info with me. The only ailments listed on her chart for me are that she suffers from anxiety, COPD, and had fractured her hip years ago but still refuses to get out of bed to this day. She insists that she can only lay on one side in bed, and her body is becoming twisted and contorted because of it. She is continuously on 1L of oxygen, and receives breathing treatments, although if she ever needs a water canister refill for her continuous oxygen the nurses take thier darn sweet time getting it. Once when she was going out to an appointment by stretcher, I asked if I should send her with portable oxygen and my nurse directed me by telling me that "its a comfort measure only" and "not that important". I pretty much took the hint as to what that meant. She often can go for 15 minutes at a time screaming loud enough to be heard down the hallway about supposedly needing a breathing treatment or meds. I probably don't need to explain why that's peculiar. She also loves to go on complaining about stomach pains, constantly asks for laxatives even though she has liquid ***** down to her knees covering the whole bed daily. If it takes me more than five minutes to refill her ice water, she will literally dial 911. Her family never bothers to come see her, although she is constantly calling different people with sob stories. Every week she tries to tell me that a different family member is sick or died, to which my response is "haven't you run out of cousins and sisters to grieve for yet?". Sorry, call me cold if you want, but now that I'm officially privy to this woman's ********, I just have no more patience left for it. Maybe it is a bit unfair of me to expect her to learn and change, but I am seriously at a loss. I have 14 other patients who are mostly polite and need care and what little time I have to give... and she is being beyond inconsiderate of that fact. How should I handle this? Any advice would be welcome and appreciated.

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Specializes in LTC, assisted living, med-surg, psych.

First thing, slow down and take a nice deeeeeep breath. This lady is indeed a lot to handle, and I'm sorry but there's at least one in every LTC. Second, she more than likely does NOT have Munchausens, as she isn't making herself ill.....she's probably only very anxious and very, very lonely.

Sometimes it helps to put yourself in the resident's place and imagine what it must be like to live in a body that doesn't work, where daily life is regimented, and you're without family or friends to visit. Sure, she sounds like a miserable old lady who probably ran her family off years ago by being negative and toxic, but if she's anything like a relative of mine, she wouldn't know the truth of it if you belted her upside the head with a two-by-four. Which, of course, is not allowed no matter HOW much she irritates you. ;)

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Specializes in Family Nurse Practitioner.

I agree with Viva. I don't think she as Munchhausens. She is a lonely old woman.

I have a great idea. Be nice to her. Be her "honey" and "sweety", be her family. See if you can make a difference. I think you can. A little love goes a long way. You have an opportunity to make her feel better. When people feel loved they don't need to seek attention constantly.

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Surely it has occured to me to just be nice to her. However, she is really some sort of psychic energy vampire... the more you give her, the more she demands. Maybe she's just a bored control freak. Either way, as I said, I have 14 other patients daily who need my time and I'm constantly being expected to drop everything and come running when she screams down the hallway. She lies and exaggerates to social services, alleging that I abuse her, and repeatedly tells anyone who will listen that she doesn't want me for an aide, which is fine by me, but nobody else on the floor will trade me a patient for her because she really is that bad. Sincerely, pulling my hair out.

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She needs a psychiatric consult, and if she's already had one, her medication probably needs to be adjusted. These patients are like bottomless pits. They can't be satisfied even after demanding and receiving 90% of the staff's time ...it's not fair to the other patients on the unit.

I feel sympathy for this patient and agree that she should be treated kindly, but I doubt that kindness will "fix" her.

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Sounds like she needs to be a "2 at all times" if she is making unfounded allegations.

It also sounds like her case needs to be reviewed by the higher ups. Your partner on the floor needs to be going into the room with you to do care and the nurse needs to be notified promptly of statements and concerns of the resident.

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She has a psychiatrist who comes to see her for 'anxiety'. He also rounds in our facility on other patients, but not very often and his visits are usually short. Typically, he only speaks to the nurse and will rarely ask me questions... probably because I'm usually busy elsewhere. I am aware that there are alot of changes going on in long term care right now with the use of "chemical restraints" or people being 'overmedicated' and that every so often, we are required to try to decrease a residents dose to see if they can handle it for their own safety. I'm guessing, or hoping, that that's what's going on now, and that maybe her ridiculousness will decrease back to its normal level all in due time. I just really wish I were kept in the loop with these things.

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Specializes in LTC.

Jeez. Sounds like my mother. :) (Whom of which I have "diagnosed" with Narcissistic Personality Disorder.) Very, VERY attention seeking. She makes mountains out of mole hills, (especially when it comes to medical/physical/mental maladies), and is by far the most sick, hurts the most, etc. Those types are very difficult to deal with and do tend to suck the life out of those around them. Re-directing does not work, as they perceive their needs are not being met. That, of course, makes them try harder to get those needs met. I.e. calling 911, yelling, etc. The only way I have found to appease them is to quickly address their needs, pour on the sympathy (that's what they want) and exit as soon as possible. Best of luck.

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Specializes in LTC, assisted living, med-surg, psych.
Jeez. Sounds like my mother. :) (Whom of which I have "diagnosed" with Narcissistic Personality Disorder.) Very, VERY attention seeking. She makes mountains out of mole hills, (especially when it comes to medical/physical/mental maladies), and is by far the most sick, hurts the most, etc. Those types are very difficult to deal with and do tend to suck the life out of those around them. Re-directing does not work, as they perceive their needs are not being met. That, of course, makes them try harder to get those needs met. I.e. calling 911, yelling, etc. The only way I have found to appease them is to quickly address their needs, pour on the sympathy (that's what they want) and exit as soon as possible. Best of luck.

My sister is the same way. I love her to death but she just drains me. Thank God she's in an assisted living facility, although I feel sorry for the staff! To her, everything is an ordeal---they make her go to the dining room for meals, nobody ever comes to see her, her aches/pains/depression are worse than everybody else's.....complain, complain, complain. She even tries to draw me into mental-illness p_____ contests ("at least YOU get to have mania, while I'm just depressed all the time").

Needless to say, I don't visit very often, and it's sad because she would do so much better if anyone could stand to be around her. That's probably the problem with the OP's resident---she needs and craves attention but is so obnoxious that she drives people away. Unfortunately, there's no fix for that. :no:

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Specializes in LTC,Hospice/palliative care,acute care.

Take a deep breath and remember this-double the misery she gives you and you might come close to the misery she feels. Imagine for a minute living her life. Or put your mother in her place.Anxiety can be crippling. Maybe she is afraid to get OOB,afraid she will fall again and fracture her other hip. Imagine not being able to catch your breath...imagine the fear of dying from suffocating. That's her life. Pills are not always the answer,some disorders just don't respond to treatment. And many residents refuse to take them. You can not change her-you can change YOURSELF. Walk away, take a deep breath, thank the Lord you get to leave at the end of the shift. She lives there.24 hours a day,7 days a week. A resident with a personality disorder like that can throw the entire unit in chaos. I would go to great lengths to make sure her ice pitcher was always filled first , her o2 concentrator was always full, she would get her breathing treatments and meds as close to the minute they are due as possible. Why push her to the edge? Why subject the other residents to that? They don't want to hear it either so you would actually be doing them a favor by catering to her. That goes for the nurses,too. If I was your charge nurse you would be rotating her care every 6 weeks

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Could you speak with the Social Service Director or Activities Director about some 1:1 visits ? The resident sounds very lonely and anxious.

Does your facility have a volunteer program? It sounds like she might benefit from some 1:1 time, and it can free you up to take care of your other patients.

I worked in a facility where we had weekly visits from volunteers with an organization who brought friendly pets (dogs and cats) , and our residents loved it! Also, social services staff had regular 1:1 visits with residents much like the one you describe. Good luck!

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