It's easy: Tamper with things and EXTEND your STAY!

RNsRWe, ASN, RN · Dec 1, 2007

If relieving pain enables a patient to accomplish things (s)he would not otherwise be able to do, what's the problem? It seems to me that you might be letting a short-term situation irritate you entirely too much. A patient who does not get enough sleep on account of pain is going to "drain the life out of the staff" much faster than the one who gets adequate pain relief and plenty of sleep to aid the healing process.
Since neither you nor the call bell goes home with the patient, you won't have to worry about it after the patient is discharged.
Retired R.N.

I'm reading the intent of this thread a little differently than you, but maybe I'm not getting it right.

For what it's worth, it's a common occurence on my floor to have people tamper with "stuff" so that they DO get to stay longer. And I do mean "get to" stay, because they don't want to leave. They want to do anything they can to stay in a comfier surroundings than they must have at home.

The particularly obvious are the drug-seeker, frequent flyers. They will claim nausea/vomiting/abdominal pain to get more narcotics for "pain relief". No one will ever witness an episode of vomiting or even nausea (there ARE signs of this) and what we WILL eventually witness will be the McDonald's bags and other crap brought in by their loving friends and family. THAT didn't make them nauseous or cause any abdominal pains, it seems. But don't worry, later on, they'll be begging for their meds.

Or how about the ones who are able to get to the bathroom, and to flush, later denying that they've had ANY urinary output (and claiming that they haven't had a BM for days, or that they've had nonstop diarrhea, whichever is likelier to get them to stay longer). And when a sample is needed from that never-ending diarrhea? Gosh, it just ended.... but can I have more pain meds? Oh, and while you're at it...some ice cream and a soda would be great. Close the door on your way out, ok?

So, with that kind of history on a regular basis from a variety of patients, it CAN be hard not to get jaded, and wonder if every patient isn't screwing with their treatments so they can "get to" stay with us forever!

RNsRWe, ASN, RN · Dec 1, 2007

But we weren't talking about pain here. We were talking about pts. who won't do for themselves when they are capable...and "using" the nursing staff as personal valets. Pts. who enjoy the "sick role" when it suits them. I work on a busy medical oncology floor and we have pts. with pain issues that do not get ignored or scorned. We also have pts. who are in acute pain at the beginning of their stay (ie, SCC) and still want to be high maintenence when their pain is under control. Our job is to get them to the point where they can do their own ADLs and symptom-free and out the door to a "normal for them" life outside the hospital.

LOL, I read your post and remembered a woman who got mad at me for not wiping her butt after she used the commode.... a perfectly able woman, who when I handed her a wet-wip and a roll of paper, glared at me and told me she couldn't possibly do it herself. SERIOUSLY?? She got herself up easily to the commode (why she didn't trot into the bathroom? She convinced doc she was "too sick" to walk the extra ten feet). She wandered around her room just fine. She reached everywhere for everything she needed to keep herself happy and busy, and she couldn't reach her own BUTT??

BTW, I did not wipe that butt....who knows if SHE did, but I sure as heck didn't.

CseMgr1, ASN, RN · Dec 1, 2007

The people who ask for their Dilaudid q 2 hours and have a fit when the doctors change it to q 3 and then a different doctor caters to them and makes it q 2 again.

I once had a patient like that. He/she feigned illness in order to receive Dilaudid and Phernergan q 2 hrs (he/she was caught mixing lotion and mouthwash up in an emesis basin). This person wound up in drug rehab and the prescribing doc had his/her license suspended.

EmmaG, RN · Dec 1, 2007

I've had patients who've done things intentionally to either get themselves admitted or extend their stay. One in particular would purposefully contaminate her central lines and ports. She'd also inject herself with insulin to induce symptoms (including seizures) that she knew would get her admitted. She ended up dead after she miscalculated how long it would take for her hubby to get home to transport her to the ER.

KaroSnowQueen, RN · Dec 1, 2007

There was a patient on our floor (not my patient, thank God), who found a wrapped, unused flush in her room, took it to the bathroom, emptied the saline out, used the syringe to obtain her own feces and injected it into her PICC line. Then she complained to the nurse that her bottom hurt!!! The nurse, knowing this patient to be a chronic complainer, decided to investigate things in the room, and she found the soiled syringe in the trashcan in the bathroom!!!!!!

And the patient, being nearly immediately found out and started on massive ABT, never did get really sick from this and couldn't understand why everyone got so upset about it all!!!!!!!!

Some things I will never understand...............

Sabby_NC · Dec 1, 2007

I so dislike it when patient's purposely mess with dressings...
Such as was the case with a dressing to one of my patient's last night...
A picc line dressing removed without mention to me of the situation. He stated that it just came unwrapped by his moving about. However I did notice his itching his person before later in my shift noticing the missing transparent dressing.
Well, I swiftly took action and redid the dressing explaining to him the risk of infection, the potentiality of his having a longer stay, and a lengthened stay at the hospital can turn out to be leathal. Patient's die from, lose limbs from, are impaired by bad infections. Please let me know next time!
I tire and am fed up of folks who infect their persons in order to keep themselves in the hotel/hospital!:angryfire:angryfire:angryfire Do patients like this have a death wish?! Is life on the outside that bad?

I would explore his behavior and why he did this.

None of us know what some go through on the outside of the hospital walls. :uhoh21:

woody62, RN · Dec 1, 2007

I had only one patient, during my career, that actually did things to harm himself. But he was a state prisoner who had had multiple surgeries to remove items he had swallowed, pushed into his rectum or up his member. He had real mental health issues, that were not being addressed, either by us or the state prison system. The day before he was to be discharges, he went to the bathroom and managed to push several small pieces of a cap off a drainage bottle up into his bladder. By the next morning, he was running a temperature but the resident was going to discharge him any way. I objected, called the Chief Resident and he was not discharge. He required another four weeks in the hospital, all most die because of the overwhelming infection and suffered acute renal failure.

Woody:balloons:

NJNursing, ASN, RN · Dec 1, 2007

There was a patient on our floor (not my patient, thank God), who found a wrapped, unused flush in her room, took it to the bathroom, emptied the saline out, used the syringe to obtain her own feces and injected it into her PICC line. Then she complained to the nurse that her bottom hurt!!! The nurse, knowing this patient to be a chronic complainer, decided to investigate things in the room, and she found the soiled syringe in the trashcan in the bathroom!!!!!!
And the patient, being nearly immediately found out and started on massive ABT, never did get really sick from this and couldn't understand why everyone got so upset about it all!!!!!!!!
Some things I will never understand...............

Ewwwwwww.........

After thinking a little more, I had a pt who was in with headaches and about to be discharged. The doctor had come in at 9pm to tell her he was going to discharge her the next day. This was a 30-something woman who had an anxiety issue. Overnight she developed some magical 'abdominal pain' which of course delayed her d/c while they investigated. When they cleared her of that the headache was back and after that it was nausea. Needless to say she suckered another week out of the MD's.

KyPinkRN · Dec 1, 2007

I so dislike it when patient's purposely mess with dressings...
Such as was the case with a dressing to one of my patient's last night...
A picc line dressing removed without mention to me of the situation. He stated that it just came unwrapped by his moving about. However I did notice his itching his person before later in my shift noticing the missing transparent dressing.
Well, I swiftly took action and redid the dressing explaining to him the risk of infection, the potentiality of his having a longer stay, and a lengthened stay at the hospital can turn out to be leathal. Patient's die from, lose limbs from, are impaired by bad infections. Please let me know next time!
I tire and am fed up of folks who infect their persons in order to keep themselves in the hotel/hospital!:angryfire:angryfire:angryfire Do patients like this have a death wish?! Is life on the outside that bad?

Incidences like this will become very serious next year when Medicare stops paying for hospital aquired infections... not that it isn't now.

banditrn · Dec 1, 2007

I will assume that you are aware that some people can have a horrendous reaction to the dressings placed over PICC sites. (I took care of a gal with hyperemesis that had such a severe reaction to the adhesives that we had to come up with some very imaginative innovations to keep the site clean, dry and sterile!)
As for the other - I have to echo Suesquatch - yes, for some it is.

I have bad skin reactions to adhesives and tapes. I had a PICC line in my arm for awhile, and after it was finally out, the marks were there for over a year.

EmmaG, RN · Dec 1, 2007

There was a patient on our floor (not my patient, thank God), who found a wrapped, unused flush in her room, took it to the bathroom, emptied the saline out, used the syringe to obtain her own feces and injected it into her PICC line. Then she complained to the nurse that her bottom hurt!!! The nurse, knowing this patient to be a chronic complainer, decided to investigate things in the room, and she found the soiled syringe in the trashcan in the bathroom!!!!!!

Sheesh. We had patients who would pull similar stunts, contaminating their lines or sites with stool. We've caught them dumping their antibiotics out; had one who was found emptying her blood transfusion down the toilet.

FireStarterRN, BSN, RN · Dec 1, 2007

Sheesh. We had patients who would pull similar stunts, contaminating their lines or sites with stool. We've caught them dumping their antibiotics out; had one who was found emptying her blood transfusion down the toilet.

This is Munchhausen Syndrome and a mental disorder.