Most Irritating Pt Award

[Pepper The Cat, BSN, RN]

We currently have a pt on our unit that is going to win the Most Irritating Pt Award of the Year.

I thought I'd see if anyone else out there had a contender or too- plus, I really need to vent!

we've had this pt for nearly 3 months now. Things have gotten so bad that we've decided that you will have him for 2 shifts max (ie Monday, Tuesday), then someone else will take over. The last time I had him, I swore that one of us was not going to make it out alive if the shift was even 10 minutes longer!

What he does:

He always wants to be where he isn't. If he's in the w/c, he wants to be in bed. If he's in bed, he wants up. If he's in the lounge, he wants to be in the room and so forth.

You can put him to bed, 15 minutes later, he'll ring to get up.

When he rings, he wants you there right away - if you are not there in 1 minute after he rings, he rings again - and again - and again - until you get there. Sometimes, he'll call his wife at home and complain, so then she calls the nsg station and complain. One night he rang for some Tylenol. His nurse was pouring it when another pt got out of bed and fell. We went to take care of that - took about 10 minutes to pick up that pt etc. If the meantime, Problem Pt calls his wife and says "they won't give me my tylenol" so wife calls nsg station.

He is non-compliant. He now has a stage 4 ulcer on his heel because he pulls himself about in the w/c using the heel - we told him to stop when a blister developed, but he ignored us. Now has a stage 4 - and he's diabetic!

If he's up in the w/c and wants something, he'll follow his nurse around until she gives him what he wants - he won't wait even 5 minutes.

At night - if his bell isn't answered in about 1 minute he'll start yelling - because he knows that in order to let the other 30 odd pts on the unit rest, we don't want him screaming.

He swears at us and treats us like crap. I swear my BP rises a good 20 points just by being in the same room with him!

So - as far as we are concerned, he is winning the Most Irritating Pt of the Year award.

Any competition out there??

[*ac*]

PM'd you my contender.

[chicookie, BSN, RN]

Nope, nothing like that one. I'm sorry. It sounds like you need a hug and spa day.

My award would go to my patient that won't take a bath just because he bruised my I'm-a-good-nurse ego.

[whipping girl in 07, RN]

Have you tried using therapeutic communication on him?

Just kidding, pillow therapy would probably be more like it, huh? Has anyone tried setting limits with him? If you start yelling we will close your door, we will check on you hourly whether you call or not, so if it's almost time for me to come by again, wait for me to come, if you're in the W/C you have to stay there a minimum of one hour, etc.

His lovely wife, does she ever come see him, or just answers the phone and then calls the NS to bytch when he complains?

I feel for you, I really do. Maybe someday he'll leave you.

[loricatus]

Sounds like your guy needs a psych consult and to be treated as if he was a psych patient.

Start by setting boundaries and rules of acceptable behavior. Include his behavior and noncompliance in the nursing notes to prompt the psych consult & possible transfer to a psych facility.

Wondering if a discussion with his wife over your concerns for his behavior problems and the possibility that he gets a psych referral would help? He could be considered a threat to self by allowing that pressure ulcer to develop.

[Pepper The Cat, BSN, RN]

His wife comes in daily. Then we have 2 people chasing us down. She just makes him worse, because she waits on him hand and foot.

Pillow therapy has been very, very tempting.

Last time I had him, he had a hypoglycemic reaction - sugar went to 1.1 (norm is 3.7 -7.3 for you US nurses) and I save him. WHAT was I thinking??

I don't know if he'll ever leave us now - we have a 3 month limitation on our rehab beds, but discharge is up in air now because of the Stage 4 ulcer - we don't know if a nsg home can manage that, and he requires too much care to go home. We may be stuck with him for a long, long time. Break out the alcohol!

[Pepper The Cat, BSN, RN]

Sounds like your guy needs a psych consult and to be treated as if he was a psych patient.

Start by setting boundaries and rules of acceptable behavior. Include his behavior and noncompliance in the nursing notes to prompt the psych consult & possible transfer to a psych facility.

Psych has been in and is trying diff meds.

We set boundries but they don't seem to work because he's figured out that if he just sits there and yells, we come so the other pts aren't distubed!

Because of Stage 4 ulcer and other medical issues, psych can't manage him.

[*ac*]

Psych has been in and is trying diff meds.

We set boundries but they don't seem to work because he's figured out that if he just sits there and yells, we come so the other pts aren't distubed!

Because of Stage 4 ulcer and other medical issues, psych can't manage him.

We have the EXACT same problem with our most irritating pts.

[loricatus]

Psych has been in and is trying diff meds.

We set boundries but they don't seem to work because he's figured out that if he just sits there and yells, we come so the other pts aren't distubed!

Because of Stage 4 ulcer and other medical issues, psych can't manage him.

Oh, I pity you.

Sound like you are in 'The Twilight Zone'

Maybe you can use earplugs on the other patients and just let him scream himself to sleep.

Pillow therapy is quite tempting, though.

So sorry for you guys

[Shenanigans, RN]

What you guys could do is not shower for like a month, then he'll be so disgusted by your collective stench he won't bother you. Of course, there are the infection control issues and the other pts... but its worth a shot... right? Or eat a heap of curry and whenever you go in his room let a few drop.

[RN1982]

Psych has been in and is trying diff meds.

We set boundries but they don't seem to work because he's figured out that if he just sits there and yells, we come so the other pts aren't distubed!

Because of Stage 4 ulcer and other medical issues, psych can't manage him.

I would just let him scream, I'm sure they figured out by now he's a bit confused.

[OldITgeek]

Too bad there isn't a way to record one of his more vocal tirades, then play it back for him...maybe shaming him into acting more his age. Have a little "come to Jesus" (no offense intended) meeting with him and the wife both present.

"Now here Mr. X, where you swear like a drunken sailor, THAT is what we consider UNACCEPTABLE behavior".