Mystery illnesses

AfloydRN, BSN, RN · Nov 21, 2006

Unfortunately... the first time you don't send him- he'll die! I worked ER for along time and am very familiar w/ what you are describing. We actually had an inmate die because for once he DID have CP- MI and noone sent him in.

fiestynurse · Nov 25, 2006

These types of inmate/patients are difficult to deal with, but you should use good assessment skills and go through the motions. Have him sign a release and get copies of his old records and check for any history of a back injury. (Old records are very helpful, especially if the outside doctor has had similar issues with him) Take his vital signs each time. Assess his level of pain and discomfort. It is very important that you do not ignore him. Carefully document his behavior carefully. How does he walk into the exam room - What is his gait like? Does he hop up on the table with relative ease? Involve custody in observing his actions. If he is doing calisthenics or out on the basketball court shortly after complaining of severe back pain - that's important to have in his records. And you may have to send him for an abdominal scan, just to cover yourself. Ask him to save you a morning sputum sample, so you can test it for blood. Unfortunately, these inmate types are very litigious. So, document, document, document!

You may also want to tell him the story of the boy who cried wolf.

Lpark27 · Nov 26, 2006

Well he seriously claims he cannot walk. We finally did send him to the ER and although X-rays and a CT Scan were all negative, he still insists he cannot walk.

Trauma Columnist · Nov 26, 2006

Is he laying on the floor somewhere incontinent of bowel and bladder? If he is, then this seriously needs to be worked up further stat. If however, he is still able to get to meals and the toilet, he may need a neurosurg consult when possible.

CHATSDALE · Nov 26, 2006

i know an rn who license was suspended for 6 months, and was lucky that it wasn't permanent

she had a prisoner who was always c/o something [her history] and when he was c/o of lower abdominal pain she wouldn't do anything..

when day shift came on he was sent to hospital immediately and was tx for burst apppendix

sometimes there are wolves out there

ktwlpn, LPN · Nov 26, 2006

I have NO experience in correctional nursing but the level of care these people demand just gauls me.They get the best care OUR money can buy.Meanwhille we have folks on medicare and medicaid getting turned down for dentures or certain types of meds...Argh-I am all for palliative care for prisoners.They are usually non-compliant when they are out on the street but once they get in the system you better jump when they say "jump" We recently had a well publicized incident in our local county prison regarding a young guy with MS-he and his family were ranting and raving all over the news to get him to the city to see specialists-prior to his "unfortuante incarceration" he was mostly just smoking crack while sitting in his living room......

ddc101 · Nov 29, 2006

That is so sad.Its mostly because the inmates are mad that they got

caught and are in jail.Some are looking to take as many people down with

them as they can.They are locked up for a reason.I often tell the co's

I work with that I am so glad for them or our city would have these

people on the streets where we live and our children play.Thank God

for corrections.

tirzo13 · Dec 5, 2006

I have had my back checked out, all negative, but a few times i have not been able to get out of bed, yet every thing appears to be fine.

I have seen my mom, also a nurse, cry because of pain in her knees, but she scans fine. A doctor told her it was in her head.

Sometimes i have headaches that make me want to bash my head in, but all checks out fine.

i keep that in my mind when tests for IM's come back negative.

anyway, we have those frequent flyers.

as stated you can't ignore them, you have to document, and often request that they go to the CTC, let them decide if they are going to the outside hospital.

Often they start hurting/feeling sick after 4 pm.

this is when the MD leaves, or on the weekend when there is not an MD on duty.

they wait till the MD leaves for the day or for the weekend because this is the best chance of getting sent to the outside hospital.

You just have to assess and cover your butt.

they may be faking, but you still have to follow thru like they are telling the truth.

Yeah, it bothers me that IM's get better care than most americans, IM will spend about 45 minutes with the PCP, when was the last time your MD gave you more than 5 minutes?

But they are wards of the state, the state has to make sure they are taken care of, since they can't really take care of themself.

VegRN · Dec 8, 2006

I agree with the other posters that said you must go through the motions and get it worked up and document the heck out of it. Better to go through the motions for a bunch of fakers than ignore an inmate with a real life threatening medical problem.

Once, a CNA and I were assisting an inmate with multiple medical issues back to bed from the bathroom. He had a huge hx of faking things but did have lots of real medical issues. He did fine walking back with SBA but then complained again he couldn't make it any further. CNA pushed him to get back to bed, he made it and then would not respond. CNA said "he's faking it again", I went and did the arm drop and wouldn't you know it it lands directly on his face! Get vitals, his BP is in the tubes, 50's/30's, md called, critical care called for w/u. Turns out they had taken out too much fluid during HD that day and he had vaso vagal response p BM among other things.

Can't imagine what could have happened if I would have just ignored it because he was a constant faker. Eeek.

I also took care of an inmate once who was transferred from the hole to our prison unit in a hospital. He had a big hx of acting out and lying. Had gotten in a fight with cellmate. The cell mate whacked him over the head with something and stomped on his ankle according to reports. They both got thrown in the hole. Inmate complained and complained of pain in his ankle, that he couldn't walk etc. Staff made him get up and get his meds, food. Was looked at by HSU staff, told he had a sprain and ignored. NINE days later showed up at the hospital where I work at with essentially a shattered L ankle, needed big time surg, was on bedrest for at least a week, lots of PT, etc. The ER Md and RN could not believe how bad it looked and that nothing was done about it for 9 days. Can you say lawsuit?

Even minimal assessments, x-rays, referrals etc would have showed that his ankle was broken.

docpsychrn42, ASN, RN · Feb 25, 2007

Unfortunately, we do have to do all that we can do to address their issues. We call these people "borderlines and histrionic personalities". They will "fake" over and over and then there is the ONE time that they are truthful and with our luck, that would be the time that nothing was done! I too feel that offenders do nothing about their health when they are on the streets and then when they come back they try to take advantage of every service they can get. In some cases, coming back to prison is the ONLY way they can get help to address their physical and mental health needs. The most important thing we can do as nurses is document everything. Do not leave out anything you have done for this guy. Make sure you document his behaviors before, during and after an episode. Document things that you see that don't corelate with his immediate problem. If he is complaining about not being able to swallow and you see him sipping away on his straw or drinking his large cup of tea without difficulty, document that. You can always refer him to Mental Health too. Let MH rule out that there isn't something mental going on with him and let that department help medical out by double teaming him on his issues. Always have consistency on these kind of inmates. That way they can't play one department against the other. Too many times I have inmates coming over to see me and they start in on how medical hasn't done something for them and after I look into his computer chart I see otherwise. I always confront the inmate on his allegations as well to let him know that medical and myself are in touch regarding his care. Just a few ideas for ya. Good luck in working with this kind of offender.

nurseT · Mar 4, 2007

Hi everyone. I've worked in a local county jail for about one year now and I'm wondering how others deal with this type of situation. We have a new inmate who insists on many medical problems such as back pain, stomach problems, coughing up blood, etc.. and that he needs to go to the hospital immediately for untreated conditions. Apparently he's complained of the same for years and has some psyche issues. He insists he needs multiple tests and puts up a fuss every time he sees a nurse. He has even gone limp to the floor yelling and screaming that the officers hurt his back and he can't walk or get up. He has since been literally dragged back to his cell. Any ideas?? We can't just send him out for the full body scan he's probably looking for! Thanks.

After a while you will get to know the repeaters. I had one guy with a history of psuedo seizure and took depakote. He came from another jail and said " They stopped giving me my depakote 4 days ago because I was leaving soon and they didn't want to refill it". He was famous for faking seizures also. I ordered him moved to the rubber room which he hated but I advised this was for his saftey. I told him I would order his meds but they would not be in until the next day. So an hour later he goes into a full blown seizure, tonic clonic. He kept having seizures back to back. Following protocol, I gave him some valium to stop the seizure activity and sent him to ER for a Depakote level and evaluation. They brought his levels back up to therapeutic and sent him back to the jail. Well after that , when ever he didn't get his way he would say, " I'm gonna have a seizure right now", he would wait for the officers to lay a mat on the floor and would lay down and pull off the best fake I've ever seen. But, I knew his depakote levels were therapeutic and this was put on. So when he would threaten to have a seizure, I'd say "OK, go ahead, your mat is on the floor". And he would get really mad and call me all sorts of neat things. I had another inmate who was not very smart at all, and he kept denying any health problems, but his bunky insisted the guy was sick. I segregated him in r-cells and had him observed over night. He checked out good the next morning and begged to return to the block. That TV is a good motivator. He insisted he was just a little constipated and he had a dry bowel movement. He was provided the usual nursing advice for constipation.The doctor was coming in but the inmate said he didn't need to see the doctor, so I let him go back to the block. The next day there is a different crew working. They tell me this same guy's bunky is complaining the inmate is ill. So I pull the inmate out into the darkened hall and it was immediately obvious his abdomen was huge, I had seen him the day before and knew it was not that big. He still insisted he was not that sick.I took him up to the exam room and before we even reached the room I had already decided without further fuss he was going to the ER. As far as I was concerned, he had an acute abdomen. I was thinking maybe a bowel blockage or even a perforated bowel. He spent 2 weeks in the hospital, 10 of those days in ICU. He had a bowel blockage, a UTI and and got worse after he got there. The ER doctor found out this inmate had had numerous surgeries in the past due to bowel blockages but the inmate was not very forthcoming with the information. So, You never know. At my jail, they are either faking or definately dying. Sometimes the officers ask me why I spend any time assessing certain inmates, and I tell them " One out of 10 is telling the truth, You guess which one ". This population behaves and lives by different rules, they lack education and some of their fears are legitimate no matter how stupid it seems. You have to Scale your instructions way down to a 4th or 5th grade level. And yet not give away too much information. I have grown women come in and havent got a clue about normal female functions, basic female anatomy. They are hillbillies who have been raised on old wives tales and practice inbreading, or illegal aliens from Mexico who think a pimple is cancer because they don't get healthcare in their country and their uncle died from a pimple on his nose. Or so they thought. So, better safe than sorry. Make a real good assessment of the guy. Request his old medical records. If he checks out ok, put him on observation, and document his behavior. If he falls over and his face turns black, call 911 and get the AED. You don't have to treat symptoms that you can't find or test every inmate for every disease possible. One thing I tell them is "I am the nurse, I get to make the assessment, and I get to decide if you are having an emergency, and I get to make the decisions" . Just always be careful.