Particular Patient Populations - Do You Struggle?

[Nurse SMS]

Do you have a least favorite diagnosis in terms of giving nursing care? I am a newer nurse, so that probably plays into this, but I am rapidly finding I really struggle when caring for patients with devastating neurological injuries. Fresh strokes and fresh spinal cord injuries in particular. I get very intimidated by the patient's (often) inability to communicate, particularly with fresh trachs. I am good about offering up pen/paper, but recently I have one who doesn't speak fluent English and who has been left without fine motor in their hands and cannot write.

I find also the families to be devastating to me emotionally in their understandable inability to grasp what has happened. Their questions of "How much better will he/she get? When do you think we can return to normal?" leave me like a deer in headlights, because it is so obvious this has been a traumatic event and a devastating one to their loved one...that nothing is going to be the same again....and that they just can't wrap their head around it.

I find myself dreading going into work when I have one of these types of patients. Trust me, I provide excellent care. I just get depressed by it.

Do you have a certain population that is that way for you?

[nerdtonurse?, BSN, RN]

DKA. Not the diabetic who's had a nasty GI bug, infection or surgery, or something that could reasonably make their sugars go wild, the ones we get every 2 or 3 weeks, usually young, and the biggest pains in tail you can imagine. They don't do fsbs or take their insulin, despite being taught multiple times, being sent home with FREE supplies for fsbs and free insulin pens, always come in with uncontrolled n/v/d (and the CT shows a full GI tract, it's called, "keep that dilaudid coming!"). Always have a positive drug screen, and not a single mark on their fingers that they've checked their sugars since their last admission -- but they're on disability because of their diabetes (makes you wonder if that's why they don't treat it). And I always look over at the person who's post-dialysis hypotension, or post BKA, or evolving stroke, or fresh MI, all from untreated diabetes, and I just want to drag them into the other patient's room and say, "This is your future. Right here. These smells. These missing limbs, these necrotic feet, that dialysis machine, that sign saying 'Patient is Blind,' that person who's trached, PEG'd and on their way to a nursing home for the rest of their life, just because they didn't treat their diabetes. Now do what you're supposed to do, not what you WANT to do."

[RNsRWe, ASN, RN]

Hypochondriacs. Ok, they're never dx'd that way, but we all know who they are!

They're the ones that keep coming back to our GI office insisting that they get scoped yet another time, they're POSITIVE there's something wrong, regardless of the fact that every test has been negative--and their best bet would be psych. Whether the symptom is abdominal pain, cramping, nausea, rectal bleeds, whatever....they always find a new way to get yet another service or med (or both).

And when they aren't being scoped, they're in the hospital, complaining of the same symptoms until they get admitted....and then get that GI consult after all

I'm sure every specialist out there has got a list of hypochondriac patients.

[DemonWings]

The non-compliants, not the ones who just don't follow diet or exercise routines because those are difficult. However, the ones who come to the hospital and refuse treatment for the very reason the came in. Had a patient come in for DKA with sugars in the 500 (via ems) and refused an insulin drip because insulin makes me feel "yucky", however he developed mysterious non descript abdominal pain while in ER, got 10 mg morphine and signed out AMA. That, my friends, drives me bonkers.

[noyesno, MSN, APRN, NP]

90-100+ year old hip fractures.

Weren't walking well before and now their families expect miracles.

[anotherone, BSN, RN]

so many. new paraplegics, trachs, anything very devastating for the previously healthy are difficult emotionaly for obvious reasons. drug seekers can be your worst pt or your easiest patient depending on if the drugs are ordered or not, same with the fakers - some are fine as long as the tests and drugs keep comming. Pts with pain that is not addressed, unpleasently confused dementia pts and their families.

[Mandychelle79, ASN, RN]

I would take a borderline personality or psychotic patient over a drug addict ( who is just going through the motions to make us believe and d/c them) any day.

Also have issues with dementia patients who are not going to ever get back to their baseline and their families think they can.

[blondy2061h, MSN, RN]

20-30 year old males with acute leukemia. I know I'm generalizing here, but they NEVER do well, and often because of their own faults. They always die, and from preventable things. I don't see this same trend with the females, but the males seem to think they're invincible. They die after months of us trying to do everything to keep them healthy. They miss outpatient visits, they don't take their drugs once they leave, they don't care for their central lines, they don't do oral care inpatient, they sneak in food that's not allowed on a low microbial diet, they have 7 visitors over, one that's hacking up a lung, they go skateboarding with no helmet and platelets of 17. They're funny, they're youthful, they're the same age as me. I like them, I route for them, I invest in them, and then they die because they didn't come in when their fever was 102 that morning, they waited 12 hours until their fever was 106, they were rigoring, and had a BP of 40/20. Soooo frustrating. And they usually like their dilaudid, too.

[anotherone, BSN, RN]

cystic fibrosis is another sad one.

[OnlybyHisgraceRN, ASN, RN]

Walkie talkies- from the icu nurse. ( no I'm just kidding, no I'm not, yeah I am.)

[Gold_SJ]

I don't know if this qualifies.

But for me the biggest struggle would have to be those occasional family members that are dead set their child has some 'mystery' illness and demand every intervention and test under the sun (Often failure to thrives, skin conditions, constipations). Putting the kids through pain, misery and multiple situations that half institutionalise them or make them think there's something terribly wrong with them.

They go from Dr to Dr, demand to be readmitted again and again, put in multiple complaints, or claim all these things happened when I witnessed myself it not to be true. Example: Claiming child vomited all their bottle, isn't doing this or that (development). Yet I saw they didn't vomit it, they are doing those things.

It makes me so frustrated and sad I'm stuck thinking about it at home and you actually don't look forward to caring for them. Although the child is generally lovely enough, the family member is like this toxic shark chasing down this condition/test/Dr/plan change etc.

Don't know if anyone can relate but maybe some paed nurses have ran into the same thing.

(I know mystery illnesses/rare conditions happen. These cases though it's very very much in doubt/or Dr truly believes there is no such diagnosis)

[Vinniesguy]

When I did emergency psych it was serial self-harmers.

It's not because they annoyed me like they do other nurses but you do your best for them and when they turn up in ED a few days later with a brand new almost-to-the-bone lac you feel like a failure.

You can stitch them up, refer them to community psych, be the best you can be - but you know they'll be back again soon.

It's that totally helpless, sinking feeling you get when their name pops up on the board...

[RNJill]

1) Trached patients-I rarely get them, so I always feel rusty/"on edge" when I care for them. It probably doesn't help that my first two experiences with such patients involved the trachs being pulled out/falling out. Yikes!

2) Reaaalllly agitated/confused liver failure patients (who aren't on the transplant list yet-or worse, are never going to be)-Their families are usually so upset, tired, and/or angry (not that I blame them), I'm so worried that the patient is going to hurt themselves (especially when they don't have a sitter) and I often feel inadequate in what I (and the whole medical team) can truly do for them