Patient rage

[Sassybottom]

Just needed to vent. I am a relatively new nurse and I have never felt such rage against a patient. I wanted to hit the patient on the head with a hammer. No hammers in the vicinity and I would never truly do something like this but I felt this rage inside that felt kind of awful. I was so incredibly annoyed.

Please ... has anyone else felt this way? What to do? I feel kind of bad that I had this terrible and violent rage. Ugh.

[flashgoddess]

Just needed to vent. I am a relatively new nurse and I have never felt such rage against a patient. I wanted to hit the patient on the head with a hammer. No hammers in the vicinity and I would never truly do something like this but I felt this rage inside that felt kind of awful. I was so incredibly annoyed.

Please ... has anyone else felt this way? What to do? I feel kind of bad that I had this terrible and violent rage. Ugh.

Learn to meditate. You will become more detached from the negativity coming your way.

[EmmaG, RN]

She has general muscle and joint aches. She has been in the hospital for a while and is supposed to be discharged in the next day or two. The only thing she has prescribed for pain is acetaminophen. She is diagnosed with renal failure and came to hospital because of cellulitis to her hand.

Diabetic?

In any case, neuropathy is common in those with RF.

Food for thought:

http://www.spineuniverse.com/displayarticle.php/article1614.html

http://www.painonline.org/acid.htm

The hallmarks of neuropathic pain are chronic allodynia and hyperalgesia. Allodynia is defined as pain resulting from a stimulus that ordinarily does not elicit a painful response (eg. light touch). Hyperalgesia is defined as an increased sensitivity to a normally painful stimuli.

Morphine and other opioids can exacerbate this type of pain, and renal patients would be at a higher risk due to accumulation of metabolites.

[leslie :-D]

plus an ativan can work wonders on those pts who are anxious about their pain.

leslie

[RNview]

i agree with the above posts. In our unit, we talk to our charge nurse about switching assignments the following day. I work in Medical Oncology. Sometimes we get a very nice patient but she almost needs a one on one care.. You know, never ending antibiotics, chemo to hang, total care, lots of prn meds, we almost cannot get out of her room. The nurse taking care of her gets too overwhelmed since she's not her only patient, it just gets into the nurses nerve after a while. So everyone agreed to switch nurses everyday only on that patient. That solved the problem. It took only ONE NURSE to suggest this idea, and there was no problem implementing it.

Some patients are just plainly a pain in the a**. Some just have low tolerance of pain. If someone gets into my nerve, I ask my charge nurse to take over for a while. Deep breathing helps me get through the day.

Your patient might be experiencing depression since she's still young with all these health problems she's experiencing, she could be crabby and hateful. Since she's a renal patient her narcotic intake should be limited. NO MORPHINE, since Morphine metabolites cannot be excreted even during the dialysis. In renal failure patients, try to use opiates not significantly excreted by the kidneys, e. g. fentanyl, hydromorphone, or oxycodone.

[Sassybottom]

Diabetic?

In any case, neuropathy is common in those with RF.

Food for thought:

http://www.spineuniverse.com/displayarticle.php/article1614.html

http://www.painonline.org/acid.htm

Morphine and other opioids can exacerbate this type of pain, and renal patients would be at a higher risk due to accumulation of metabolites.

I have had patients with Neuropathy and they are usually prescribed Neurontin for pain. I don't think she has Neuropathy because it would have been passed on in report or been listed in her history and physical if she did.

[EmmaG, RN]

I have had patients with Neuropathy and they are usually prescribed Neurontin for pain. I don't think she has Neuropathy because it would have been passed on in report or been listed in her history and physical if she did.

Maybe, maybe not. Just giving a possible explanation for her level of pain.

[Sassybottom]

Maybe, maybe not. Just giving a possible explanation for her level of pain.

Possibly. But I just think it would be weird that she would be hospitalized for that long (it was a little over a week I think) and rounded on by the physicians, cared for by all the nurses, and seen by all the other pt/ot staff during that period and not be diagnosed with neuropathy - especially with how vocal she is about her pain.

[withasmilelpn]

Maybe her doctor needs to be made aware? Find out how long she's been experiencing pain like this, what makes it worse, severity, etc. and let the doctor know, it could be undiagnosed or her history is incomplete. Perhaps she could use a referral to a pain clinic on discharge?

It sounds like you don't really believe her. You could be right and picking up on those unconscious signals of lying that our bodies somehow pick up when our brain might not be so sure. Or she could just be a drama queen needing attention. Either way, I think all the above posters had good advice, especially asking another nurse to share or takeover her care is good.

I have a patient right now that I can not stand, which is unusual for me. Luckily for me, she is mostly independent and ready for d/c, so I am in and out in a flash, but I did consider switching too! Good luck!

[babynurselsa, RN]

And sometimes you can meditate on giving your patient a little "pillow therapy"

THis will bring the smile back and then you can get on with your day.....

Now mid you i only said to meditate upon it

[MB37]

I have a question - why was the little old lady sobbing and grimacing? If she reported pain and was obviously telling the truth, why wasn't SHE being given pain meds? Maybe the docs at your facility are unwilling to prescribe narcs...