a patient who things she's in a hotel

Nurses General Nursing

Published

I just wanted to get your opinion on a patient that my floor often gets. The diagnosis is intractable abdominal pain, which she states is a 10 out of a 10 on the pain scale. She has been in and out of the hopsital several times so far, each visit lasting usually a week or more. Our hospital is the only one that will admit her. This patient is fully ambulatory, walks up and down the hallways without any trouble, smiles, giggles, laughs, passes notes to the nurses, talks on the phone, finds ways to criticize our policies. She leaves the floor and goes down to the entrance area and outside to smoke - at least every hour (for which a doctor has written an order). Without fail, she hunts down the nurse every hour for her dilaudid IVP (yes, dilaudid every hour!) for her "10 out of 10" pain. I'm not saying she isn't in pain, I just find it hard to believe. Apparently we are the only hospital that will admit her (she said she has tried all others). This patient is driving all of the nurses crazy!

Specializes in CDI Supervisor; Formerly NICU.

Remember, she may indeed have intractable pain. Being a asshat doesn't preclude her from deserving treatment.

Of course, she could just be a loser who wants the dope, too.

Specializes in med-surg, psych, ER, school nurse-CRNP.

Ooooh, Michigan, be very careful about saying you can't STAND drug seekers. I said that on here one time, and it got turned around that I said I HATED drug seekers. I got flamed so bad for that, I never thought it would stop.

That being said, the patient I was referring to was someone much like this on in demeanor, and having said it before, let me reiterate. I am right there with you. I can not STAND seekers. It's nice to know I have company.

And no, I am not saying that everyone is a seeker. It does sound like this one might have a tad of borderline thrown into the mix, possibly?

Specializes in ICU/Critical Care.

Flame me. I don't care. I realize that there are people who are actually in a lot of pain and those who are just there for the drugs.

Had one patient claiming to have chest pain and docs wanted to have a CT scan of the chest done to rule out pulmonary embolism. The patient was prepped with benadryl and steroids before the CT scan and then he refused to go.

He was admitted to another hospital just two days prior to being admitted to my hospital and the CT scan showed no pulmonary embolism. All his cardiac workup was negative. Labs were WNL. He would make remarks about how the docs didn't believe him and that his wife was a lawyer and "would I please push the dilaudid faster and give him benadryl afterwards"...

I've had other patients, cancer patients, who actually needed all the dilaudid they got.

Ooooh, Michigan, be very careful about saying you can't STAND drug seekers. I said that on here one time, and it got turned around that I said I HATED drug seekers. I got flamed so bad for that, I never thought it would stop.

That being said, the patient I was referring to was someone much like this on in demeanor, and having said it before, let me reiterate. I am right there with you. I can not STAND seekers. It's nice to know I have company.

And no, I am not saying that everyone is a seeker. It does sound like this one might have a tad of borderline thrown into the mix, possibly?

when you really think about it, it's not 'drug seekers' per se, that we struggle with.

it's the lying, manipulative, deceptive behaviors that accompany the dx.

and who the hell wouldn't resent that?

leslie

Specializes in ICU/Critical Care.

Thank you Leslie. I totally agree with you. It didn't take me long to learn whether or not a patient was B.S.ing me.

Specializes in ICU, M/S,Nurse Supervisor, CNS.

I had one of those types this weekend. Admitted for...well to avoid violating HIPAA, I'm not going to list the exact diagnosis, but it was not something that would cause physical pain. However, the man suddenly, right after being admitted of course, had continuous 10/10 abd pain requiring Morphine IV q4h around the clock, followed by his antiemetic. He was a clock watcher and called about five minutes before the med was due to ask for it. He was a very nice man, but obviously very manipulative. Finally, when his doc came, she d/c'd the iv analgesics and antiemetics. I actually fell for his sob story at the beginning of the shift, but as time went on, I could see what he was up to, plus he'd been admitted for this same issue several times in the past. He was an easy patient to care for, but the problem was my other patient was circling the drain and required a LOT of attention and care that day. It just made me mad to have to leave my very critically ill patient to give this man meds that he likely did not need. I'm not saying he wasn't in pain, but I honestly did doubt it along with the nausea as he kept eating ice and drinking water with no problems.

Specializes in med-surg.

We had one guy that set his watch alarm to wake him up when his meds were due. :banghead:

Specializes in Case Management, Home Health, UM.
We had one guy that set his watch alarm to wake him up when his meds were due. :banghead:

Yep. I had a patient like that once many moons ago, when I was working the night shift as an Aide. When I reported my observation to one of the nurses, she proceeded to make my life a living hell until I quit, went to school and learned that I was right...and she was wrong.

I also had a patient several years later who received Dilaudid q 2 h for "abdominal pain". That individual wound up in drug rehab and the physician wound up having his/her license suspended.

See if you can switch it over to Dilaudid IM.

See if you can switch it over to Dilaudid IM.

perhaps mixed w/a dab of phenergan?

can't have her getting nauseous...

leslie:saint:

Specializes in ICU, Telemetry.

We have a pt comes in, usually last week of the month, positive for everything on the tox screen -- and of course, he's 10/10 for abd. pain all the time -- he's been PET'd, CAT'd, MRA'd, MRI'd and scoped dozens of times and there's NOTHING WRONG WITH HIM. We call his doc "Doctor Pusher" because we're running a pool on how long he lasts before the FDA yanks his license....

Anyway, last time I had the pt, the guy across the hall was dying, and that's the pt who needed my help, not Mr. Pain in the Belly. So, I tell him that his BP's too low to give him any more morphine just now, and I can't legally give him any more. I go back across the hall.

The US calls saying Mr. Pain in the Belly's heart is going crazy. I go tearing in there, thinking the coke has finally killed him, and...

wait for it...

he's doing jumping jacks to get his heart rate up enough to get his pain meds.

he's doing jumping jacks to get his heart rate up enough to get his pain meds.

grrrrr...

did he get his med?

leslie

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