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!
Curious, why the last week of the month? Is that sort of for a "free ride" before the monthly check comes in? I am not even a nursing student yet so I'm not sure what you mean.
No, he didn't get any pain med from me; when he started throwing a fit, I called the house doc -- not "Doctor Pusher" and he was told he could get thru the night on tylenol or leave AMA. He left AMA.
Vayacondia, what I've seen on a lot of my drug seekers is that they a) come in positive for lots of things, few of them legal, and b) they tend to be on "disability" for imagined ailments. They get a check the first of the month, and they are usually out of drug money by about the 20th -- we actually sit at the nurses's station saying, "Yup it's about time X, Y and/or Z shows up..." And sure enough, between the 20th and the end of the month, they do....
Seeker or not, I just give the drugs. I figure at least they are getting clean drugs in a controlled and safe situation. I am not there to detox them, I am there to do my job as a nurse and keep them pain free and get them the heck out of the unit and back in the crack house (joking here guys ). I try very hard not to make judgment calls on people because very often we nurses label persons with chronic pain as "seekers". God, had a pt. on a ketamine drip at 20, a dilaudid PCA, getting 10 of valium round the clock, roxy round the clock, 50 of methadone qid, and ativan prn. People keep reffering to pt as a seeker (I call the pt superman! How s/he maintains resp. drive I will never know. lol) because the pt screams out in pain on all of these meds. It is craziness, but pt has a longterm chronic condition that has gotten to this point. I can not imagine being so dependant on medication, and I just try to focus on the fact that my job is to relieve suffering (although I work in the ICU... so I usually end up prolonging it) and not to impress my morals or judgments on my pt. in their delivery of care. I try to treat my heroin addict with the same level of compassion as my cute little grandma in the room next door.
You're too nice...If it was me I would say "Wow, your pain must be better because you look happy and you are smiling and laughing"...I can't STAND drug-seekers. And about coming late with their meds, when they start that "You were suppose to bring it five minutes ago", I say "Well, not everything can be on time. This is a hospital and I have other patients besides you". I'm not going to interrupt my care of another patient just to get a drug seeker their pain meds on time.
I love reading your posts because between you and Leslie, ya'll are outspoken and I love it.....
Curious, why the last week of the month? Is that sort of for a "free ride" before the monthly check comes in? I am not even a nursing student yet so I'm not sure what you mean.
percisely,....have done detox nursing.....and this would be the high census time, especially in cold weather......the old "three hots and a cot"
I hate dealing with drug seekers, especially the manipulation that comes with it. Working Telemetry we get the chest pain group who come in positive for coke and marij. Refuse to be npo for a stress test and refuse lab to stick them for enzymes. They just dont want to be found out. The saddest part is that the docs (especially hospitalists) just please the pt and reinforce their behavior. They dont have to put up with it and if they can order dilaudid q1 hour to keep them off their backs then who cares, because they dont have to stay and deal with it. Lately when I have a problem with one of the seekers, I get on the phone with the doc about it. Even if its nothing Im requesting, I just let them know what Im dealing with. (even at 3am) I feel that if I have to sit here and put up with this SH*T then so will you. Sometimes it helps to keep the doc from dragging their heels on the d/c paperwork.
I love reading your posts because between you and Leslie, ya'll are outspoken and I love it.....
Thanks. I don't want to offend anyone. I just believe in being honest and sometimes people misconstrue it as being "mean" or "witchy". Plus, I just don't care what people think of me. I know who I am. I know I'm a good person. I believe in me. I know I can be a little outrageous but that's just my personality.
I don't mean to sound like I'm being judgmental and I agree, detox is not our job on the floor. But if you have to set an alarm to wake you up for your pain meds, then you might not need that dose for awhile.
I don't mean to sound like I'm being judgmental and I agree, detox is not our job on the floor. But if you have to set an alarm to wake you up for your pain meds, then you might not need that dose for awhile.
that is what i thought, when, many moons ago that happened where i was working,.....however with exp. comes knowledge.....i imagine at least some of those persons where true chronic pain patients, and sustained release meds hadnt come on the market yet...
I do have to agree about the detox issue. I'm not a detox nurse and I'm not there to detox the patient. Sorry but just detox alone does not cure someone with an addiction. They need psychological therapy also. I had to explain this to a patient's wife whose husband was an alcoholic. Yeah, detoxing the body of all those chemicals helps but it doesn't cure the mind of the need for them.
). I try very hard not to make judgment calls on people because very often we nurses label persons with chronic pain as "seekers". God, had a pt. on a ketamine drip at 20, a dilaudid PCA, getting 10 of valium round the clock, roxy round the clock, 50 of methadone qid, and ativan prn. People keep reffering to pt as a seeker (I call the pt superman! How s/he maintains resp. drive I will never know. lol) because the pt screams out in pain on all of these meds. It is craziness, but pt has a longterm chronic condition that has gotten to this point. I can not imagine being so dependant on medication, and I just try to focus on the fact that my job is to relieve suffering (although I work in the ICU... so I usually end up prolonging it) and not to impress my morals or judgments on my pt. in their delivery of care. I try to treat my heroin addict with the same level of compassion as my cute little grandma in the room next door.
Dolce, RN
861 Posts