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!
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....
Ah, yes, the "disability" ruse. Being a drug addict or alcoholic, or morbidly obese, makes adults a shoo-in for SSI, and it doesn't hurt to coach your kids to act up in school so they can get it for ADD/ADHD - assuming they weren't already diagnosed with it before their first or second birthday.
Meanwhile, people who really DO have disabilities must struggle to get what they deserve.
Specializes in CVICU, Burns, Trauma, BMT, Infection control.
I agree about not being a detox nurse and when I was working in Burns we gave known drug abusers large amounts of opiods to keep them from withdrawing and to provide analgesia.Although most people who are already on high dose opiates for pain relief have trouble getting adequate analgesia at all because they're so tolerant.But working on a busy floor with sicker pts. having to watch the "floor show" that the seekers always have to put on is a bit over the top. I almost want to say"tell me when you're done,I have things to do".
My sister was labeled a drug seeker. She was at the ER several times a month for intractable headaches. CTs were negative, MRIs were negative, so the ER nurses decided that she was a drug seeker, and started treating her like human garbage. So she started trying other hospital ERs, hoping to be treated like a human being again. But now, of course, she was a traveling drug seeker, and was treated even more like scum by the know-it-all ER nurses who can spot a drug seeker a mile away.
Finally, she was found to have Lyme disease that had gone undiagnosed for several years, and was causing neurological complications. I wanted to make copies of that diagnosis, find every nurse that had decided my sister was a drug seeker, shove it up their *sses, and slap them until their ears bled.
Specializes in vascular, med surg, home health , rehab,.
You know what? We aren't psychics. We all start out fully believing our pts are telling us if not the complete truth, at least partially. When you go round after round with pts that are in the midst of ******** out the kitchen for an extra cheeseburger and you go in after they are calling the station hollering for phernagan for nausea....please. Truth is there are a lot of people who take advantage of the system and the current trend to just give out narcs to whoever wants them based on what they want. Red flags: "I'm allergic to morphine, dilaudid, methadone....etc, etc....demerol works". Clock watching. A normal or low bp and hr on someone stating level 10 pain and yapping on their cellphones or walking out to smoke. The manipulative behaviour, "your the only good nurse here, just leave the oxycontin here I'll take it in a minute". (pt who we actually found outside selling his meds, then theatening to report the new grad who fell for it for leaving them with him). The PCA's dont work on me....huh? "Don't dilute it, give it fast or it won't work and all the other nurses do it". Sorry, not very politically correct I know. I find it easier just to schedule my day around the meds, the docs won't deal with it and I have other things to take care of , like other pts with real issues, to argue. Are we ever wrong? Yes, of course as you just stated, it happens. But bear in mind, we are on guard because we deal with this increasingly more and more. We gone the extra mile to take care of someone who, when cut off their meds, find the strength the hop on up and out of bed and go AMA. They don't want to do anything that might actually solve their problems. I have no answer to this problem. Better to give narcs to 100 drug seekers endlessly than to miss one legitimate person in real, undiagnosed pain? Problem is lately, have seen several people OD and die, addicted to meds they had legal scripts for and no challenge to their addiction. Young people. Who are the families mad at now? The prescribers, the doctors, the nurses.
Specializes in med-surg, psych, ER, school nurse-CRNP.
My sister was labeled a drug seeker. She was at the ER several times a month for intractable headaches. CTs were negative, MRIs were negative, so the ER nurses decided that she was a drug seeker, and started treating her like human garbage. So she started trying other hospital ERs, hoping to be treated like a human being again. But now, of course, she was a traveling drug seeker, and was treated even more like scum by the know-it-all ER nurses who can spot a drug seeker a mile away.
Finally, she was found to have Lyme disease that had gone undiagnosed for several years, and was causing neurological complications. I wanted to make copies of that diagnosis, find every nurse that had decided my sister was a drug seeker, shove it up their *sses, and slap them until their ears bled.
Not discounting your sister's pain, but did she seek treatment at a primary or specialty practice, in addition to the ER? I'm sorry, but if she did not, only coming to the ER, with no clear clinical findings, and no follow up, would make any medical professional suspicious.
I hope she is better. I am not saying I condone how she was treated, but had it not been your sister, try and see it from the other side of the gurney. C/O pain, no clinical findings, ER shopping, see what I mean? Yes, she has a valid reason. No, the nurses did not automatically know that.
Hope she had no lasting effects. Lyme dx can be a nasty bugger.
I feel for you, those pts with all this pain on a scale of ten but it doesn't affect their ability to socialize with staff and other pts-and the frequent smoke breaks, diluadid and benydryl are the worst, I always cringe when I see the orders for those frequent flyer folks, I told one doc I feel like I'm working in a B&B with drugs.
I agree about not being a detox nurse and when I was working in Burns we gave known drug abusers large amounts of opiods to keep them from withdrawing and to provide analgesia.Although most people who are already on high dose opiates for pain relief have trouble getting adequate analgesia at all because they're so tolerant.But working on a busy floor with sicker pts. having to watch the "floor show" that the seekers always have to put on is a bit over the top. I almost want to say"tell me when you're done,I have things to do".
My God.........jumping jacks? Good show!
I once had a customer who doused herself with lighter fluid and lit it to get drugs.
AngelfireRN, MSN, RN, APRN
2 Articles; 1,291 Posts
This is true.
You always say so well what I want to, but can't around the size 7 that usually resides in my oral cavity.