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!
I have to agree with all the above. LOL, but I know of no way to get out of dealing with them. The eyes of the world are on us, and everytime some yells....Unfair Treatment... we are the bad guys. So you spend time with the drug seekers and the frequent flyers and the real pts. get slower care. How do we fix this?
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.
Did she seek treatment? Yes, she did. Primary care, specialists, neurologists, including one of the premier headache centers in our area. The ER visits were what she was told to do by her neurologist when the rescue meds that he gave her for breakout pain didn't work.
She wasn't wandering the halls looking for cheeseburgers. She was huddled in the exam room with a towel over her eyes (photophobia), earplugs in (loud noises made it worse), whimpering, trying desperately not to break into tears. Especially after being treated like dogsh*t by some burnout of an ER nurse who was sure she was drug seeking.
No, the nurses didn't automatically know that she had a reason. My point is, they decided that they knew what her reason was (drug seeking), because that was their catch-all reason for anyone claiming of pain that didn't have a reason they could point to on a CT scan.
My point is not that there are no drug seekers - of course there are. I'm a nurse, and we get them where I work too, and I'm not any happier about it than the rest of you. My point is that it isn't a nurse's job to punish drug seekers by treating them with contempt. And not even for the sake of the drug seekers - for the sake of the patients that you THINK are drug seekers, but you're wrong about.
We had one of our seeker frequent fliers come in last shift. She's going to get a SERIOUS surprise on discharge; seems she was in an MVA, and the cops (who came up and made sure we knew to call them if she was DC'd or tried to leave AMA) found enough drugs in her car to start a CVS. Not to mention her tox screen was positive for everything -- literally everything on the screen.
Wonder if she's going to get her q4h 25 mg demerol IV push in the county lockup?
This woman was discharged a couple nights ago (for like the 5th time since i've been there). This time the doctor wrote an order for a psychiatric evaluation. I have no idea what type of mental illness she may have, but I just get that "vibe" from her. Does anyone know what I'm talking about? I can't pinpoint or call it what it is, but I definitely think there is something there.
A while back she was my patient. She had just gotten back from one of her social smoking breaks and I walk in to do my assessment, and one of the things I always ask is "How are you feeling tonight?". Well, she went from a pleasant attitude to, "I"m in the ******* hospital, how do YOU think i'm feeling!?"..... I was like ooooooook, ms. psych!
p.s. i just realized that instead of THINKS i put THINGS in the title for this posting. my bad!
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
this woman was discharged a couple nights ago (for like the 5th time since i've been there). this time the doctor wrote an order for a psychiatric evaluation. i have no idea what type of mental illness she may have, but i just get that "vibe" from her. does anyone know what i'm talking about? i can't pinpoint or call it what it is, but i definitely think there is something there.
a while back she was my patient. she had just gotten back from one of her social smoking breaks and i walk in to do my assessment, and one of the things i always ask is "how are you feeling tonight?". well, she went from a pleasant attitude to, "i"m in the ******* hospital, how do you think i'm feeling!?"..... i was like ooooooook, ms. psych!
Many of the people labeled as seekers, are truly persons with psych issues that are simply self medicating. You can't really hold it against them. If I saw little blue men and no one believed me that I saw them, I might just pick up a crack pipe too...
Jumping jacks to get the heart rate up enough to get pain meds for abdominal pain???
That's about as close to proving you don't have pain as I've ever heard of. Abdominal pain, in particular.
Anybody ever seen a scrunched-up hot appendix, the PID shuffle, or ambulated a postop abdominal surgery? Jumping jacks indeed!
At least he got his exercise. I've had a ruptured ovarian cyst, and I found out then that a persons insides jiggle when they walk. That was painful, it hurt just to walk. No way I could jump up or run fast even if a cougar was chasing me. The pain was that bad.
this woman was discharged a couple nights ago (for like the 5th time since i've been there). this time the doctor wrote an order for a psychiatric evaluation. i have no idea what type of mental illness she may have, but i just get that "vibe" from her. does anyone know what i'm talking about? i can't pinpoint or call it what it is, but i definitely think there is something there.
a while back she was my patient. she had just gotten back from one of her social smoking breaks and i walk in to do my assessment, and one of the things i always ask is "how are you feeling tonight?". well, she went from a pleasant attitude to, "i"m in the ******* hospital, how do you think i'm feeling!?"..... i was like ooooooook, ms. psych!
softstorms
291 Posts
I have to agree with all the above. LOL, but I know of no way to get out of dealing with them. The eyes of the world are on us, and everytime some yells....Unfair Treatment... we are the bad guys. So you spend time with the drug seekers and the frequent flyers and the real pts. get slower care. How do we fix this?