Im having major issues right now with a patient that I do multiple 1:1's with. Heres the HX:
Pt came in almost comotose from being noncompliant with his DM. He also has a HX of multiple heavy recreational drug use to the extent where his liver is shot and his mind is that of a teen (hes about 27). He is constantly hungery and extreemly verbal about his "misgivings" that the Dr.'s give him (the restrictions on what he can and cannot eat). He has been here since 2/11 and will stay here untill a custody hearing can be arranged and he can be admitted into an assisted living facility.
The reason why he is a 1:1 is because he was constantly in the kitchens (we have 3 on the 65 bed unit) and is a flight risk.
The Dr.'s have made compromise after compromise with him and he still is noncompliant. One of theses such compromises is that he can have as many tomatoes as he pleases, well he took advantage of this and had about 10 bowls of tomatoes delivered to his room per day in addition to his regular meals. well now he is having rectal issues due to the acidity. He refuses to take showers and keep himself clean and he constantly smells of fecal material despite the sitz baths that he does take.
Many times he has tried to change his own diet and "trade" items on his tray. Of course I tell him he cannot do this showing him the long list of restrictions they have placed on his diet. Each time he curses me out and threatens to leave AMA.
There are also been times where I or another nurse has turned around to do something and he slips out of his room only to be found in the kitchen again.
Security has been called many times due to his actions.
As you can imagine this is a very difficult patient and this is a very small picture of what we have to deal with on a daily basis...
CAN SOMEONE PLEASE GIVE ME TIPS ON HOW TO DEAL WITH HIM AS I AM ALMOST CERTAIN THAT I WILL BE PUT WITH HIM AGAIN AND AGAIN UNTILL HE IS DISCHARGED?!?!?!
Cat, she's asking for advice on how to deal with this pt who slips off to the kitchen whe no one's looking, then says she's at the bedside for 12 hours. Doesn't much matter what her title is, is she at the bedside constantly or isn't she?
I try to be nice and constantly try to reinterate that we are only trying to help his situation.
Are his actions possibly a result of his loss of mental capacity due to the extensive drug use??
Don't try and be friends. Use limit setting and be firm. That will gain respect. He needs to see that you will follow through as well. Don't waver when you say something, do it.
There are also been times where I or another nurse has turned around to do something and he slips out of his room only to be found in the kitchen again.
!
Ok, I guess you can't turn your back on him then, right? He has proved what he will so don't do it. I know that for 12 hours it is very hard to sit with one person and stay in one place but it is for his health. He needs you to do this.
The bathing......unfortunately he has the right to refuse a bath.
wow! question (anyone can answer this): I understand that a patient has a right, but when does it get to a point where the patient is interfering in another patient's right not to smell him/her...I guess my question is: How long will hospital/ nursing home allow a patient to refuse to bathe, before something can be done? Is it days, weeks, months?
When I said turn your back for a second I literaly mean a second, We have computer charting and the way its set up you have to look down to see the screen.
The reason I have nurse in my name is because 1. I consider myself a nurse (I guess people do not consider us CNA's nurses, sorry for the confusion) plus 2. I will graduate soon from a nursing school.
our 1:1's are done by us Nurse Techs (CNA's) which is my position as of this moment until I get through school.
I might get into trouble for this, but really if he is his own man, let him sign out AMA, really hospitals are not prisons. If he's pinked you have a different situation but really you are not a guard, there is only so much you can do - Sometimes people make choices we dont agree with, and you have to let them do it
I'm assuming that he is legally unable to leave because there are court proceedings in the future and for a while they were going to bring in off duty cops to watch him.
The reason I have nurse in my name is because 1. I consider myself a nurse (I guess people do not consider us CNA's nurses, sorry for the confusion) plus 2. I will graduate soon from a nursing school.
I understand tehre might be court in his future, but if hes not pinked, or there is someone else in charge of his care - then he can sign out. I only say this becuse I have had a similar kind of thing, so long as you cover your self. When I have had patients say they are going AMA I just get the paper work calm as possibe - lots of times it helps them realize were just trying to help and that they are not stuck at the hospital. Good luck sounds like an really tough deal. One idea if you are stuck with the guy, can you "hide" the snacks he can have in the kitchen so if he "grabs" its the right thing? Or can you get somthign he can have and have it bedside so its less tempting to wander?
All I am asking is help with a problem patient who I am having problems with. I do not want to defend my name or title or whatever you want to argue about. Thank You to those who have offered their experience and wisdom.
If this continues to be too difficult a task to stay on subject I will ask a moderator to close this discussion.
All I am asking is help with a problem patient who I am having problems with. I do not want to defend my name or title or whatever you want to argue about. Thank You to those who have offered their experience and wisdom.
If this continues to be too difficult a task to stay on subject I will ask a moderator to close this discussion.
Thank You
Ducky the lowly non nurse CNA
Just a word of advice. Before posting to any forum, it's really a good thing to lurk for a while to get the flavor and see how things are done.
You would have done a LOT of reading that way and maybe avoided this. Also actually reading the terms of service is a good thing.
The mods here are great, if they feel a thread needs to be closed, they'll do it.
As nurses we're a bit sensitive about UAP calling themselves such. There's a thread about this here already, it got a little heated.
And we appreciate CNA's, We do! But they are not nurses.
:banghead: 
:nono: 
TazziRN, RN
6,487 Posts
Cat, she's asking for advice on how to deal with this pt who slips off to the kitchen whe no one's looking, then says she's at the bedside for 12 hours. Doesn't much matter what her title is, is she at the bedside constantly or isn't she?