The one with the never-ending problems

[evilolive, BSN, RN]

I feel sort of bad, but not truly this morning. We have this resident at my facility who has a never-ending list of problems. He's been sent out to the ER more than a handful of times, and generally sent right back. To put it lightly, I'd rather have 15 of the most annoying little old ladies than this one man, and he's only in his 40's! (usually the younger ones are more tolerable).

He's known in the community as a chronic pill seeker. I don't know half the time if he is lying to me or not, I usually just give him his PRN meds when due and go along with my night. Sometimes he complains about "twitching," or intense jerking of the body, for which he has Valium PRN. Other times he complains about pain, for which he has MS Contin scheduled, and Demerol. More than a few episodes of nausea/vomiting/diarrhea have occurred, so he had a short-lived compazine order. He's had a foley cath in and then removed in the last two weeks, and has uncontrolled DM. Then tonight he started complaining about urinary retention to the 3-11 nurse. From what I understood, he said he hadn't voided since around 6pm. He's on a 2000ml/day fluid restriction currently, as well. So, I took the claim semi-seriously and when I began my shift at 11pm, I thought "okay, well it's only been 5 hours, think about when you sleep for a certain period of time for so long and don't need to pee, he should be okay." Every once in awhile he would c/o not being able to pee, and he'd ask me if I talked to the doctor yet about putting the catheter in. He'd then ask me for something for his ears, because his ears were so blocked up. And with the N/V/D, "don't you have a pill for that?"

The evening nurse had already called the covering to appease this man, to which the covering said "I don't feel comfortable giving that order after such a short period of time" - or something to that effect.

So, I let it ride through the night. Eventually this man dozed off and I could do my med pass for everyone else who wasn't getting the same amount of attention that he's been getting. So I'm counting off narcs with the day nurse, and I hear him saying her name, loudly. "I need that catheter STAT." Because he couldn't tolerate the two of us finishing count before the day nurse got the order to actually cath him, he went and immediately called his grandmother. No sooner than the nurse I was counting with get on the phone to reach the on-call, this man's grandmother called the other day nurse back. This nurse assured her that we were following up as they spoke and said that she would be in touch.

It's people like this that really are starting to bother me. He's friendly enough, but was even recently spoken to by our admin for overstepping boundaries with demented residents. He's just awkward, and there are just too many "problems" of his, that I can't handle him anymore.

So, I know the right thing to do was probably to call the on-call at 3am to get the order to straight cath and/or foley cath him, but it didn't seem like a pressing matter at the time. Just out of curiosity, have any of you had residents with urinary retention, and how long have you waited before calling the on-call MD to get the order to cath (who generally knows nothing about the other residents)?

Personally I think he's a closet perv who probably just wanted a hand on his junk, but that's just my opinion. I could be WAY off. I just don't want the **** to hit the fan today.

Sigh.

[morte, LPN, LVN]

this is where a bladder scanner would come in handy......prob get an order for "straight cath if no urine, in _____ amount of time" and i wouldnt tell the patient.......and if you really think he is seeking inappropriate touching get a guy to do......and a psych consult

[Whispera, MSN, RN]

I think he's lonely, and makes demands because it gets someone to come into the room.

[morte, LPN, LVN]

I think he's lonely, and makes demands because it gets someone to come into the room.

that may be, but they (the institution) may be looking at 20-30 years of this behavior....i think some interventions are in order, sooner than later

[texastaz]

[quote=evilolive;3625004

He's known in the community as a chronic pill seeker. I don't know half the time if he is lying to me or not, I usually just give him his PRN meds when due and go along with my night. Sometimes he complains about "twitching," or intense jerking of the body, for which he has Valium PRN.

He's on a 2000ml/day fluid restriction currently, as well.

Personally I think he's a closet perv who probably just wanted a hand on his junk, but that's just my opinion. I could be WAY off. I just don't want the **** to hit the fan today.

Sigh.

This fits the profile of a PT I use to care for. He was a young LTC psych patient, had been a addict, total care PT also had been a convicted violent sex offender. However - his goal was to get the fix. The facility had several other pervs and they would go straight for the perv fix without seeking additional medication. Just my experience & - but nothing amazes me anymore. Trust your intution and "Yes" and a scanner would be great. Good Luck!

[scg08rn]

Usually 8 hours without a void I call the doctor and explain the situation.

[epac104]

As a male, I would completely trust a female's intuition in this situation. And cath the patient for her. I don't doubt that some people are pervs. Or lonely.

[debRN0417]

What kinds of diversional activities are planned for this young person? Are things being done to keep him busy and his mind off his somatic issues? Sometimes that is the problem...too much time to think about what is wrong with me. Sometimes, though, there are poeple who are just like that and want/need/demand attention. I'm not saying this person is not ill and needs attention, but I can relate to what you're saying!

[Morning-glory]

You might also have a look at all those meds to see if there is anything that would cause the retention. This is a tough one and I have had my share of "looking for some fun" types. And a drug screen to see if he is getting any junk on his outside visits. Esctacy will cause retention at low doses and decrease the inhibitions. All kinds of other stuff can cause a problem. With a drug screen, you may get a better idea of what you are dealing with.

Good luck, and may something work for him soon.

[achot chavi]

no void in 8 hrs, I'd call the doc,

better yet ask the doc, you want to be notified after how many hours of no void...

even if he is a pain the u-know what, you are his nurse and have legal responsibilities, better be safe than sorry. If he is taking too much of your time and you cant set limits, get the SW involved, as your other pts deserve your attention as well.

[evilolive, BSN, RN]

Turns out the res. ended up going to the ER that morning after the day nurse unsuccessfully attempted to straight cath him - no return. He has the foley in again. Last I checked on him Sat. morning he had been running a temp., most likely an infection from the catheterizations.... we'll see what happens when I go back into work Tuesday night.