The patient who wouldn't stop screaming...

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So I had a patient last night, chest pain r/o MI with a history of fibromyalgia, depression, and anxiety. No known history of memory loss or dementia- normally independent at home.

She would NOT stop crying. Literally. I'm taking report and she's screaming- I assess her and she's c/o "I just don't feel good" Forty questions later we determine that she has 8/10 leg pain, which is a chronic problem for her. Her vicodin is ordered 1 tab TID (scheduled) and was given at 2000. It's now 0000. So I call and get the ordered changed to 1-2 q4-6h prn, and give her two. I also give her (scheduled BID) Klonopin 0.5mg. No sooner than she swallows the pills she's screaming "oh my god, help me, my legs hurt" etc, etc, etc. I very nicely tell her I know she's in pain, that the med will take about 30 minutes to take effect, and ask what else I can do to help in the meantime. "Nothing" Half hour later I ask if the pain is improved, and she states it is, but starts crying about: SOB (LSC, 98% RA, but she's hyperventilating, and we give her O2@2L as ordered), "I want my socks off"- okay, well you were capable of putting them on, so take them off, I'm too hot, I'm too cold, I'm hungry, I'm thirsty, and my personal favorite "Oh GOD, Oh GOD I just can't stand it, HELP me OH WHY OH WHY do I have to suffer this way"- a statement made not because of pain, or shortness of breath, but get this- lady partsL ITCH!! We are not talking about an alzheimer's pt- this is an alert, oriented, normally independent 60- something year old. ARE YOU KIDDING ME? I end up calling the doctor more than once, giving extra klonopin, etc, but nothing I do can console the woman. Yes, I lost my patience. Yes, I completely lost all empathy when the woman screamed like a banshee over the blood pressure cuff, repeatedly took off her O2 and c/o shortness of breath, etc. But I tried EVERYTHING I knew to help her, and spent over 4 hours trying to calm her down (breathing exercises, visualization, pain meds, anxiety meds, hand holding, ice packs, warm packs, positioning, etc) only to hear the next shift judgementaly say "You mean to tell me she's been like this all night????)

I give up

They don't pay me enough.

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Specializes in orthopaedics.

Some patients you can't make happy no matter what. It sounds like a good psych consult is in order. Sorry about your night. I hope your next one is better.

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Specializes in ED, ICU, Heme/Onc.

She'll probably sleep all day too. Please tell me that you documented each and every visit into the patient's room??? Pretty please??

I am so sorry that you had such a rough night.

Blee

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Please tell me that you documented each and every visit into the patient's room??? Pretty please??

I am so sorry that you had such a rough night.

Blee

I don't think that would have been possible- I barely LEFT the room (did I mention it was an ER holding area with 3 other patients IN THERE, dealing with this?) Luckily, one slept through it and the other two were too demented to understand (but were agitated by it, for sure)

I did, however, write at least 15 notes- assessments, interventions (both offered and refused), calls to the MD, AND her stated relief from pain medications. And yes, the doc was very aware of her psychological state.

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Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.

I"m with the others on a psych consult and maybe a little "vitamin A or G" via IV/IM :rolleyes:

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Specializes in Med/Surg.
So I had a patient last night, chest pain r/o MI with a history of fibromyalgia, depression, and anxiety. No known history of memory loss or dementia- normally independent at home.

She would NOT stop crying. Literally. I'm taking report and she's screaming- I assess her and she's c/o "I just don't feel good" Forty questions later we determine that she has 8/10 leg pain, which is a chronic problem for her. Her vicodin is ordered 1 tab TID (scheduled) and was given at 2000. It's now 0000. So I call and get the ordered changed to 1-2 q4-6h prn, and give her two. I also give her (scheduled BID) Klonopin 0.5mg. No sooner than she swallows the pills she's screaming "oh my god, help me, my legs hurt" etc, etc, etc. I very nicely tell her I know she's in pain, that the med will take about 30 minutes to take effect, and ask what else I can do to help in the meantime. "Nothing" Half hour later I ask if the pain is improved, and she states it is, but starts crying about: SOB (LSC, 98% RA, but she's hyperventilating, and we give her O2@2L as ordered), "I want my socks off"- okay, well you were capable of putting them on, so take them off, I'm too hot, I'm too cold, I'm hungry, I'm thirsty, and my personal favorite "Oh GOD, Oh GOD I just can't stand it, HELP me OH WHY OH WHY do I have to suffer this way"- a statement made not because of pain, or shortness of breath, but get this- lady partsL ITCH!! We are not talking about an alzheimer's pt- this is an alert, oriented, normally independent 60- something year old. ARE YOU KIDDING ME? I end up calling the doctor more than once, giving extra klonopin, etc, but nothing I do can console the woman. Yes, I lost my patience. Yes, I completely lost all empathy when the woman screamed like a banshee over the blood pressure cuff, repeatedly took off her O2 and c/o shortness of breath, etc. But I tried EVERYTHING I knew to help her, and spent over 4 hours trying to calm her down (breathing exercises, visualization, pain meds, anxiety meds, hand holding, ice packs, warm packs, positioning, etc) only to hear the next shift judgementaly say "You mean to tell me she's been like this all night????)

I give up

They don't pay me enough.

This woman sounds like she is one brick shy of a load. Sorry you had such a rough night.

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Specializes in school nursing, ortho, trauma.

You'd think that a patient like that will eventually tire themselves out.. but it never works out that way.

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I am so sorry that you had such a terrible night.You are indeed a great nurse because you followed through and did everything you could both physcially and emotionally.This is the type of patient that just sucks you dry.A psych consult is a good start.One has to wonder exactly how "independent" she is at home!!!

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Specializes in Acute Mental Health.

Well, I know I can hardly wait to actually finish ns and become an rn so I can work! :chuckle

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Specializes in ob/gyn med /surg.

sounds like the type of pt's i usually take care of ( they assign them to me ... lucky me ). you are a great nurse and have the patients of a saint. i send you hugs ,,,

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I doesn't sound terribly unusual, unfortunately. The woman obviously has some debilitating psychological problems.

My theory about these types is that they were victims of neglect as small infants, leaving permanent emotional voids in their psyches that are like the proverbial bottomless pit. She was probably left to cry it out for long periods as a small babe.

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Specializes in MICU, SICU, PACU, Travel nursing.

she sounds like she could have benefited from a little IV Ativan;)

maybe some benedryl too........

sorry your night stunk so bad

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