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????)
Vit. H 5mg, IM, Stat. I also probably would have asked for something IV for the pain, either MS04 or Toradol perhaps. Then said, THIS IS THE STRONGEST thing they make for pain, it should work within 10 minutes...
I agree, toradol turns pain off like a light switch, without turning the patient off. Very good med if the kidneys can stand it, and most can stand one dose.
Side note: I feel your pain r/t the screaming. We had a little ole demented hip postop once who didn't know who, where, or what she was, or why she hurt so much, etc. She screamed for a week and had two heart attacks due to screaming alone. She was medicated as much as possible without compromising her LIFE and it didn't help. I don't know how we lived through it, I don't think we were quite the same afterwards. I really hate it that they have to do ortho surgeries on people who never know what hit 'em.
This sounds like a patient with a personality disorder who will try to suck dry 110% of the resources around them.
A few weeks ago in clinical, my assigned nurse told me she was giving me her personality disorder patient who would not quit screaming. What an adventure. It was a smart move to give this type of patient to a student, though. It freed up the RN for other patients' care.
I think the personality disorder patients will take a mile if you give them an inch. What can you do, with press-gainey and all? It's sad because catering to them only makes the behavior worse.
Specializes in School Nursing, Pedi., Critical Care.
Oh my! I can so relate. Unfortunately you have to put those patients in their place right off the bat because they will drain you dry. Hello geodon or haldol :) or you will NEVER see your other patients:bugeyes:
A little off subject but your post had me thinking about a similar patient/situation i had the other night.
On a good day i consider myself a little burnt-out. On a bad day i have near zero tolerance for screamers and crazies and wanderers and restraint-requiring sillies (a flaw in my nursing persona that i'm well aware of).
At any rate, i came to work in a bad mood (runnning late, etc.) and sat down to report...with a lady screaming in the background "...help me God! Oh...help me Jesus!...etc." So...of course i find out the screamer is mine (my headache and temple-throbbing-pulse immediately gets worse...) She had been doing this all night (according to the nurse)...though i didnt say anything (unlike the nurse who took your report)...but again...my headache escalates and my temples are pounding. Patient was a tranfer out of ICU and waiting for a bed, 'mildly' demented, and stable.
"help me God!,...help me Jesus!.." still in the background...
So, first thing i do (after report) is check her meds and find the strongest narcotic/sedative/shut-her-up-the mostest drug, fill my syringe and walk red-faced into her room. (reporting nurse said nothing helped so i didnt expect my syringe-full of liquid sympathy would make a difference)...
Without saying much (again, burnt-out and frustrated...with a headache)
I push the med (meds) and flush them...again not saying much...just walked out.
On my way out, the lady says "...Oh..Thank you God!...Thank you Jesus!...you sent me an angel!" Fell alseep and napped with a semi-smile on her face for several hours.
So...although i was red-faced and headached and grumpy(displaying terrible nursing-abiliies)...the lady was comfortable, quiet, and calm.
What kind of heard-hearted, spiteful burn-out nurse are you anyway???!!! I can't believe that you could be so insensitive to someone who was obviously in emotional distress!!! You sound like the type of nurse who's in it just for the money and the job security, and doesn't understand that nursing is a PROFESSION and a CALLING!!!!! You just need to try harder next time to find a way to console your patients, and not be so UNCARING and JUDGMENTAL!!!!!!
(Actually, I don't believe a word of that, but since a thread like this invariably gets a post like that, I figured I'd fill the void.)
What kind of heard-hearted, spiteful burn-out nurse are you anyway???!!! I can't believe that you could be so insensitive to someone who was obviously in emotional distress!!! You sound like the type of nurse who's in it just for the money and the job security, and doesn't understand that nursing is a PROFESSION and a CALLING!!!!! You just need to try harder next time to find a way to console your patients, and not be so UNCARING and JUDGMENTAL!!!!!!
(Actually, I don't believe a word of that, but since a thread like this invariably gets a post like that, I figured I'd fill the void.)
Some patients respond completely opposite to consoling, I had one that became a monopolizer when you consoled her, if I was firm yet still kind that I had other patients to attend to as well as her then she would lay off the call light long enough for me to get in an assessment or two on the other 5 patients I had, there are some out there that think the world revolves around them and if they aren't the center of attention they will do anything and everything to monopolize your time which can throw you whole shift down the crapper rather quickly, not to mention unfairly take time away from other patients who are just as miserable and in need of help.
ShayRN
1,046 Posts
Vit. H 5mg, IM, Stat.
I also probably would have asked for something IV for the pain, either MS04 or Toradol perhaps. Then said, THIS IS THE STRONGEST thing they make for pain, it should work within 10 minutes...