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????)
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.
:rotfl::rotfl::rotfl:
you slay me...
but just to throw it out there, maybe she was never left to cry it out.
maybe () she was coddled to the degree where she throws a scream-halting hissy fit when no one is at her beck and call.
hmmmm...(*rubs chin*)
op, i have no patience with histrionics.
sometimes i have resorted to, "ENOUGH!!!" followed by a softer voice, encouraging pt to let meds take effect:
So, first thing i do (after report) is check her meds and find the strongest narcotic/sedative/shut-her-up-the mostest drug,
Hahahaha! I have to remember this line (w/ all credit due, of course!).
Believe it or not, I find another very strong "bargaining" tool is FOOD! Well, maybe not 'bargaining' 'cause that sounds soooo unethical (boo-hoo), but more a mutual understanding...You quit screaming and I will get the food they prefer.
Usually, it is very simple things from the vending machine...and yes, I pay for it. A few bucks out of pocket is worth peace and quiet on my shift.
I find that most of the screamers are not really in a lot of pain, but seem to be more agitated from being bed-bound. If they do have pain, it is often from being in bed!
I remember getting frustrated with another nurse's patient one night for screaming and banging on the bedside table. She went out to smoke, I marched in and said - kinda notsonicely- "WHAT is wrong with you tonight?! What's the deal here?" The deal turned out to be chest pain and he was intubated within the hour for respiratory failure.
Fortunately I knew to investigate rather than ignore because he had been my patient before and it was out of character. I wonder how many people who are normally histrionic get into real trouble with the "crying wolf" syndrome.
leslie :-D
11,191 Posts
:rotfl::rotfl::rotfl:
you slay me...
but just to throw it out there, maybe she was never left to cry it out.
maybe (
) she was coddled to the degree where she throws a scream-halting hissy fit when no one is at her beck and call.
hmmmm...(*rubs chin*)
op, i have no patience with histrionics.
sometimes i have resorted to, "ENOUGH!!!" followed by a softer voice, encouraging pt to let meds take effect:
that stress is exacerbating mental state;
and s/he needs to deep breathe/meditate.
and that i will check on him/her in half hour.
usually, it's the shout-out that shuts 'em up.
and yes, you do have so much patience.
you're a better nurse than me.
leslie