What is your least favorite kind of med-surg patient?

wannabemw · Nov 23, 2008

EtOH pts with End Stage Liver Disease...ugh, eww, the smell is awful! I felt so bad for my pt w/this, however he did it to himself!

ewilson3 · Nov 24, 2008

I am a new nurse and recently had this situation. I had a patient in for you guessed it "abdominal pain rule out pancreatitis," he also was an alcoholic and smoker but claimed he hasn't had a drink in two years. He was also on the patch. I work nights and was walking by the patients room and sure enough it smelled like smoke. (I had been warned if this happens to call security because he has been warned twice earlier in the day). I call security, they find cigarettes but no lighter in his belongings. Then they searched the bathroom and found another box of cigarettes and a little "device". He has been telling me i don't even have a lighter how could i be smoking. Well he was taking a piece of lead from a pencil and a kleenex and putting it in the outlet to create a spark to light his cigarettes. Needless to say I got my supervisor involved and the patient was discharged later that day. I tell ya, this is why i love/hate nursing. Always something new and interesting every day, but I prefer to not have to deal with this at 3 in the morning!

glimpses · Nov 24, 2008

my least favorite patient is probably the one with end-stage liver disease...frequent sticky lactulose messes with noncompliant patients or down clogging NG tubes, frequent loose stools, decreased LOC often with patients becoming noncompliant, worried and stressed relatives...

diane227, LPN, RN · Nov 30, 2008

I work on a med surg unit and my least favorite patients are the ones who also have borderline personality disorder. They are so demanding and hard to take care of.

BertinaRN, ASN, RN · Dec 2, 2008

Lately we have had an influx of drug seeking patients on the unit, most of them are frequent fliers, and seek pain medications. I even had one pt who told me straight to my face "I might as well feel great while I am here, and man these drugs are great". I felt as though I should some how inform the MD of the statement so I did, and we slowly weaned the pt off, the pt became enraged and really did become a HUGE problem, the total stay was 23 days by the time of discharge, three specialists, 1 psych MD and the pt was self pay, so you know who took the bill for that. Those are the pt's I have a hard time treating, because I have other Pt's who really are in pain, and the MD is afraid to prescribe anything worth taking, when they deal with the drug seekers everyday abusing the system, and the medications.Thankfully I only have 1 out of 6 like that at any given time. I have learned to research symptoms, diagnostics, and how they relate to pain. I use the faces scale more than the numbers with those types of patients to try and have an accurate rating for the MD, and I unfortunately sometimes have to discourage Md's from increasing doses based on the research, and prior pt history in the facility. That is the part I do not like, I was taught to never doubt a patient when they say they are in pain, but when I have a pt smiling and laughing while they state their pain is a 10, I just have to follow my instincts. :twocents:

NurseKatie08, MSN · Dec 8, 2008

My least favorite patients are the demanding know-it-all types that want to tell you exactly when they're supposed to get their meds, and exactly how their dressing is supposed to be changed--I'm talking a simple cellulitis dressing change--wash, dry, apply ointment, wrap it up...."That's not enough water....you're scrubbing too hard, now you're not scrubbing hard enough, that's not enough ointment, it's too loose, now it's too tight."

Nevermind that she was A&Ox3, independent with the treatment for the skin breakdown on her upper extremities, and probably could easily have washed the leg herself, but refused to try because "I don't need to know how to do this."

Also refused a CXR for a fever---"well, what is the CXR going to show?" I won't know until I have the results!!! :banghead:

Longie · Dec 9, 2008

I don't like taking care of the noncompliant patients. They come in the hospital and stay for an extended period of time not really committing to any treatment plan, or refusing cares. It stinks that they waste the staff's time, the taxpayer's money, and they occupy a room that could be used for someone who probably would be more appreciative of everything we do!

:yeahthat:Especially renal/dialysis patients who are noncompliant with their routine outpatient dialysis/meds/diet--they come in, get dialysis in the hospital, scream at the staff because they aren't being given all the no-no foods they've been consuming on the outside, blood pressure/blood sugar takes nosedive B/C MD Rxs increased/new meds thinking admission meds weren't working when in fact they simply weren't taken--stay a month or so, get things halfway under control enough to be discharged and guess who rolls back in several weeks to months later:angryfire

ARKYLE · Dec 9, 2008

Post-op hip replacements!

newrn05 · Jan 21, 2009

I absolutly hate drug seekers. I recently had a patient who refused to go home after having an ovary removed via a lap surgery. OMG that don't hurt that much. She was received dilaudid, phenergan and benadryl. Everyone knows that when a patient has these ordered every 4 hours and demands they get them together that it is to get high. The Doctor she is admitted under admits patients to our hospital but does not round on them. The Dcotro that rounds on them sees her and immediatly dc's all of her meds and puts her on lorcet 10's with 1 mg morphine for breakthrough. I speant 3 hours that night calming her down and stopping her from yelling screaming and swearing all night. Mind you I had 6 other very ill patients that could have used some one on one attention like that from their nurse but didn't cause I was too busy playing babysitter.

queenjean · Jan 21, 2009

My least favorite pts are pts with moderate to severe borderline personality issues, and ANYTHING ortho.

I'll take your drug seekers and your detoxing drunks anyday--for some reason I have no problem with these pts and even enjoy taking care of them. But the borderlines and anything ortho--ugh! With them I'm waaay out of my comfort zone.

Tweety, BSN, RN · Jan 22, 2009

I absolutly hate drug seekers. I recently had a patient who refused to go home after having an ovary removed via a lap surgery. OMG that don't hurt that much.

One must be careful. I remember a day nurse labeling a guy a whiney drug seeker after a lap chole because he complained of uncontrolled pain and she failed to assess the patient properly "everyone knows a lap chole doesn't hurt that much". Turned out he had a nicked bile duct....opps.

tsalagicara · Jan 22, 2009

Lately we have had an influx of drug seeking patients on the unit, most of them are frequent fliers, and seek pain medications. I even had one pt who told me straight to my face "I might as well feel great while I am here, and man these drugs are great". I felt as though I should some how inform the MD of the statement so I did, and we slowly weaned the pt off, the pt became enraged and really did become a HUGE problem, the total stay was 23 days by the time of discharge, three specialists, 1 psych MD and the pt was self pay, so you know who took the bill for that. Those are the pt's I have a hard time treating, because I have other Pt's who really are in pain, and the MD is afraid to prescribe anything worth taking, when they deal with the drug seekers everyday abusing the system, and the medications.Thankfully I only have 1 out of 6 like that at any given time. I have learned to research symptoms, diagnostics, and how they relate to pain. I use the faces scale more than the numbers with those types of patients to try and have an accurate rating for the MD, and I unfortunately sometimes have to discourage Md's from increasing doses based on the research, and prior pt history in the facility. That is the part I do not like, I was taught to never doubt a patient when they say they are in pain, but when I have a pt smiling and laughing while they state their pain is a 10, I just have to follow my instincts.

I want to say that I totally understand and feel your frustration, both from a health care provider's point of view and a patient's point of view. The true "drug seekers" make things very hard for patients that really are in a lot of pain. It's from the patient's point of view that I, respectfully, also want to tell you that not everyone screams, grimaces, cries or writhes around when he/she is in pain. Smiles and laughter do not necessarily equal less pain. Sometimes, humor provides a great distraction from the pain... and sometimes, it isn't culturally acceptable for the patient to outwardly show what he/she is feeling.