Worked several times this past week and there isn't many times in my short career where a pt has frustrated me to the point where if we could smack the pt I would but let me tell ya, this one did!!!
30-something yr old drug abuser - VERY open about this and honest which is surprising - who got beat up by friends (nice friends huh?!) who dropped the pt at the hospital and left (again, nice friends huh!) where it turns out that there's a brain hemmorhage in the frontal and Rt temporal lobes - bad enough that it required surgical intervention which also necessitated removal of the frontal portion of his skull. It was NOT subsequently put back in once the swelling resolved and when pt came to us still had no skull protecting the frontal lobe. Pt had a nice temporal to temporal suture line that was well approximated and healing nicely. Because this pt had very little impulse control related to the brain injury, it meant that there was a security guard 24hrs/day.
When I got this pt they had taken away the pt's percocet order being that this pt crushed it and snorted it - STUPID nurse for not watching this pt since history was known! And therefore received injectable morphine. Being that pt is a known drug abuser - including narcotic abuse - it's no wonder that the morphine dose of 5mg did NOTHING for the pt's pain. When I got this pt they were VERY whiney and irritating and I TRIED my best to get some semblance of pain control but even getting the dose tripled the pt still complained that I did nothing to help with their pain and that I sucked.
This pt was also a clock watcher which can be VERY frustrating and constantly badgered me throughout my shift. Well rules are rules, I'm not about to bend them because your pain control sucks. I called the doc, they choose what med to give you and how MUCH to give you, so BACK OFF!!!
Even while charting this pt would sit in front of me and bug me - and when the pt started to pick at the incision I had had enough and told him/her in no uncertain terms NOT TO PICK IT!!! That it would get infected and since no bone = no brain protection = brain infection = NOT GOOD!!!!!!!!! Ya this didn't seem to sink in and several hours later the security guard came to me and told me that the pt had picked at the incision again and now it was bleeding - UGHHHHHHHHHHHHHHHHHHHHH!!!!!!!! When I went in the room I seriously wanted to smack this pt having told this one not to do this exact thing several hours previously. Thankfully it was close to shift change and I was able to hand this one over to the next nurse to have to deal with!
The next shift I had this pt I came on shift and made it known that if the pt asked for the pain med more than one time that for every request I was delaying administration by ONE hour - ya, I didn't get pestered so yay for me!
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