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!
Showing posts with label drug abuser. Show all posts
Showing posts with label drug abuser. Show all posts
Tuesday, May 14, 2013
Sunday, November 6, 2011
Hospital addiction syndrome - who would have thought!!!!
At work we've had the "pleasure" of taking care of a particular lady.... I'll try to paint you a picture....
Age - over 18 - so an adult
Diagnosis - Sepsis secondary to abdominal absesses & NARCOTIC ABUSE
Additional information - VRE positive and thus in isolation
Now note that our unit is NEUROLOGY... not Gen. Med! But we had an open iso room and thus this patient became "ours"..... shitty luck for us!!!!
This patient became the BANE of our existance!!! He was DEMANDING and insistive.... to the point that he would have a BM on a commode (which he is COMPLETELY capable of going onto a toilet - but refuses to) and expect us nurses to empty it!!!!
Also, EVERY TWO HOURS, ON THE HOUR would this patient ring his damn bell and expect us nurses to come running with his PRN narcotic med. And then indicate that we're causing him physical AND emotional pain when we get busy (or just ignore him) when we don't have his narcotic available.
What would rightly irritate me would be when this patient would complain to me that we were causing him anguish and that "no one knows how it feels to break a bone and have pain from it".... UMMM YES I DO!!!! When I was 23 I was in a 4 wheeler (ATV) accident and had soft tissue damage and a hairline fracture of my femur.... to be in the hospital for 3 days for IV pain relief.... so YES I know how you feel!!! But I assure you, I wasn't on the buzzer paging my nurses when I was due for my pain reliever and then questioning whether they're giving me the "FULL" maximum amount - HELLO NARCOTIC ABUSER!!!!!!
Now, this is the type of patient that no matter WHAT you do for him, he is going to complain, complain and complain some more.... which causes nursing burn out..... ever heard of such a thing?! Yep, sure have... in literature, not in real life and boy was he creating it for MANY a nurses on my unit! So much so that the UNIT AS A WHOLE indicated that whoever was doing the schedule would only allow nurses to have this patient for ONE shift a week - unless they wanted him (there was ONE nurse who could stand this patient) - because anything more would cause one to think about quitting or switching units, or just calling in sick.
And an interesting thing started to happen.... based on our documentation, the doctors and administration started taking notice. And I kid you not, one of the doctor's orders is as follows:
If patient does not take prescribed antibiotic, he does not get ANY narcotic medication until he does &
If patient pulls out PICC line, he is to be immediately discharged from hospital.
OMG did this order MAKE OUR DAYS!!!! No more could he try to manipulate us nurses with his crap! We held the upper hand.
More information also started to come to head as administration got involved.... obviously we knew that this person was a narcotic abuser, but he's also a hospital hopper (we figured as much) but from the hospital that he was at last, we found out that he was diagnosed with: HOSPITAL ADDICTION SYNDROME!!!!!!
Boy did THAT one explain a few things!!! Now for those who have never heard of such a thing (I never had), it's along the same line as munchausen syndrome - which I googled and found out that it's sort of like hypochondria - the difference between the two....
munchausen syndrome people KNOW they are lying about the condition that they "say" they have..... whereas
hypochondria people BELIEVE that they actually HAVE the condition
The possibility is that this patient probably created the absesess by injecting narcotics into his abdomen to create this so that he could be admitted to a hospital and have people wait on their every need and demand!!!!! So guess what our doctors and administrators did?! GET him discharged.... now that he was MEDICALLY stable and could be managed as an outpatient, there was no reason to be in the hospital anymore.
The day that he was discharged was of course the day it was my "turn" to have him again..... I could have called in sick (seriously) then found out that he had JUST been discharged.... what a freeing feeling!!!!!!!! I could have had a party!!!!!!!!!
Age - over 18 - so an adult
Diagnosis - Sepsis secondary to abdominal absesses & NARCOTIC ABUSE
Additional information - VRE positive and thus in isolation
Now note that our unit is NEUROLOGY... not Gen. Med! But we had an open iso room and thus this patient became "ours"..... shitty luck for us!!!!
This patient became the BANE of our existance!!! He was DEMANDING and insistive.... to the point that he would have a BM on a commode (which he is COMPLETELY capable of going onto a toilet - but refuses to) and expect us nurses to empty it!!!!
Also, EVERY TWO HOURS, ON THE HOUR would this patient ring his damn bell and expect us nurses to come running with his PRN narcotic med. And then indicate that we're causing him physical AND emotional pain when we get busy (or just ignore him) when we don't have his narcotic available.
What would rightly irritate me would be when this patient would complain to me that we were causing him anguish and that "no one knows how it feels to break a bone and have pain from it".... UMMM YES I DO!!!! When I was 23 I was in a 4 wheeler (ATV) accident and had soft tissue damage and a hairline fracture of my femur.... to be in the hospital for 3 days for IV pain relief.... so YES I know how you feel!!! But I assure you, I wasn't on the buzzer paging my nurses when I was due for my pain reliever and then questioning whether they're giving me the "FULL" maximum amount - HELLO NARCOTIC ABUSER!!!!!!
Now, this is the type of patient that no matter WHAT you do for him, he is going to complain, complain and complain some more.... which causes nursing burn out..... ever heard of such a thing?! Yep, sure have... in literature, not in real life and boy was he creating it for MANY a nurses on my unit! So much so that the UNIT AS A WHOLE indicated that whoever was doing the schedule would only allow nurses to have this patient for ONE shift a week - unless they wanted him (there was ONE nurse who could stand this patient) - because anything more would cause one to think about quitting or switching units, or just calling in sick.
And an interesting thing started to happen.... based on our documentation, the doctors and administration started taking notice. And I kid you not, one of the doctor's orders is as follows:
If patient does not take prescribed antibiotic, he does not get ANY narcotic medication until he does &
If patient pulls out PICC line, he is to be immediately discharged from hospital.
OMG did this order MAKE OUR DAYS!!!! No more could he try to manipulate us nurses with his crap! We held the upper hand.
More information also started to come to head as administration got involved.... obviously we knew that this person was a narcotic abuser, but he's also a hospital hopper (we figured as much) but from the hospital that he was at last, we found out that he was diagnosed with: HOSPITAL ADDICTION SYNDROME!!!!!!
Boy did THAT one explain a few things!!! Now for those who have never heard of such a thing (I never had), it's along the same line as munchausen syndrome - which I googled and found out that it's sort of like hypochondria - the difference between the two....
munchausen syndrome people KNOW they are lying about the condition that they "say" they have..... whereas
hypochondria people BELIEVE that they actually HAVE the condition
The possibility is that this patient probably created the absesess by injecting narcotics into his abdomen to create this so that he could be admitted to a hospital and have people wait on their every need and demand!!!!! So guess what our doctors and administrators did?! GET him discharged.... now that he was MEDICALLY stable and could be managed as an outpatient, there was no reason to be in the hospital anymore.
The day that he was discharged was of course the day it was my "turn" to have him again..... I could have called in sick (seriously) then found out that he had JUST been discharged.... what a freeing feeling!!!!!!!! I could have had a party!!!!!!!!!
Subscribe to:
Posts (Atom)