Soooooooooo. I have this patient. We have all had this patient. You know, the patient that exacerbates all of his own problems.
This particular patient was on the floor for no other particular reason (at least none that I could figure out from digging through his chart) than he had a Potassium level of 5+ 2 days ago, and he was complaining of constipation.
The potassium level of 5+ had been resolved 2 days prior with a dose of Kayexalate. Kayexelate also makes the patient shit. A lot. So basically, the patient had been complaining about not having a bowel movement for um........36 hours? Hardly a medical emergency. . . . .Can I add to this that the patient was refusing every single thing that medical and nursing staff were trying to offer to alleviate this supposed discomfort? The docs wrote for stool softeners, the patient refused to take them. The docs wrote for enemas, the patient refused. The nurses tried to "encourage activity" the patient preferred to lay in bed, sleep, and occasionally (when the nurses entered the room and woke him) moan in pain and ask for narcotics. Which would hardly alleviate the supposed constipation. . . . .
Oh, and before I forget, when this patient was asked to remain NPO (nothing to eat or drink) for a test to see if he might have a bowel obstruction, he refused. . . .
What I said to the patient. . . . ."Mr. Smith, I just need to make you aware of the possible consequences of these actions. . . . ."
What would get me fired. .. ."You know, if you would just get your 400+ pound ass out of bed, walk around the unit a bit, take the meds we are giving you and do what we asked you to just once? You would probably feel a hell of a lot better. And no. The docs are not going to write for you to have oxycodone for your "severe stomach pain". Now could you please kwitcherbitchin and get the hell off my cardiac stepdown unit, where you got put cuz there were no other beds, and free up the space for someone who might actually be having a heart attack? Your potassium has been 4.1 for the past 2 days, you don't really need to be here."
But I can't say that.
It would bottom us out on the Press-Gainey surveys.
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1 comment:
Oh dear.
I've often questioned why we continually try to help and spend lots of (insurance) money on people who absolutely, steadfastedly refuse to help themselves, even in the smallest of ways, and, in fact, seem to go out of their way to make their own situation worse.
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