"I just can't help you..."

6 I have a resident at my SNF...rheumatoid arthritis with contractures of upper and lower extremeties. This man is sometimes confused, but mostly with it. Gets Norco, Oxycodone, Soma, Lyrica, Stadol, Voltaren Gel, Baclofen with no relief whatsoever. Screams constantly. All PRN meds are given exactly at the intervals (i'm there 6 hours to the dot.) He is friendly when we are in the room, then when other staff goes in he tells them how we never give him any meds, are such bad nurses, nobody cares about him etc. I frequently have the aides tell me he is complaining of chest pain and when I go in he wants to talk about his TV show. When I ask about the CP he denies ever saying it. I feel so guilty for saying this, but I am SICK and tired of hearing "OH GOD HELP HELP HELP" all day long. I am sick of being told I don't do anything for this man. I am so sick of other residents telling me to give him something. I already did! There's nothing else I can do! Turned, repositioned, offered a snack, one on one, everything...nothing works! MD knows...has ordered everything under the sun...she is just as frustrated as us...I'm so tired.
I can sympathize... I go through a similar situation. You're human hon.. we all get those feelings when pushed over the edge.

Could the interactions of SO many meds be causing behavioral symptoms? Has there been a psych consult? A pain management consult? Was he better before the addition of any of the meds? I see too much medication....too many different things that when added together are not good, especially in the elderly (?SNF- maybe not old?). Anyway...needs someone with fresh eyes to look at meds/behaviors- jmho And bless you

i feel you. sometimes there is nothing else we can do. i just chart patient's behavior and quote him/her to protect myself and of course inform md. even if he said "you didn't give me my percocet". i chart those as well. good luck!

Hugs. Frustrating. Have you tried massage? Sometimes that helps bedridden pts. It feels like you've been hit by a truck when you're on extended bed rest....and that's without the contrx etc....

i agree about a pharm review, but an anxiolytic may be considered.leslie

There is now speculation that opioid metabolites actually contribute to hyperalgesia, a perverse reaction to the build-up that increases pain. This is particularly possible with elders who have reduced renal function.I would agree with Leslie that an anxiolytic be considered. If behavioral issues can be r/o it may be time for a narcotic rotation.

Quote from leslie :-Di agree about a pharm review, but an anxiolytic may be considered.leslie

Had a Houdini want to be in liver failure in the ICU.... came in as a walkie talkie GI bleed, then spent a month writhing and demented. Tried to convince the Docs to dial back the opiods and benzos... when there's nothing physiological, and nothing else that can be isolated... time to look at the meds!! FINALLY killed the benzos, and she came out of it!!

Do you think he is in physical pain or seeking attention?

every nursing facility has one or more residents like this. I just learn to do what i can for them and just deal with it.

Back when I was getting my CNA, I was in a State LTC facility when a pt... way back at the end of the hall... would spend the day screaming/moaning in the most haunting, keening voice... "OOoooooohhhhhh...Heeeeelllppppp meeeeee". The woman was an absolute skeleton. It always amazed me that a human could be in that condition an still be alive. Nothing we did had an effect on her pleas. Heart breaking!!

Poly pharmacia. Chronic pain sufferers often need different pain intervention. This medication salad as you see it, all his meds are short acting. Where is his long acting medication? MS Contin. Fentanyl patch, Kadian. Oxycontin.. anything . Then use the other bits of "salad:" for break through. Where is this man's pain consult?