Nurses: WWYD!?

[GLP1U5er]

You have a patient who has presented as immobile and laid for 3 days in their own mess. A year of investigations didn't explain their pain but in hospital it's discovered hip and pelvic fractures.

You know this patient has a long history of alcoholism and cannabis use. The fanily tell you they are not themselves, they make false claims of the past, sometimes are unkind to nurses and family but this is not them.

What would you think was the issue/ what would you think was needed?

@Notaflippinclue i agree, sadly that's my experience as well. hence the first step being a bath and a solid review.
sometimes long term alcoholics will have been drinking to numb underlying cancer pain.

Why are you asking nurses, presumably they were assessed by a doctor. Without telling us what actually happened and what relationship you have with them we are limited in what we can help you with.

Can I ask, are you in the U.K. because honestly, this sounds like a private healthcare system.
If the OP is in the U.K., this just wouldn’t happen due to zero beds or staff.

What investigations did they have and agree to, are they new or old fractures, are they trauma or stress fractures, what was their mobility like before the fall, who found them.

@ThewrathofBethDutton a worked in a tiny tiny canadian village for 30+ years and we were really successful at getting all the professionals in town to work together and we integrated and set up many novel ways to best utilize the beds we had.
the long term care facility (only one in town) had 22 beds plus 2 respite beds. and we used the respite beds for stable longer term patients to recover in (knowing full well that if a community respite bed was needed we could shuffle them back) the physio dept set up a day program that was both attended by community members and hospital (including long term care/respite) patients where for a few hours they were off the wards doing arts and crafts and gentle physio (for community patients they also were able to use the special tubs and lifts).

handy was that all departments worked in the same building, so the mh team could pop down if their regular clients didn't show or staff could take pt's up to them if needed and a sw on staff.
but tiny villages also know the bar staff and dealers housing situation firemen where the dr's live and police it really did take a village.
no dr's in house at night, 2 rn's and 2-3 lpn's for the 18 bed hospital section which covered maternity to palliative care.
hard work, nothing cutting edge happening there but good care.

I’ve never met a single family that have said “actually yeah, he’s always like this, he’s generally quite horrid”. Every abusive patient comes with a family saying he’s not normally like this, he’s normally wonderful etc.

I also note you don’t give any details of the ‘unkindness’. Because there’s a big difference between forgetting to say please or thank you, and the violence or verbal abuse many of us are experiencing at work

This sounds absolutely fantastic, I envy and marvel at this.
Unfortunately this wouldnt happen or work in the U.K. as our health service is completely broken.
There are not the facilities or the funding.

However, good care is still the priority of the nurses. No one wants to dismiss or not give the best they can. As pp have said, caring for folk in addiction is complex and difficult.

My first instinct was to say a wash, fresh bedding, fresh clothes and pain relief promoting comfort…. But of course you need permission and cooperation to do this. If you are being assaulted and abused, then that complicates things. This is where families can really help by being involved and helping. I have done this so many times in the past as it calms and they are more likely to cooperate with care.

OP, I am so sorry that you are experiencing this, you must be frantic with worry x

Re the behaviour changes I’d query Wernickes encephalopathy or, if lasting longer, Korsakoffs. Has their B12 been checked?
You haven’t said enough about pain for me to comment on that, sorry.

part of the reason we were able to do this is that we were all in one building as i said, but the hospital coo was very fluid with departmental money.

the adult day program was poorly utilized by the community so he infused hospital patients to maintain the funding. he did that with all the various department budgets like the respite beds.

zero reason for a bed 300 meters away to be empty with acute care brimming.
the ltc staff were equally able to provide palliative care or full bedrest. home care would assist them with the narcotics/syringe drivers and go to the ltc ward if they didn't have an rn on staff.
as nurses for the longest time we refused to admit non maternity patients into dedicated maternity beds due to antibiotic resistance and attempts to maintain that wing as close to sterile as possible, eventually women and children were allowed to use 1 of the beds (we averaged 99 deliveries a year).

Ok, I will bite. I would suggest this patient needs:

Orthopaedic plan, pressure area check/pressure reliving equipment, pain relief, 4AT/AMTS, review of causes of delirium, Pabrinex, CIWA scoring, referral to drug and alcohol liaison team and PT/OT assessment.

But most of this is for the doctors to decide - dunno why your ire is directed at nurses (except that patients and relatives seem to find it much easier to shout at nurses as they are more visible). Plus if he/she is telling everyone to go fuck themselves (as is very, very common from all sorts of patients) then lots of these things are tricky to actually implement, confused or not.

This.

I think this is the actual patient/relative.

Often alcoholics are manipulative people, they’ve lied to themselves and others about the extent of their problems over many years. They’ve lied prioritised themselves and their need for alcohol over others needs including children. There are some excellent support organisations such as Al anon uk who I recommend getting in touch with. I’m not saying don’t believe what your relative is saying but please do due diligence before making any allegations. I’m an ex nurse but also have family experience of an alcoholic so have been to support groups and listened to the stories of those trying to support them.

Are you asking about what nursing care this patient should receive or how they should be managed medically?