Allison Brown

02/08/2019

NUR 4143

Background:
During my clinical immersion in Endoscopy my preceptor and I were assigned to a patient that
needed a colonoscopy. The patient that we received was a paraplegic and had been bed ridden for the past
couple of years. She also had a colostomy bag in her mid-abdominal area. By reading her chart, we found
out that she had fired several of our doctors, even though I personally thought they were good doctors.
This was her first time having a colonoscopy by the new doctor. While doing her pre-operative
assessment she seemed like a very nice individual. She was experiencing a little pain at the time due to an
enema that she was given up on the floor. She had received IV Dilaudid while she was on the floor for the
pain that she was experiencing.

The procedure was scheduled to be done without sedation, because the patient had been known to
come into the hospital to seek drugs numerous times. In her history, it was stated that she had been
observed sticking her fingers in her colostomy bag and in her rectum to cause self-inflicted pain.

Noticing:
After we finished checking her in, she kept asking if she could have pain medications. She was
furious when she found out that her colonoscopy was going to be done without sedations, and continued
to ask for other alternatives. Finally the doctor agreed to give her 0.2 ml of Dilaudid to help her cope with
her pain. She kept complaining that the dose was not enough and that she was receiving a stronger dose
on the floor, when in fact she was not, according to her MAR.

Once we started the procedure she was fine as she was watching it on the screen, the second that
we pulled the scope out she was complaining of pain. The results showed self-inflicted bruising to the
rectum and that was all. The doctor told her that he had already given her pain medication and that there
was no reason that she needed anymore.

After we got to the PACU she was complaining and yelling to the point I could not give the nurse
a report. She was complaining about the care that the doctors and nurses had given her, which was totally
different than before her procedure. She kept asking for pain medications the whole time she was
complaining and was upset that we would not give them to her. The next day they had to call security to
come and get her out of the hospital because she would not leave. She ended up coming back a week later
begging for pain medications, but she was escorted away.

Interpreting:
The clinical judgement and clinical reasoning that we used was that the patient did not need
continuous strong pain medications because we only inserted the colon scope about 6 inches into her
rectum just to see what was happening at the opening. Judging by her actions she may have been a drug
seeking patient, because she was not experiencing any pain during her colonoscopy, but was in
excruciating pain afterwards. We tried to take into considerations that she may still have feeling in that
part of her body since she was stating that she had pain, however since she was seen by numerous people
inflicting this pain on herself it was hard to justify giving her pain medications. We tried alternative
therapies such as deep breathing, guided imagery, and therapeutic communication. Sometimes it is better
to use alternative therapies so that individuals do not become addicted to pain medications and have the
potentially to overdose. The patient was not happy with those therapies though, so we had no choice but
to send her back to the unit after her PACU care was completed.

Responding:
An article that I read talked about behaviors that drug seeking patients display when they are
upset and want to get more medication. These behaviors include; complaints of headaches, request for
narcotics or benzodiazepine, reporting ten-out-of-ten pain, and requesting medication parenterally
(Grover, Elder, Close, & Curry, 2011). All of these behaviors were reported by our patient. These
behaviors along with clinical reason and judgement also pointed us in the direction that she was at the
hospital seeking drugs. We tried to use alternative coping methods to get her mind off of the drugs, but it
did not work out like we wanted it to. I think more people need to be aware of these behaviors, so that we
are not giving them drugs to potentially cause an overdose.

Reflection-on-Action and Clinical Learning:

I really like being one on one with a preceptor. When we are with our preceptor we get to do a lot
more skills since there is only one of us. When it is 8-10 of us in a group with our instructor, we were
always having to take turns doing things such as drawing blood or putting foleys in, so not everyone got a
chance to do those things. Working one on one with a nurse allows you to do everything to your own
patients and even others, and everyone is willing to let you try new things. It makes me feel like an actual
nurse because we are providing complete care and not having to take turns.

One of my midterm practicing goals was to give report to the recovery nurses on Atleast two
patients per shift. I have been able to meet that goal because I have been giving report to the recovery
nurse on all my patients that we are assigned to. I was nervous about this goal at first, but it has gotten a
lot easier as time has gone by and the more times I practice.

Another one of my goals was to be able to complete a pre-procedure admission within 60 minutes
of the patient checking into the facility. I am still working towards this goals. I have been able to check
numerous patients in before the 60 minute mark, but if they have a lot of medications or a substantial past
medical history that hasn’t been entered into the computer yet, it takes me longer than 60 minutes
sometimes.

My third goal was to give timeouts on two patients per shift before the start of their procedure I
have been able to meet this goal by giving a timeout with the doctor, tech, CRNA, nurse, and patient in
the room to ensure that we have the right patient, for the right procdure.
 References:
Grover, C., Elder, J., Close, R., & Curry, S. (2011). How Frequently are "Classic" Drug-Seeing Behaviors
used by Drug-Seeking Patients in the Emergency Department? Western Journal of Emergency
Medicine, 13(5), 416-421. doi:10.5811/westjem.2012.4.11600