Nasty patients!!

Hey guys,
Sorry i'm so late with this post!!! I'm putting 2 up today coz i forgot last week!!

I’m on an ortho inpt prac at the moment and last week had to deal with an extremely difficult pt…
He was admitted with a tibial plateau fracture that had been immobilised with a Richard’s splint. His surgery was being delayed until some of his swelling had settled so the doctors asked for him to be RIB. While talking to the pt I found out he had been an inpt for multiple other lower limb fractures, was a heavy smoker and had been treated with antibiotics for the 3 weeks prior to his admission for a chest infection (? Pneumonia).

While an inpt he had been transferring himself to a wheelchair so he could go outside and smoke (at least 8 times a day)…

I explained my role to him, showed his some bed ex’s, attempted some deep breathing ex’s and cough/huff and explained that moving around/transferring would increase his swelling and that was the only thing delaying his surgery and that the doctors would like him to RIB. He was quite angry with me… “You’re the first person that has told me that, no one else said anything and your just the stupid physio so what would you know!!”

He nastily told me he knew all the bed ex’s and not to waste his time. He refused to cough or huff due to pain in his knee and I thought his pain may be the reason for his aggression.

I went and asked the RMO to come and chat to my pt, and suggested he may need some more pain relief as he appeared to be in quite severe pain (probably exacerbated by his excessive mvt!!) – I went with the RMO to chat to our pt and I was not the only person the pt was angry with… The doctor explained to him that they would like him to RIB to decrease the swelling and he offered him some immediate release pain relief (the pain team were coming to R/V him later that day and we’d explained that to him)… The pt refused pain meds and asked to be left alone (not in those words, a lot more expletives were used)!!!

I feel as though I did the right thing by getting the RMO to come and talk to the pt and offer him pain relief but he was a very angry man!!

What would u guys have done in this situation or do you have any suggestions of how I could have handled it better…
Thanks
xox