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August 04, 2005

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The little that is known about pain and how to treat it is often misunderstood or ignored by physicians. Some patients were receiving less than a quarter of the pain medication they needed

Anonymous

ok.. that all sounds TEXTBOOK perfect, but i'd like to really know what you'd do about a patient like this... e.g. - 23 y/o girl with a hx of polysubstance abuse and hep c p/w lower back pain from spinal abcess/om sitting in bed, compact in hand putting on lipstick, laughing at her boyfriends jokes with perfect vs claiming to be in a 10/10 pain?? She is on a dilaudid PCA and the md's up it FOUR times during my shift! I am USUALLY very much in agreement with the whole.. "a patients pain IS what they SAY it is".. BUT.. OMG!!! sometimes I don't feel like a nurse.. I feel more like a drug dealer providing their next "fix"

shrimplate

One should not have to awaken to pain.

Eric

Shrimplate: I agree, I hate pain. And I think litigation regarding improper pain management will become more prevalent against nurses, since there are very few physicians who are willing to accept the liabilies associated with treating intractable pain. I was reading somewhere that patients are claiming law suits against physicians that don't order pain meds effectively. It won't take long for patients to figure out nurses can be liable as well.

Maria: I have to admit, I usually ask for a lot of pain medications for my patients in pain. One physician and I even joke about it. She asked me once, "so what do you think she needs?" My reply was "Morphine 2-10mg IV q3-4h PRN". She laughed, and gave me 2-4mg IV q4-6H prn. I thought that was fair :-)

May: I like to think no one that makes it through nursing school is stupid, although I do believe there are questionable beliefs out there. I obviously exaggerated about the sleep bit. If the patient admits to being pain free, and has indicated to the nurse a satisfaction in pain level and pain management, I also would not wake them up. But if there has been extensive periods of pain, and if the patient has stated a dis-satisfaction with nursing's management of the patient's complaint of pain, I will ask if they wish to be awakened. I especially offer this "wake up call for pain meds" when I notice the patient frequently awakens in extreme pain.

What I do continue to react strongly to are the nurses that receive a request for pain medication, then get distracted for a while, and when they get to the room with the pain medication, they don't administer it because the patient's eyes are closed. I do think you can be in severe pain and suffer the physical effects of exhaustion, and I think nurses should medicate in these situations, and not assume the patient "must be pain free because he looks like he's asleep."

may

one definition of sleep is: the natural suspension of consciousness.

if the patient is asleep after being given pain medication, it is stupid to assume they are pain free at that very moment? if they did not specifically request to be awakened for the next dose, and you see them drooling in real deep sleep, it is stupid to leave them alone and say they are pain free at that moment and will go ahead and wake them up to take pain meds?
well, i think i'm stupid, because i defintely don't get that argument.

Maria

Oh. My. God.

Really, WHERE WERE YOU while I was an intern? Writing down information for patients? Charting vitals that resulted in holding meds? Explaining differences between PO and IV?

We've been advised not to provide dosage ranges (i.e. write "Vicodin 5/500 1 tab po q 3 to 4 hours prn pain" vs "1-2 tabs po..."). I usually don't write time ranges, either--I mean, you might as well write "q 4hr" instead of "q 4-6hr".

In my experience, nurses tend to give the highest dose written (by the primary team) for, which bugs the living hay out of me. Don't freaking give 2mg IV of haloperidol right off the bat; can't you at least try 0.5mg first and see if that does the trick so the patient doesn't get freaking snowed???

Sorry.

You rock. Your patients are so lucky.

shrimplate

Pain meds are cheap, and at work we have just tons of this stuff lying about in the Pyxis machine. Really, what could be easier?

There is already enough pain in the world. We need not tolerate more.

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