burn pain management

Dec 24, 2003 10:31 PM

by nekhismom

Hello all. I have a question. My little 12 y/o brother has 1st, 2nd and 3rd degree burns over his chest covering about 8% of his body. He has been sent home in my care to perform debridement and dressing changes bid. I am a new grad with no burn experience. He has been prescribed Lortab 7.5 mg before dressing changes and silvadene creme. The problem is that the Lortab doesn't seem to be easing his pain at all. The majority of the burns are 2nd degree, so they are very painful. This kid weighs 115 lbs so he's not exactly small, and I just wanted to know if in your experience this is the kind of pain management that is used for such painful burns. I know it's not MAJOR, he's not an ICU pt, but he still hurts, and I can't stand hurting him. SO, is there anything else I can ask his Dr. for to control his pain? The dr. suggested motrin in between dressing changes, and that's fine, it's just during the dressing changes that my brother screams and cries. ANy suggestions would be appreciated.
Thanks!

renerian · Dec 25, 2003, 05:02 AM

wow

I have never had a burn myself but did float to burn and I really do not think Loratabs are the correct med at all. Ask for a very strong med. I hope the burn nurses taught you well.

Poor guy and poor you for having to do that.

renerian

**jnette** · Dec 25, 2003, 06:03 AM

Wow. How I hate this for you and him. Poor little guy.

Burns are extremely painful, I've had several. I would think he should be getting something to spare him this pain. Please talk with his doc.

It would be the compassionate thing to do for both your lil' brother AND you !

I wouldn't want to be in your shoes.

DelightNP · Dec 25, 2003, 09:22 AM

Am I the only one that doesn't think this is appropriate? Are you providing the only skilled nursing care he is receiving, with no experience in wound care, debridement, infection control, or adequate pain management? That is not kosher at all.

And Lortabs are ridiculous for that sort of pain. IMO, Lortabs are useless all around. I'd definitely prescribe something stronger.

renerian · Dec 25, 2003, 10:53 AM

insurance

This has happened to me twice in my life. Once the insurance company that my grandmother and dad had (both deceased) found out I was a nurse and the primary caregiver they would not cover wound care. Many lay people do dressings. In home health I had taught probably hundreds of non skilled people how to do dressings. Way of the world with short stays and most insurance companies we work with at my job pay for 1 to 2 visits for a nurse to teach a family member how to do something-that is it. Seldom have I had approved repeated visits but I sure hope some companies pay for it.

renerian

DelightNP · Dec 25, 2003, 10:55 AM

I'm sure it can be done, I'm just not sure its the best thing, especially for a child with partial thickness burns.

But then, I'm really rather conservative.

z's playa · Dec 25, 2003, 02:00 PM

I'm going to be HUGE on pain management when I graduate. If the pt is still screaming, the pain is not under control. No other way to interpret it. I would get the doc to explore new and stronger options for sure!
Can't stand it when doctors tell you that the meds already ordered SHOULD be enough.

Happy Holidays!

nekhismom · Dec 25, 2003, 07:46 PM

Thanks everyone for your responses. I am one who believes that pain is what the pt. says it is, and if they are screaming, they NEED MORE MEDS!! PERIOD!! I have no wound care experience, but the dr. flat out refused to get a home health nurse or aid or any kind of in home assistance for my brother, so my mom asked me to take care of the wounds. I questioned him about pain relief, even asked for morphine (can you tell I'm used to a hospital?

) and he said he just wanted to increase the lortab from 5 mg to 7.5 mg.

My poor little bro, his burn is becoming more painful every day, and he just SCREAMS in pain with his dressing changes, even with lortab and 400-600 mg of motrin.

One more thing, shouldn't the debridement be sterile d/t the increased risk of infection? If so, the dr. never once told my mom that would care should be sterile. We learned in school that burn care should be sterile, but I know things don't always work the same way in the real world.

Thanks again for everyone's support and answers. I wish my little brother had some of you all for nurses/NP's! Then he would have proper pain relief!

nekhismom · Dec 25, 2003, 07:52 PM

Originally posted by DelightNP
Am I the only one that doesn't think this is appropriate? Are you providing the only skilled nursing care he is receiving, with no experience in wound care, debridement, infection control, or adequate pain management? That is not kosher at all.

And Lortabs are ridiculous for that sort of pain. IMO, Lortabs are useless all around. I'd definitely prescribe something stronger.

I think it's totally inappropriate, too, especially since I don't have burn care experience. I've never even been on a burn care unit! We didn't have one in my area, they were all shipped out. My brother was burned at night, so he did not go to a burn unit, so he NEVER received any skilled nursing care other than what little I can do. That makes me REALLY nervous. I agree that Lortabs are pretty useless, at least in my experience. THey certainly don't help him! Do you have any suggestions as to what I should ask his Dr for specifically? He seems really keen on the Lortab.

Thanks!

renerian · Dec 26, 2003, 03:44 AM

did you call

Is the doc ordering the care a FP/IM/Pediatrician? Maybe he needs to see a burn specialist and I am sure that doc will sign for home health. Would your insurance cover it? You can always call your insurance company and find out if they work with a case management company and start there. Sometimes, alot of the times actually, you have to know how to work the system. People do it all the time. Start calling. You can always call the burn doc and get them to call in something stronger. I am sure they would.

renerian

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burn pain management

burn pain management

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