Pain medication and confused patients.

[dirtyhippiegirl, BSN, RN]

Background: I'm still on orientation to a mixed critical/acute care burn unit. I did run this by my preceptor and he said that what I did was right. Just wanting some more opinions here.

My patient was starting to heavily detox off his alcohol habit. At the beginning of my shift, he was confused but would follow commands to stay in bed, etc. About half way through my shift, he started to become increasing confused, hallucinating, and combative. He had all the AWAS stuff available, as well as precedex running, but nothing really seemed to be helping.

Anyway, morning comes and the on-call NP drops by. Update him on the situation. He's going through the chart when suddenly he's like "has this guy had anything for pain all night?" Yes, I gave him 15 of PO oxy (the max) at 0800 and 0000. "Well, why didn't he get anything at 0400?" Because he said that he didn't want any pain medication. "You're going to believe anything that he's telling you? (Gestures to the patient who is now hallucinating that he's drinking from a cup.) What if his agitation is partially because of his pain?"

blah blah. I was just like "yeah, you're right, sorry" and left.

I WANTED to say that I don't feel comfortable giving pain medications to a patient who actively denies wanting them. Was the patient very, very confused? Yes. However, our 0400 conversation went something like "Hey, are you in pain right now?" "Yeah, my hands hurt." "Okay, well I can give you some pain medication for that." "No, I don't want any pain medication."

Anyway, what would you fine nurses have done in this situation? I know that there are alternate pain scales for cognitively impaired patients but the patient, although very confused, was still able to answer my questions. Does his impaired mental state negate his refusal of pain meds?

[PediLove2147, BSN, RN]

I personally would not have given the pt anything at 0400 either. He obviously understood your question at the time since he answered appropriately.

[LoveSbux]

I agree, if the patient didn't seem to be in pain and said he didn't want anything, I wouldn't have given it either.

[dirtyhippiegirl, BSN, RN]

Thanks guys. :) I think what our NP was getting at was that I should have used the oxy to help sedate him on top of all the other stuff we were giving him. Very frustrating!

[DixieRedHead, ASN, RN]

I think that I would have told him he needed to stay ahead of the pain. Much easier to control that way especially with something like burns.