[imagin916]

Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!

Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!

[Rapheal]

Vent away. This site is great for when your tolerance has run dry. Here is to hoping that tomorrow is a better day for you.

[tntrn]

Sounds like we all can diagnose his real problem! But since you brought it up, here's my feeling on that 10/10 pain system. First of all, I think it's pretty demeaning to patients to show them that stupid little card of cartoon faces. Just me, but I like to try and have a conversation with the people I am caring for, and even if there is a language barrier, it is very rare that someone with them can help out with that. Secondly, when I broke my arm, went to the ER, my buddies asked me about the pain, and it's like, "you mean right this minute? If I don't move it it's a 3, if I move it this way it's a 7 and if I try to use it, it's a 10!" It's such an inaccurate system. Whatever happened to questions like " are you having pain?" , 'Would you like more pain medicine?", and "Has your pain subsided after your meds?"

I think your post also points out that the perception of pain (from our standpoint also) is very subjective. This guy claims to have 10/10 pain exhibiting no outward symptoms, while someone in the next bed might describe 4/10, but be exhibiting symptoms of much more than that.

[healingtouchRN]

pain measurement using the Wong Scale is really for those who can't rate pain with numbers, or describe it as with children. But if some one can use the numbers or description then it is accurate to do so. Subjective pain measurement is what they pay attention to in courts of law. Just because the person is not having what we call objective pain, does not mean he/she is not actually hurting. The Wong scale is not meant to be demeaning just a tool so that we can all be on the same page. I also use the question, do you need more meds, would you rather have the pill form or an IV form...when there is a choice (I am in critical care). We must use numerical or Wong scale as it is our policy & assists with Quality Assurance. Some people are never pain free, those with chronic pain, so a 2 or 3 on the scale is tolerable to them. & use of other pain management therapies are optimal choices to do so. Ok, off my soap box now.

[imagin916]

In the courts of law you do have to document (and treat) the patients pain, but you also must have a REAL good reason to keep giving narcotic pain meds. This man had already recieved morphine and torodol, if we kept giving him narcotics as he requested and something happened to him (who knows how much he took at home before he got there too), we would be responsible and the court would ask what kind of subjective data we had on this patients pain to justify giving so many meds. Pain is not 100% objective, and we must also use our judgement when administering pain meds, not just "give them what they want" just because they claim to have pain. Someone who comes in for "severe" abd pain is going to look like they have pain, not be sitting up, smiling, walking to bathroom with complete ease, and not be tender on palpation.

[athomas91]

one word TORADOL.........
it is simple - explain to his wife and the pt
"Sir, I understand that your medical knowledge is limited - however - the narcotics that you have been taking are likely the cause of your problem - so by treating you with more narcotics - we will only worsen the problem, thereby making your pain worse"

if he/she can't understand that - it is their problem. haldol works wonders....

[harry Krishna]

Originally posted by athomas91
one word TORADOL.........
it is simple - explain to his wife and the pt
"Sir, I understand that your medical knowledge is limited - however - the narcotics that you have been taking are likely the cause of your problem - so by treating you with more narcotics - we will only worsen the problem, thereby making your pain worse"

if he/she can't understand that - it is their problem. haldol works wonders....

ah my kind of woman. I'd work with you any day A.T...
Droperidol also works wonders, then there is always some Pavulon.....................

[marcicatherine]

Here's a funny about the pain scale.
I once heard my charge nurse talking to one of our "frequent flyers". She was in for a migraine........again, the 3rd time that week. Anyway, the charge nurse asked her to rate her pain on a scale of 0-10, ten being the worst pain you can imagine. Of course, she rates a 10/10. The charge nurse looks her straight in the eye and says "you mean to tell me, if I ripped your arm off and beat you with it, it wouldn't hurt anymore than you do right now?" Not very compassionate nursing, but hilariously funny.

[kevro1013]

In our ED a nurse that had been an ED nurse for 45 years used to say 0 is no pain 10 is acid in your face....

[FlyingED]

On our charts we actually circle the pain 0-10. When dealing with patients, such as the broken arm earlier, who are fine sitting there doing nothing who rate there pain at that moment 2, but when they move it becomes an 8. I merely circle both numbers and arrow between them, then note the pain in my charting.

Toradal- gotta love it. Let me tell you a great story. I have always been told that Toradal works especially well on hollow organs i.e kidneys etc. Well, I had a female patient with sever s/p rectal surgery pain. The MD and I threw everything but the kitchen sink at her, Demerol, Morphine, Dilaudid, Ativan nothing worked more than thirty minutes. Finally, I said lets try Ketorolac. Even with the risk of bleeding we had no other options. Fifteen minutes after giving the shot, the patient was up out of bed asking to be discharged. She said that the last shot I gave her worked wonders and wanted to leave. Gotta love Toradal!

cory