[sharann]

Thanks guys.
I still get teased about this by the nursing sup. I just tell him that until he is the one in my shoes and hears the screams of pain(or great theatre), then he better quit it!
He is just kidding with me though so it's ok.
I agree that until they tell me that pain is what the doctor thinks it is or the nurse judges, then I will medicate as much as I have to.

[DanceRN]

I'm sure all of us have been "fooled" at one time or another. Don't even ask me what the most pain med I have given a pt is. We use the sedation scale along with aldrete and pain level. If a patient states pain level is an 8 but sedation is a 4 and aldrete is an 8 then they are ready for discharge from PACU.

One of our MD's has the pt cough (abd. or chest surg). If the pt can't cough or is splinting then they are a 7-10 if the pt coughs but winces 4-7 and if th pt coughs without problem 0-4. He uses this to "verify" what the patients states pain level is.

[sharann]

Thanks DanceRN.
Wow, sounds like an interesting new pain scale there by Dr. McCough. So, he "Verifies" this cough scale. Gee, I should use my "Nurse I'm thisty" scale. Pain is 10/10, no wait, 100/10, and the patient can thrash around, scream prfanity, demand food, want their cell phone and visitors, and have to pee as well. I ask them which they want most. PAin meds or peeing? Pain meds or water? PAin meds or your ipod?
Guess which one always wins?
I love narcotics(for the pain control!), they are proof that there is a god.
One question though. IF the patient had ankle or knee surgery, does he make them hop on one foot for major pain and 2 feet for mild?

[webbiedebbie]

I know there are some out there that would pull this on nurses, but I had something happen in my recovery over 5 years ago.

I woke up from surgery with horrendous pain...the nurse tried everything...I was on a PCA pump, she called Dr...dose increased...still not helping.

When I got to ICU, my new nurse pointed out to me that my IV tubing had disconnected and I had not had any pain medication for probably the past 4 hrs I was in recovery!

[sharann]

webbiedebbie,
I have done that to a patient once but I figured it out in 15 minutes. I kept giving a loading dose and the patient kept having pain. Then I traced the tubing down and lo and behold, it was feeding the floor a nice 15mg of Morphine. So once I hooked her up...amazingly felt better!
So, yes I AM an idiot, but I am getting better. I learn from my stupidity

[PACUJennifer]

I've probably been fooled more than I know. Recently I had a patient who was a drug addictions counsellor. Unfortunately,he didn't tell me until the patient in bed #4 (that had put up a fuss to get the "right" analgesic prescription, "only such and such works for me"),had been discharged to Post Recovery Lounge -that "John" was one of his clients -a loooong time drug addict. He was setting himself up to make a tidy sum on the street as soon as he got out,likely as not.

We've ALL be there,hon!

[sharann]

Thanks Jennifer. People are very simple yet compex at the same time.
Also, very sneaky sometimes!!!

[DutchgirlRN]

As long as you didn't give more pain meds than what was ordered and the patient remained stable I don't see where you have done anything wrong. The patient is the one in the wrong IMHO.

[azhiker96]

My wife has 18 years hospice experience so I asked her how she tells if a pt has pain or is just drug seeking. She said it's easy, if they have pain, they get relief. If they're drug seeking, they get stoned. I believe every one of my patients and dose them until their sats start dropping.

A user will feel surgical pain just as others do, maybe even worse since they haven't had their usual dose and therefore are not even up to baseline. I don't work rehab so it's not my job to wean them off narcs, especially when they're fresh out of surgery. Last week I gave my largest dose. 6mg Dilaudid in one push. I checked the MAR and that was what the pt had been getting, q6h. Still seemed a little strange but her pain improved dramatically after the med and she didn't get stoned.

[sharann]

I choose to err on the side of beliving my patients whether I KNOW they are messing with me or not. My job is to treat the pain, and since we are asked to have them rate theri own, we must treat accordingly.
I have never given 6mg of Dilaudid push or any other route, but since opiods have no ceiling, it sounds completely plausible.
I just felt lame at the time. I stand by my descision to medicate her as much as legally allowed by orders.
Interesting stories everyone.