[ktwlpn]

The other side of the drug seeking topic-I have a resident who received ONE does of percocet after open heart surgery.....Page after page of nurse's notes in the hospital (a large teaching hospital in a near by city) and at the nursing home in the past week show DAYSof restlessness and anxiety......She extubated herself post op and tore apart her pleura vac-tore out more then one IV......She's a got a suture line a freaking FOOT long-----does anyone think that SHE MIGHT HAVE SOME PAIN???? We have all seen this I am sure-how many s/p ORIF's lay in bed picking and pulling and not eating and in pain because they cannot say "O nurse-I broke my hip the other day and had surgery-Can I have something for pain? I heard in report this am that "She is driving us all crazy" Well-duh.. she was awake ALL night ringing the bell "Put my head up" "Put my head down" "My head is not right" "I'm hot" "I'm cold" Please pass the analgesics.....

[earle58]

what does she have ordered for pain relief? any prns? is anything being given, i.e., tylenol or motrin?

also, i have found with elderly, is when they have surgery, the effects of the anesthesia remain in their system for a while.

if she is being given tylenol or motrin and it's not helping her, i would definitely call her doc and relay her agitation.

i have found prn vicodin works very well with orif's.
and more than once, i have told a doc that i will document the s/s of pt's pain, as well as md's refusal to prescribe effective relief (if that is the case).

leslie

[michelle95]

I know I may be a little off topic (well, depending on how you look at it)...but, where I work a mentally retarded lady sliced her neck open during a fall...all the way to the jugular vein. Thankfully, she didn't nick the vein. However, after she went to the hospital and had it sutured and stapled up, guess what she got sent home with for pain? Motrin 400mg Q4 Prn. Yep. Me or you? We would have had Tylenol #3 or Darvocet at the very least.

I guess old people and MR folks don't feel pain. Just like newborns.

[Surgical Hrt RN]

This is a HUGE pet peeve of mine! These patients are CLEARLY uncomfortable. MEDICATE THEM!!!! A lot of surgeons that I have worked with lately have way undermedicated these pateints.......and then they wonder why they develop pneumonia or atelectasis! GEESH!!!!

[earle58]

the facilities can also receive deficiencies on their annual surveys, for undermedicating a patient...

there's just absolutely no reason for this.
i hope someone steps up to the plate for this poor lady.

[Angela Mac]

what boils my blood-

is when you question why "Agnes- with a hip fx" has not been receiving pain medicaiton, and you hear, "She has dementia, she doesn't feel pain." OR "Her psych meds numb her pain."
Yet--- "Bob" in the room next door gets his percocet every 4 hours on the dot.

[Hellllllo Nurse]

When I was in RN clinicals at the LTC/rehab where I happed to be employed as an LPN
I noticed that ap who was 48 hrs s/p aka had not received any thing for pain since being addmitted 26 hrs prior, and that the Lortab which was ordered for him had not even been ordered. I had recently seen the pt prior to the amputation, and he was a very different person. Besides being totally confused, he was in obvious pain.
I bugged several staff and supervisors to help w/ this and got nowhere. Finally, I interupted a meeting to speak to the ADON and ask for help addressing the problem. She borrowed a Lortab from another pt and got this pt's Lortab ordered, thank God.

Another incident (as an employee) occurred when as an LPN, I could not get anthing but Tylenol ordered for a pt who had a fresh humerous fx that no surgeon would touch. It was this occurance that so disgusted me that I finally left the facility.

[obeyacts2]

Oh I am dealing with this right now!!!!!!!! At my homecare CNA job I have a elderly gentleman with an ORIF, (sent home WAAYYY too soon, but thats another story) They are giving him a minimal dose of Lortab, PRN(thats on the label) THis man is miserable at night. The day help took up the subject with the home health RN (from different agency) and she suggested if Lortab wasn't enough to hold him (drum roll here) give him some Tylenol!! I have respectfully documented the next time this guuy is in misery I am calling the doc myself to complain. That got a shocked look. Hey, if they want to keep hours like a dermatologist or an accountant, they should have gone into those fields instead. (Off topic, I dont feel much sympathy for my OB who hates night shift either) I also was told to let him have a second sleeper if he is uncomfortable (yeah, so he will be groggy and in pain), What is it that these old folks dont need pain meds? While I am on the subject, isnt 12 days a bit soon to send somebody home with a fresh ORIF of a fx femur (broke just below the hip)? They sent him home with orders to stay in his wheelchair for 3 weeks, no bearing weight on the fx side. Then, PT is supposed to start. I just have real concerns on this one.

Laura

[earle58]

Originally Posted by obeyacts2

While I am on the subject, isnt 12 days a bit soon to send somebody home with a fresh ORIF of a fx femur (broke just below the hip)? They sent him home with orders to stay in his wheelchair for 3 weeks, no bearing weight on the fx side. Then, PT is supposed to start. I just have real concerns on this one.

Laura

hi laura,

12 days sounds like more than enough time for an orif. i've had sev'l pts being sent home after 4-5 days.

what i question is this patient sitting at a 90 degree angle in his wc for hours at a time.

that sounds like it would be contraindicated, as well as painful.
it doesn't sound right.

but i'm very glad to hear you advocating for his pain needs.

leslie

leslie

[apaisRN]

My great-aunt, who's in her 80s, was sent to a sub-acute after repair of a shoulder fx. (I think it's called that, we don't have these facilities here. It's kind of a cross between a hospital and a nursing home.) All she had was Tylenol. She's very stoic, of course, but when I asked her to rate her pain, she said 6/10. I was a nursing student at the time and didn't know much, but I knew that wasn't right. I asked the nurse who told me that doctor wouldn't be by until tomorrow. I asked for the charge nurse and found she WAS the charge nurse. I asked for the manager and she was very sympathetic to my complaint, thank heaven. Aunt eventually got some narcs, although even then she said it didn't help much. I couldn't believe the previous nurse wouldn't call the doc for some Percs or something on this poor old lady . . . I know you're busy but I could never let my patients suffer like that. I'd rather somebody's dressing change didn't get done than another patient be in pain. The dressing can be done later, the pain hurts right now.