Administering pain meds to a sleeping pt - page 2

I'm a new nurse and recently received my first "negative" comment on a patient survey. Pt was a young woman s/p lap appendectomy; she complained that I "must have forgotten" about her pain meds and claimed that I medicated... Read More

  1. 8
    Quote from nerdtonurse?
    I don't wake surgical patients up to medicate them for breakthru pain; a big problem a lot of people have is that they think they should experience NO discomfort whatsoever. I had a TAH/BSO, and the first thing I wanted was the pain pump gone and the foley out once I could stand up on my own two feet. I knew enough to know that a) this is gonna hurt, and it's gonna hurt for a while, and b) the last thing I need to do is keep myself so narc'd up I couldn't walk or stay so stoned I killed off my GI motility and then have a nice bowel obstruction thrown into the mix. They actually came and checked the pump because I only used 8cc of dilaudid the entire time (I got the pump yanked the morning after surgery) and took 1 PO pill for the drive home -- after that, it was NSAIDs. I don't like pain, but pain won't kill you. Pneumonia, GI obstructions, PEs, DVTs, and other things associated with someone laying there in a stupor will kill you. My doc told me I had one of the fastest recoveries he'd ever seen, and it's because I made myself move despite pain, not because of all the pain medicine I took.

    Having said that, if I've got a terminal CA patient, you bet I dose them around the clock -- you don't want the pain to get on top of them, you want them on top of the pain.
    Pain can kill you. If your pt is in pain and isn't moving because of the discomfort, he can get a DVT, pneumonia, etc. Not everyone is going to just "suck it up" and move. Inadequate pain control impairs the healing process.
    RLeeRN, dthfytr, sharpeimom, and 5 others like this.

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  2. 3
    I agree with Flo and ONCRN63.....w/Flo.- look at the day or so previous to your shift, and talk to the patient when you do your first assessment. With both, I agree that pain is better dealt with in a proactive manner- catching up is horrible, and in the process limits the patients ability to do what he/she needs to do to increase mobility.

    Also, scheduled pain meds are reason to awaken.
    NRSKarenRN, RLeeRN, and sharpeimom like this.
  3. 1
    I have had pain and if I need dilaudid for "breakthrough" pain I wouldn't be sleeping......It would depend on the patient.....ortho's yes, I'd wake them, their pain can get ahead of them quickly.......TAH/BSO.....If they are asleep I probably wouldn't.

    Where did the patien ge the idea that not to be awakend for a pain med was "reportable"....sounds like the following nurse when the patient c/o pain threw you under the bus....."Oh she didn't wake you for your medicine????.......well you can report her you know....."

    BUt if that is what the powers that be want....then so be it. I owuld probably check with the patient when I gve them the po....."Do you wnat me to wake you to see if you want more pain med If you are sleeping when it is time for more medicine?" I woulld also re-instruct the patient on the necessity of using the call buton for requesting pain medicine that is on a "as needed" basis....and I would explain (nicely) that I don't have a crystal ball and that they need to let me know when they are in pain.....just my
    opossum likes this.
  4. 5
    Be careful that you don't snow your patient. I'll take them waking up and mad at me for having pain over having them go unresponsive on me, any day. I always tell the post surgicals that I can reduce their discomfort, but I can't make them pain free.
    nola1202, ChristaRN, vashtee, and 2 others like this.
  5. 3
    I will ask each of my postpartum patients if they want me to wake them and at what time interval. If they have been going a little longer than four hours without difficulty, we will pick a time--usually five to six hours--and I will assess them at that time. I let them know that they are certainly welcome to call me sooner, and for those who are breastfeeding, we can evaluate throughout the night. But I also caution them that if they say they don't want to be awakened, I won't be waking them.

    I also will not wake someone up for pain medicine. If you can sleep you are not in agony.
    Maybe not in agony, but the sleeping patient can certainly be very uncomfortable. If it reaches a certain level, you can end up with a patient who is chasing severe pain, something no one wants.
    NRSKarenRN, michelle126, and xtxrn like this.
  6. 0
    I am big with education. My surgical patients are usually observation and would be dc'd the next day. I make sure they are aware that I will not wake them but if they want pain med to ask since they are not scheduled. Also I try hard to stick with PO overnight before they go home with the usual, "you can't go home on IV meds" When I check on pt's, usually if they are hurting they stir enough to be able to let me know they want pain meds or I ask if I notice they are not fully asleep.
    If the pt is admitted for an extensive time then my approach would be a little different and more proactive. But I still will not wake a pt and will educate them in advance so there is no confusion.
    We do not get ortho pt's.
  7. 5
    I really don't understand where this myth comes from that patients have to ask for prn meds. It's our job to assess for the need for prn meds, even if the patient doesn't ask.

    Coming to an agreement ahead of time about pain meds through the night is always a good plan, some patients with chronic pain will have some sort of routine they stick to and can tell you ahead of time what they will need.

    Post-op patients however don't have as much experience with pain control and you need to be the one to foresee the issues that may arise with getting 'behind" with their pain control.

    In California it's actually the law that you administer or at least offer prn meds as though they were scheduled for the first 24 to 48 hours post-op unless you find contraindications for doing so.
    NRSKarenRN, Laurie52, xtxrn, and 2 others like this.
  8. 0
    Quote from Flo.
    Yes, I have waken sleeping pts to asses their pain. I work ortho so if the pain gets out of control it is very difficult to get back under control. If the pt has been taking 4mg dilaudid po q 3 hrs for the past 2 days, you bet I'm waking them up. I also have a conversation with the pt at the start of the shift in which I ask them do they want me to wake them up. Some people would rather sleep.
    I agree completely

    Our unit was day 0-2 post op joint replacement & spine surgeries. Many times people may look comfortable but are in fact just resting quietly. Also, if a short time later they awake, either in abrupt pain, or gradually escalating pain, their perception is that they've been in pain a long time. That start of shift conversation is a great intervention.

    And to the O.P, don't take it personally. Sometimes patients have expectations, sometimes realistic, sometimes not, about their POC. Think of it as one more new tidbit to be learned.
  9. 2
    Quote from MunoRN
    I really don't understand where this myth comes from that patients have to ask for prn meds. It's our job to assess for the need for prn meds, even if the patient doesn't ask.
    Yeah, sometimes it sounds like we get bonus points for every PRN med we don't give. With that in mind, we surely wouldn't want to bring the subject up. And if a call bell goes off and someone actually asks for one, dang! there go those points.

    It'd be funny if there weren't nurses who actually function like this. I know, because I've had some of them. And so have family members.

    We ARE supposed to bring up the subject and assess, with the patient, whether additional meds are needed or not. That's a big part of our job!
    NRSKarenRN and nopainNurse like this.
  10. 3
    Young woman with a lap appy who you had a good rapport with and then complained about you afterward...

    it's probably not what you did (or failed to do), OP. I work on a surgical floor and have experienced this with a few patients, too. At the beginning of shift (nocs), I have a routine: introduce myself, assess patient and check lines / drains / incisions, ask pain level and any concerns, and go over plan for shift. We go over each med to be given, any dressing changes in AM or planned intervention (NG tube flush, bladder scan, etc), and when and how pain PRNs work. I encourage patients to take something before bed if POD 0/1/2 or later if surg was open; many describe feeling 'uncomfortable, sore, out of sorts' but 'not exactly pain' as the evening winds down but this seems to turn into the 'woke up with awful pain at 4am' if not addressed. We do hourly rounding and I often tell patients that I will be popping in every hour or so but will not wake them unless asked, (or if something seems amiss.) Most are okay with this...

    but I've learned exactly what one poster already said: patients often have unrealistic expectations about pain / recovery. I now add the 'progression of recovery' schpeel to my routine: importance of ambulation, use of IS, incisional vs. generalized pain, POs vs IV meds, return of bowel motility, etc. I ask patients to describe the pain they have, where and when they have it, and how/when it gets better/worse. Medicating a patient Q2 with IV narcs for what may actually be gas pain isn't going to help them when they stay a week or more for an ileus. This seems to be working better for me and most of my patients seem to relax when they know what to expect and what may/may not be normal.

    Cosign that I will wake patients for scheduled pain meds, especially chronic pain pts and onc patients.
    lolaviex, nola1202, and ~*Stargazer*~ like this.

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