Administering pain meds to a sleeping pt - page 3

by opossum 11,595 Views | 49 Comments

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. 0
    Quote from OCNRN63
    I would, so they don't wake up in out of control pain. Then you have to play "catch up" trying to get them comfortable again.

    Sleep is an escape mechanism from pain. It does not equal "comfort."
    and I also ask them at the start of the shift about what they will need during the night. Depending on how recent the surgery was or what leve of pain they were in, that helps you judge on what their pain might be like during the night. They only way to really know is to ask them.
  2. 1
    I don't know that I'd wake someone up for a prn pain med, but I'd do what I could to make sure the patient was really asleep. Patients can look asleep and not be asleep.

    If the patient was needing scheduled and prn pain meds while awake, I'd be more inclined to awaken him or her whether sleeping or not, to assess and give if needed.
    Not_A_Hat_Person likes this.
  3. 1
    I would have the conversation. I will warn that if I don't wake up, the pain might wake them up, and I don't want that to happen, that it is not fun to suddenly be in pain. If they have been receiving meds consistently and have not yet experienced pain (dep on dx/procedure) they might not right now understand that the reason they currently do not have pain is because we've been ahead of it all day.

    Basically post op or pain producing dx, I would wake them.
    OCNRN63 likes this.
  4. 2
    Quote from OCNRN63
    I would, so they don't wake up in out of control pain. Then you have to play "catch up" trying to get them comfortable again.

    Sleep is an escape mechanism from pain. It does not equal "comfort."
    This is exactly right. What nurses need to understand is the theory of pain control. The higher you let it go the more it will take to get it under control. A little bit of discomfort is OK but I recently had some major surgery and the pain control nurse was a serious joke. After 2 days of enduring horrific pain I grabbed the resident, told him exactly what I wanted and got it. When the pain control nurse found out she had a tizzy fit charging into my room screaming about how she was going to get things changed blah blah ... I basically told her to sit and twirl I also told the night nurse to wake me up for my pain meds. Everyone's pain is different and poosy footing around with pain control is ridiculous. Yes, you can be asleep and be in pain.

    The best plan is to talk with the patient before hand to have a plan of action. If they want to be woken then fine, if not even better.
    Laurie52 and xtxrn like this.
  5. 1
    "Sit and twirl." I'm going to keep that one for future use.
    xtxrn likes this.
  6. 0
    I don't wake sleeping patients for PRN pain medications (unless terminal) if they appear to be comfortable. Am I the only one who uses the FLACC scale to assess for pain?
  7. 1
    When I worked night shift I would talk with my patients that I thought would have more pain before they went to sleep. I would give them their nightly meds and ask if they would like to just be left alone throughout the night, or would they like me to come and wake them to take them and they can decide if they want to be medicated. Only a few times did I medicate with IV narcotics when someone was asleep, and that would be the med seeker that no matter what would request the meds exactly on time and I can verify they get it say Q4hr on the dot for the past few days. Being a newer nurse you have to learn judgement calls, but you need to always make sure you are looking out for the patient. They do not know how some of the meds work like you do, and what they "think" could harm them. Don't worry, it is one survey and one patient. You will get more that just don't like you for whatever reason or give you a bad review.
    tyvin likes this.
  8. 9
    Quote from vashtee
    I don't wake sleeping patients for PRN pain medications (unless terminal) if they appear to be comfortable. Am I the only one who uses the FLACC scale to assess for pain?
    FLACC is for pediatric patients or patients without verbal abilities, it is not validated for use in sleeping adults.

    Patients can be asleep and appear comfortable and still be experiencing significant pain and/or get behind on their pain control.
    LPNnowRN, nopainNurse, rnmi2004, and 6 others like this.
  9. 3
    Quote from rn/writer
    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!
    And when they do call to ask then we label them as a "seeker"; either way they lose.
    Not_A_Hat_Person, xtxrn, and OCNRN63 like this.
  10. 0
    Quote from mbuchanan2107
    When I worked night shift I would talk with my patients that I thought would have more pain before they went to sleep. I would give them their nightly meds and ask if they would like to just be left alone throughout the night, or would they like me to come and wake them to take them and they can decide if they want to be medicated. Only a few times did I medicate with IV narcotics when someone was asleep, and that would be the med seeker that no matter what would request the meds exactly on time and I can verify they get it say Q4hr on the dot for the past few days. Being a newer nurse you have to learn judgement calls, but you need to always make sure you are looking out for the patient. They do not know how some of the meds work like you do, and what they "think" could harm them. Don't worry, it is one survey and one patient. You will get more that just don't like you for whatever reason or give you a bad review.
    How about the patients YOU didn't think would have more pain? What happened to them? Were those the med seekers?


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