Administering pain meds to a sleeping pt - page 4
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... Read More
Aug 29, '11I will ask the patient on my first round, if they are taking pain medication, if they want me to wake them up for it. If they say yes, I wake them up every time they are due for it, if they say no, I tell them to call me if they want anything. I document their response.
Aug 30, '11Once had the opposite problem. Patient only had IM Demerol ordered and was terribly afraid of needles. This pt had run himself over with his skimobile (never would tell me how he did that) and had multiple rib fractures. I went to check on him during the night. Couldn't see him breathing, so I turned on the room lights. His respirations were so shallow to avoid pain he had circumoral cyanosis. I put him on 2 LPM via nasal canula, then gave him the Demerol ventrogluteal (often works well with ortho patients) anyway. An hour later his call bell came on and he thanked me for giving him the Demerol (phew! what a relief).
Aug 30, '11For me it depends on the patient...diagnosis plays a role as well. I work in a geriatric rehab, so often once my patients start working in depth with therapy, they are really hurting (especially the orthos). Often I notice I have to encourage my patients to utilize their PRNs (many of them don't want to be a bother, then there are the stoic old men as well). I also get to know my patients very well (since I have them for weeks at a time) so I can often predict when so-and-so will want some tylenol, etc. Every patient is different. As an example I have one patient --we'll call her A (post op hip hemiarthoplasty) who received a total on 30mg PO Oxycodone during my shift to control her pain, but have a patient (we'll call her B) in her mid-nineties s/p fall at home with multiple compression fxs (most old, one new) who completely denied pain throughout and wanted nothing more than her scheduled Lidoderm patch which she said helped just fine. You'd better believe if I was working 11-7 I'd be waking up patient A. Would round on B, but definitely wouldn't wake her up unless something seemed amiss.
ETA: Then again, IV pain meds don't come in to the mix in my setting as we only give PO, topical or IM (rarely) narcotics. Only time I've administered meds to a sleeping patient is SL Roxanol to hospice patients, which is a totally different ball of wax.Last edit by NurseKatie08 on Aug 30, '11 : Reason: addition
Aug 30, '11Quote from rn/writerYeah, 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!
You nailed it! Assess don't assume.........PRN Meds are there for a tool to use to help the patient, not to play keep away.
Aug 30, '11I ask my pt what they would prefer when I do their assessment. Some patients want to be woken up when it's time for PRN pain meds, others want to ask for them. It seems to work out for me. Or, at least I haven't gotten any negatives about pain control yet.
Aug 30, '11Quote from Mgrn123Vital signs are an inappropriate gauge for whether or not to medicate for pain. This is basic information that you can find in most pain management educational materials.Happens to the best of us. Chart chart and chart. In this situation check her Bp pulse etc.... Tell her u do it at night while she is awake so u don't scare her. Check her hx of meds administered if she has been there a while and based on that judge if she needs pain meds. low Bp hr etc don't do it abnormal hr Bp etc she may be in pain. Hope this helps!
Aug 30, '11Quote from OCNRN63Very true, and if the pain becomes out of control, they can have vasovagal reactions, and drop their BP significantly-- then you've got someone in horrendous pain, who isn't safe to medicate because of waiting too long. It's the overall assessment- the whole person, diagnosis, history- chronic vs acute pain (chronic pain patients take a lot more because they're used to a higher 'start point' for pain)....and what the patient says is pain- not what is assumed.Vital signs are an inappropriate gauge for whether or not to medicate for pain. This is basic information that you can find in most pain management educational materials.
http://www.medicinenet.com/fainting/page4.htmLast edit by xtxrn on Aug 30, '11
Aug 30, '11Quote from StrwbryblndRNI see what you are saying. My only issue with this is that those observation patients are in overnight and they are denied the pain relief available/ordered because ....they "can't go home on IV meds".......but if the Doc felt they could go home on PO meds.....they would have gone home, wouldn't they? Instead the Doc felt there was a need to spend the overnight for pain control and observation.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.
It's tough to know for sure but I agree if they are sleeping.......I don't wake them unless pre-decided I would.
Aug 30, '11I agree with nerdtonurse? about dosing CA patients--I have had a patient with bone cancer with a pump programmed for base rate and up to four additional doses MS per hour. Patient NOT in control of pump, nurses were, and if he was sleeping you bet I pushed the button to keep his pain under control. Never saw a human being in so much pain--very sad.
Aug 30, '11Quote from nerdtonurse?Excellent point - we're nurses not magicians.a big problem a lot of people have is that they think they should experience NO discomfort whatsoever.
It's like the patiens who moan if they have the slightest bruising after a blood test. Like do they think it's normal to have a piece of steel plunged into their vein and be left with no trace whatsoever?
Aug 31, '11Thanks for the responses, everyone!
It's clear to me that PRN pain management needs to be tailored to each patient, and will undoubtedly involve some trial and error. From now on, I plan to ask my patients ahead of time if they want to be woken up, and really explain the difference between scheduled vs. PRN pain meds.
Communication is HUGE here...
...and then, there are those patients that are simply never going to be pleased.