holding the pain med - page 2

i dont understand why some docs (and nurses) do this. in fact i would love to understand and am thinking about conducting my own survey. i have had countless patinets with MASSIVE decubiti whos... Read More

  1. by   ADN 2002
    I had a patient the other day that had separation of the symphysis pubis as a result of childbirth. The pt was a really sweet, Spanish speaking lady in a LOT of pain (if somebody breaks your pelvis, you have pain, right?) I came in (I am a student) to take care of this pt and the family needed an English speaking person to talk to somebody on the phone, so I took the phone and it was the pt's sister wanting to know why the pt had not had anything but Tylenol #3 since the birth of the baby (she was about 24 hrs postpartum). I told the sister and the pt and family that was present -- very limited English between the three of them -- that I would check and see what was ordered for the pt. I was not shocked to see prn orders for Percocet and Demerol, neither of which had been given. What's more, the pt is not breastfeeding, so it doesn't really matter what they give her at this point b/c it won't hurt the baby. They just hadn't given her anything, I suppose b/c she could not ask specifically for a stronger med - but the look of pain on her face was at least a 7 or 8 out of 10.

    I rounded up the pt's primary nurse and got her a dose of Percocet - and it made a world of difference. Needless to say, the pt and family really took a liking to me...

    It's scary, though how pain goes unmanaged. I myself was on the wrong end of the stethoscope this past June when I had my gall bladder out. They wheeled me out of the PACU as I was coming to and I started screaming in pain. When I got up to the floor, my nurse saw how I was acting and how uncharacteristic it was of me to be behaving that way and immediately checked my orders for pain meds. A couple minutes later, she brought me 25 of Demerol, which by the time the drug started working, I was much better and starting to drift off again. After I got out of the hospital, just out of curiosity, I got my records and found I had only been given 25 of Demerol in the PACU - I could have safely been given more, given my documented RR and overall status at the time.

    Even though I wasn't insensitive before, I have found myself to be more sensitive to the pain needs of patients (whether they need ice, heat, meds, whatever) since this experience. I think that many health care workers need to experience something like that to let them know that pain really is what the patient percieves it to be.
  2. by   Ted
    Our small community hospital is about to be visited by JCAHO next year. The administration's main focus has been implementing effective assessment and management of pain for all patients who enter our happy little doors. The nurses and doctors are getting tons of inservices on the subject. (Unfortunately, we're getting bombarded with tons more paper work . . . but that's another topic for another discussion thread.)

    I've always believed strongly in providing effective pain management. When I worked in hematology/oncology, I've seen a number of patients die extremely uncomfortably despite everyone's best efforts to control the metastatic pain. At least the physicians and nurses of that particular unit tried to control the pain through gallons of morphine and dilaudid gtts and other medications, pain management consults, warm packs, diversional activities, etc . . . At least we tried!

    It pisses me off when physicians and nurses don't or won't even try . . . for any reason.

    I don't want to "preach to the choir" as I read other people's frustrations surrounding ineffective pain management.


    Anyhow, since my hospital is bombarding us with tons of last minute inservices regarding pain management (and other JCAHO issues like restraints, etc), I thought I'd share some "inservice misery" about pain management "ala JCAHO":

    www.jcaho.org/news/pain_kit_2001/index.html

    www.jcaho.org/standard/pm.html

    I actually read the articles . . .

    Cheers,

    Ted Fiebke

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