holding the pain med

  1. 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 wounds need suctioning and packed. sometimes there is pain med ordered and sometimes not. sometimes when the pain med is ordered the nurse doesnt give it.
    ive heard the story that these dont really hurt because there are fewer nerve endings under the skin but some of these stage IV and even II look painful to me.
    mostly these are patients who are non verbal. they still give non verbal signals...flinching, moaning, pulling away....but the surgeons who debride these wounds, right in the beds, dont seem to care.
    i ran into a room with a syringe of morphine for a patient like this and the surgeon wouldnt let me give it.
    she had no allergies, she had recieved it before, and her respirations and sat levels were good.
    i still dont understand why i couldnt give it. he said....she doesnt need it....********.

    i assisted the most immature and nastiest surgeon ive met thus far insert a chest tube the other night.
    the pt was 51 years old and an md himself.

    i gave him 1 mg versed...no sedation.
    i gave him 1 more mg versed....barely touched him. thats when the surgeon began to cut.
    this poor guy was screaming and begging for more medication. i asked the doc if i could give it and he wouldnt answer me. i guess it had to be his idea. i didnt care whose idea it was so long as the pt got it.
    finally he let me give one more.
    this pt told him before the procedure he had a low tolerance for pain and a high tolerance for pain meds. and this was a doc who had a plueral effusion. he would very sparingly take percocet only when the pain got intense.
    so why was this not given when i had the syringe right there filled?

    when that doc started cutting and the pt started screaming i just held his hand tightly. i felt that cut too. it was terrible.
    i tried to engage that doc (pt) in a conversation about freud just to divert his attention. and that worked for a while.

    so here again...like so many countless times...a patient was in a great deal of excruciating pain for seemingly no reason. (he was on a constant pulse ox and his sats were good, especially for a plural effusion)

    when i have to perform a complicated dressing change or some other procedure which is sure to cause pain i GET an order for meds.
    then i find that other nurses do the dressing changes and dont medicate the patient. too time consuming to get the narcs i guess.
    i think this is so cruel.
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  2. 14 Comments

  3. by   Doey
    frustrated, I'm with you. I don't know why some docs (and nurses) aren't more aggressive with pain management. I mean it's a chest tube duh!!! I would think it's pretty common sense that if someone cuts your skin with a sharp instrument and shoves a garden hose into you where it doesn't belong that it just might hurt a tad. This was totally reprehensible and barbaric. There is no reason in this day and age that someone not get some modicum of pain relief/control. Doctors have been sued for inadequate pain control. And so they should.
    Obviously we know where JACHO stands on this with the advent of pain as the 5th vital sign. Why is it still being ignored?? I hear so many excuses. The BP is too low. Sat too low. Etc. While we should be looking at the whole patient when assessing pain, it is possible for pts. in pain to have a low BP because they are in pain. Get rid of the pain and the BP goes up. Yes sats can be low but that doesn't necessarily mean someone can't be medicated. Of course the patient would have to be monitored but you would be doing that anyway.
    In light of what has been going on, if a POW had this done to them without being medicated for pain everyone would be horrified and think it was an atrocity. Why don't we think that now? I'm tired of doctor's egos getting in the way of adequate pt. care because a nurse suggests something and it wasn't their idea. I don't think the pt. gives a rats a** who's idea it was, just that they had pain relief.
    I certaintly would document that the pt. was crying out in pain and that the physician was asked about pain med with "no new orders at this time". Legally speaking, in the instance of the chest tube insertion, could the nurse be held liable also if the pt. sued?? I would report this, make out an incident report, whatever to try and ensure it doesn't happen to someone else. This is just another one of those things that eats away at nurses day in and day out. BTW I also agree with you about the decubiti. I don't care how many nerve endings there are if a pt. is non-verbal I would look for clues (as you did) and assume if I have to that they are in pain.
  4. by   P_RN
    Add me to the list. I've watched a GI doc do a bedside Colonoscopy that ended with discovery of a ruptured lumen. The lady screamed, the doctor refused med. She died within 24 hours.

    I've seen a doctor manipulate a frozen total knee, again at bedside , and the doctor shoved the nurse away when she came with a syringe of morphine for the patient.

    I don't know why. All I feel is that there are some cruel people in this world who enjoy having control over the lives of others.

    PRN does not mean as the NURSE/DOC decides, it means AS NEEDED for the patient.
  5. by   RNPD
    Have also sen what you described, especially bedside debridement with no anesthesia or analgesia.

    I refuse to participate-have left the room on more than one occasion. While this pisses off the surgeon mightily, no one has ever proceeded w/o me. Nor have they done any more than threaten to write me up. And I always report it to my NM first.

    I am no longer faced with this situation, because when the docs see me, they automatically order the lidocaine. And that's good, because it's the first of the supplies I gather.
  6. by   GPatty
    I've never heard of such atrocities in people!

    Tell me now what I can do withot jeopardizing my nursing license, because I don't think I could ever stand idly by and watch something like that. Isn't there a state office that Dr.'s like that can be reported to? Can't something be done?

    Julie
  7. by   misti_z
    I'm with all of you. I try my best to medicate (get order if needed) before a complicated dressing change. Had a nursing instructor who was previously a wound/ostomy nurse, I did one dressing change in school on a elderly gentlemen with a stage V decubitus, thoughout the procedures she was telling me 'he is not really in that much pain, there are no nerve endings below the skin' But excuse me, if I had a sore on my a$$ 6 inches in diameter and ~ 3 inch deep it would hurt like he//. If is terrible and unnessecary to allow a human being to lay in bed screaming--excuse the harshness of my message.
    Frustrated I've had the same experiences as you and fell the same way. And had something similar happen just last night. Patient with ganegreen in Rt foot scheduled for a AKA in the morning. I enter the room and she is crying in pain (tears and all). I check the med sheet PRN Lortab 1 q4. The lady has her leg rotting off and we can only give her a Lortab??!! I give her the Lortab--maybe she is one with a low tolerance to pain medication. Check back on her in 35 minutes after she got the med and she is still in horrific pain, so I call the doc, she refuses to give me an order for anything else--refused to even allow 2 Lortabs--stating she will get something better after surgery!! Makes absolutely no sense.
  8. by   BrandyBSN
    How terrible.

    Sometimes I think that the hospital I work in for clinicals "OVERMEDICATES" for pain, but If I was that patient, i would surely rather be overmedicated than under. It is morally wrong IMHO to allow patients to be screaming and crying from pain when we have all of this technology and pharmaceutical advances that we can implement. What is the point of having all these meds, if we cant use them. Its just wrong. As nurses, we are there to decrease human suffering, and but the patient in the best position for nature to act upon them. How can docs and nurses like that SLEEP AT NIGHT, knowing that they could have alleviated that suffering, but choose to add to it?

    May we always sleep with a clear conscience, knowing that we did everything humanly and medically possible to combat suffering.

    BrandyBSN
  9. by   frustratedRN
    and yet we give the junkies and alcoholics tranquilizers and morphine galore.
    most of our junkies get morphine q1 or 2 for their "pain"
    i think that nurses have to take a united stand against this because as it was said...if that had been done in a POW camp it would be classified as inhumane.
    ONLY BECAUSE IT IS...
  10. by   suzannasue
    UNTIL HEALTH CARE IS DRIVEN BY THE DESIRE TO HELP PEOPLE WE NURSES WILL CONTINUE TO SEE THESE ACTS THAT "IMHO" ARE "BATTERY". HEALTH CARE IS PRESENTLY DRIVEN BY PROFIT AND GREED. WE NURSES HAVE ALWAYS BEEN REGARDED AS PATIENT ADVOCATES YET OUR PLEAS FOR MERCIFUL TREATMENT OF PATIENTS ARE FREQUENTLY IGNORED. WE HAVE TO PROVIDE THE APPROPRIATE DOCUMENTATION REGARDING PAIN CONTROL ACCORDING TO JCAOH YET I SEE NO REQUIREMENT OF THE MD'S TO DOCUMENT A FREAKIN THING. WE ARE HELD RESPONSIBLE,SUPER RESPONSIBLE, FOR EVERY ASPECT OF THE PATIENT'S RECOVERY AND IF "WE NURSES " HAVE BEEN SO NEGLIGENT REGARDING THEIR PAIN CONTROL, WHY CAN'T THOSE WITH THE CAPABILITY OF "ORDERING" ANALGESIA BE HELD RESPONSIBLE FOR LACK OF PAIN CONTROL???? I DON'T SEE A
    CLINICAL PATHWAY FOR PAIN CONTROL BEING INSTITUTED, NOR DO I SEE MD'S BEING MANDATED TO DOCUMENT THE LEVEL OF DISCOMFORT FELT BY THEIR PATIENTS AND WHETHER "THEY" HAVE RESPONDED ACCORDINGLY AND HAVE MET THE GOAL OF "0"
    PAIN.
    THIS IS ANOTHER EXAMPLE OF WHAT WE HAVE "ALLOWED"
    TO HAPPEN TO OUR PROFESSION. 99% OF THE RESPONSIBILITY AND NONE OF THE RESPECT. BEAT ME,DADDY,PLEASE,I LOVE IT.
  11. by   night owl
    When a pt. cries out in pain, grimaces or pulls back, that to me are clues that the pt is having pain. Would a dentist continue drilling if you're having pain? Of course not, he'd give you more novacaine. So what is it with doctors who DON'T medicate at all?
    To me they are sadists and actually get sexual satisfaction in inflicting pain and I make sure I document that doctor refused to order pain medication especially when brought to his attention that the pt was or is in pain in my charting.

    I gave a pat. tylenol 650 mgs for "discomfort" one time because he had decubes everywhere. He was doing alot of moaning and groaning and I wanted him to feel more comfortable. The next day the doc gave me a bunch of sh*t in front of everyone in report because the order read tylenol for a temp above 101 and nothing about pain. She said, I could make an incident report about this and I said, "Do what you have to do doc, but I hope when you are in a nursing home full of decubitus, moaning and groaning in pain that some one gives you a mere tylenol for discomfort to make you feel alittle better!" She walked out of the room. Everyone said "good for you!" The order was changed to tylenol 650 mgs prn for pain or temp above 101. We are the pt's advocate. It is abuse as far as I'm concerned...
  12. by   Genista
    It's just ignorance! Once I had a pt in severe pain & called the reluctant MD for prn pain meds. Pt had hx of drug use, but had real & obvious injury requiring pain relief. MD was afraid of giving pain med to person w/ hx of drug abuse.Clarified with MD on phone,"So, you are saying you don't want to give any pain medication to this man even though he says his pain is 10/10 and he has XYZ injury?" (got the order for that one). Another time I had to ask the MD to go into the room & tell the crying pt himself why he won't increase the MS PCA even though the man is in severe post op pain, is maxed out on PCA limit for past 5 hours & RR is WNL. (Yep, he upped the PCA dose). It's an uphill battle, but someone's got to fight it. I always document my phone calls w/ MD & pt's statement of pain. It's inhumane to ignore c/o pain.
  13. by   frustratedRN
    i think its a great idea to document all this....really...i wish i had...
    come to think of it i never CHARTED that i wasted morphine cos the doc wouldnt let me give it. i just wasted it in the pyxs. but i did report it to the unit mgr. she said i should have given it anyway and just told the surgeon to take it up with the medical doc who ordered it....lol wish i had

    but a serious question arises....im not being a smart ass but other than to cover myself...what effect will charting all this have on the ultimate goal of providing adequate analgesics?

    i guess im asking two things...whos going to read them and why
  14. by   tobias fonge
    Any doctor who is not sensitive to the pain of their pts might be burned out. They are a scandal to a profession to which they may not belong. How can we ignore a screaming pt's pain especially during dsg changes or chest tube insertion? That is why we nurses have to be patient advocates. The doctors might hate us for that but that is why we are there. Some body have to stand up for these poor patients who are not having effective pain management. Are we surprised when because of poor pain management, they progress from acute to chronic pain and they come all the time to get relief when we could have managed them effectively the first time?
    In a situation where we have problems getting the doctor's attention to address these problems, we can forward these complaints to the higher ups all the way to the medical director. It may not do anything but at least we will know we tried.
    I am back in school and they tell us a pt is in pain when they say they are. Don't they tell the doctors these things? To be fair, there are some exceptions out there who do effective pain management.

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