It is drilled into our heads during class time that there is no reason for a person to have severe pain. We are to assess and reassess how pain meds are working and make sure that we get the pain level down to an acceptable/ manageable number. I've experienced at least 2 times in the last couple of months at clinicals that have confused me because I felt that the patient was undermedicated and the nurse disagreed with me and didn't seek additional pain relief. I'll give the two situations and maybe someone can help me understand the reasoning a little better.
The first lady, Mrs. A, was a terminal cancer patient who had been in the hospital for several weeks, with increasing pain. She refused hospice because she thought that she would get better. The last week of my clinical at that facility, Mrs. A was suffering greatly and asked for pain medication often. When I reported to the nurse that Mrs. A was still in pain even though she had been given all the medication that she could have, the nurse said that there was nothing more we could do for her because she refused hospice. Once she goes to hospice, the nurse said, they could increase her pain meds (she was on morphine and various other pain meds). I asked her why we couldn't manage her pain anyways and she said that there was some kind of limitation on how much morphine that could be given without being on hospice. ??? Could someone please explain this to me. I felt so awful for this poor woman. I don't know what happened to her after I left. I can only imagine that her pain got severe enough that she eventually requested hospice services so that she could get pain relief.
The second event happened today during my clinical at a subacute facility. Mrs. B is a post surgery pt. in pain, rating her pain at 7/10, with moaning and fidgeting. I didn't take her bp (someone else had taken it) but I took the rest of her vitals and they were within the normal range. She had had 1 vicodin 2.5 hours earlier and it was clearly not lasting long enough. She only had vicodin ordered-1 or 2 tablets. No tylenol, no nothing else for pain. I let the nurse know this and she said that there was nothing more to do for Mrs. B because she couldn't have more vicodin for another 1.5 hours. I asked her if it might be possible to get an order for something else, even Tylenol, and she said that we would just wait and the next time we would give her two vicodin instead of one. The reasoning was that maybe the vicodin would work longer next time with the higher dose. Ok, my question here is, I understand wanting to give the vicodin a chance, but what would be so bad about addressing the pain she was having that very minute? I felt so helpless. I went back to the patient's room and adjusted her and tried to make her as comfortable as possible. I checked her often and adjusted her as much as she wanted. I talked to my instructor and explained what happened and she pretty much agreed with the nurse that unfortunately, sometimes there is nothing more you can do for a person. I guess I'm just really confused. What would have been the harm in picking up the phone and letting the doc know the patient was in pain and needed something more for pain? I don't want to act like I don't trust my instructor's or the nurse's judgement. They know a great deal more than I do, so could someone please explain this to me? I wanted with all of my heart to get on the phone to the doctor and ask him for something more, even a little bit of Tylenol.
