Infection from Hell/Pain Scale Epilogue

SmilingBluEyes · Aug 30, 2004

wonder if a baclofen pump would be good enough for said doctor's family member in pain????

nurseygrrl, LPN · Aug 30, 2004

Yes, they have Baclofen pumps and they have been a God send for many of the MS and SCI patients at my facility. It greatly reduces muscle spasms, contractures and the related pain due to them. They work by delivering metered doses of Baclofen directly into the spine. They do reduce pain in most patients, but in some they do not. Also, in some patients they do not reduce pain enough to eliminate the need for analgesics. I'd like to smack docs sometimes!

SmilingBluEyes · Aug 30, 2004

I am sure baclofen is a godsend to some...but when it's obviously NOT working sufficiently, time to try SOMETHING else, not just blow it off.

leslie :-D · Aug 30, 2004

furthermore, neurogenic pain and neuromuscular pain have 2 different etiologies.

the baclofen would assist in relieving neuromuscular and would not address neurogenic.

CHATSDALE · Aug 30, 2004

I agree that acute pain is best relieved with a constant blood level....first day after surgery i didn't know i was in the world....given one demerol pust 2nd day...after that apap#3 prn...needed maybe one or two...these nurses were experienced post op and i got some really good care

jannecdote · Sep 14, 2004

We can thank the Joint Commission for that stupid pain scale. It's something they can look for and check off their list. I agree that it is a ridiculous method of assessing and treating pain. Pain meds are immensely more effective if constant levels are maintained, but most docs were taught that they should only be ordered PRN, because there are still people who believe that patients that are in pain can become addicted to the medication. Nonsense. They NEED the medication. The body heals better when it is not having to cope with high levels of pain. I have seen a few docs starting to order scheduled pain med doses, with a separate PRN order for breakthrough pain. I think that method makes more sense.
Many nurses seem afraid to give narcs for various reasons (especially if surrounded by other nurses who don't give them - they are afraid to be the only person giving narcs at regular intervals, for obvious reasons). The scheduled doses take that out of the equation. Scheduled doses also takes out of the equation nurses that are either not responsive to their patients pain or just too darned lazy to go to the Pyxis -- or whatever -- and take out the narc. There is no excuse for that, by the way, but I'd say most of us have seen it happen, nonetheless.

I need to make a copy of that last paragraph and post it at work!! Sometimes I actually feel paranoid because I firmly believe in giving out pain meds regularly to those who need it and I feel like The Pain Med Queen on the shift. The CNA's I work with tell me they like working with me because they know the patients won't be restless during the shift. I've heard too many nurses telling stories about other nurses who dope their patients up so they won't be bothered with them or keep a portion of the narcs for themselves. I just want my patients to be comfortable and pain free!!!!!

LydiaGreen · Sep 14, 2004

I like the pain scale and think that it works if explained properly to the patient, understood properly by the patient, and if the patient is aware of the nature of severe pain (ie. not waiting for the pain to climb to a 9 or 10 before asking for something - keeping on top of the pain on a regular schedule to prevent it from getting out of control). The problem with the pain scale is when a patient does not understand it, when a patient is too stoic for their own good, or when a patient is not cognizant enough to utilize the scale.

We have routine orders for pain meds for certain types of surgeries including the PCA pumps. The prn orders can be a problem. If it's ordered on a regular basis, a normally stoic patient would accept it - if it's on a prn basis, they will wait and wait and wait until they are climbing the walls with pain before asking for it and will deny pain until they are blue in the face.

The pain scale works well for some, but not at all for others. There should be an acceptable and approved second system for patients that the pain scale is not appropriate for.

CHATSDALE · Sep 22, 2004

Whew! Glad to just be able to sit here and post again!
Last time I was here I had just visited the ER Fri the 20th - simply couldn't stand that prostate agony (and paying $133, almost half my first paycheck, to hear the followup MD say my urinary tract was just "irritated" by being cathed did not improve my mood either :angryfire ) any longer. Anyway, it was a long wait but the doc said yep, acute prostatitis. D/C'd the Levaquin, started Septra DS and also got a Rx for Vicodin 5/500. Finally, I thought, some definitive relief!
I was terribly wrong in my assessment. :o
Saturday at work (14 hr shift) around 1330 I started getting dizzy, figured I'd possibly taken too much Vicodin (1 or 2 tabs po q 4hrs, I took 2 tabs around 0900 and 2 again at 1300). From there I quickly deteriorated, raging fever, chills with severe shaking, cold even with 2 shirts on and the room temp over 80F, then meltdown with prodigous sweating. Called the on-call to get a staff in to relieve me, he was miffed, said I was getting to be unreliable and he couldn't find anyone, so just hang in there. Yeah, right! The rest of the day was pure hell, me sitting on the couch barely conscious and the client I work with throwing tantrums (kicking stuff, throwing objects, etc) because I couldn't take him out (I did try to explain, but no luck). Staggered home at 2300 and spent a very restless, sweaty night, then right back to work at another ISL for 11 hours this time because I had to assure the on-call I'd work Sunday so he wouldn't ask my supervisor to fire me (he tried anyway). Again another hellish day - was cold even OUTSIDE in near 90 degree weather with sweat pants and a black long sleeved shirt, going between nuclear meltdown (one of the more laid back clients said I looked like a giant red Roman candle to him) and freezing purgatory. My tempurature fluctuated between 103 and 104 degrees, possibly even higher. Also constant dry heaves, couldn't and didn't eat a single thing at all from Friday afternoon through Tuesday evening. My blood sugar slid all the way down into the low 70's, probably the lowest it's been in 2 years.
Tuesday morning around 0515 I wake up and instantly I know I have a SERIOUS problem. I can't breathe right. Actually, I couldn't take a deep, full breath. Sat up and was able to take a bigger breath with some difficulty. After brief consideration of the situation (high cardiac risk, no good reason for the fever to go on, etc) I drive to the ER, for the third time in 17 days. ER was about empty, they took my vitals straightaway and after me describing my respiratory distress leads me straight to one of the medical rooms, the one with the heart monitor and all those scary gizmos. Hooked up and damned if my heart isn't gone all crazy. Not those nice 'beep, beep' steady spikes you always see but sheer chicken scratch. Now I'm getting REALLY worried. They did an EKG, chest X-rays, took blood, then the doc ordered a CT scan. During CT scan the nurse practically RUNS into the rooms with a plastic cup FULL of these ENORMOUS blue/white capsules and says "Your potassium is really low.....take these NOW". Turns out my potassium level was just 2.6 (normal ref range 3.5-5.0 per lab printout)! Eventually they ER finds a doc to take my case and I'm admitted, they started me on IV potassium and went back to Levaquin, IV as well.
The hospital stay was pretty straightforward, but LOTS of blood draws! I think they got me 11 or 12 times, 7 or 8 the first day alone. My left elbow is a horrid black and blue mess, got me on the top of the left hand a couple times too after a nurse was forced to give up on the elbow (IV was in the R elbow, the ER nurse mumbled something about the CT protocol requiring it there, true?). My sodium has been constantly below normal (128 to 132) for sometime, too. Blood sugar took off like a rocket soon as I started eating, so had to take insulin along with my PO meds (glipizide, atenolol/chlorthalidone, Lisinopril, Avandamet) to keep it down (it went between 200-350 or so).
The nurses and assistants were all great, very nice and helpful! :) I was lucky that the doc who admitted was a nice guy that was always willing to stay and listen to any of my questions and explain things all the way through, even if I didn't like to hear it. Normally I would have wanted out of hospital just as fast as humanly possible, but the doc said he was concerned if I got out too soon I'd relapse (indeed every day my temp would rise over 100) and I'd be back in hospital. After 3 weeks of ghastly misery in all forms I couldn't agree more. If I had to stay at work for 3 days in agony again I'd find a sword to throw myself upon and be done with it.
Finally got discharged today, I have to take the Levaquin for a MONTH this time ($$$$$$!), also some Vicodin and my usual meds. Need to get hooked up with a clinic and get some help paying for my Rx, espescially the Avandamet (been off that for some time), and schedule a follow up with a (hopefully good) primary care physician that my hospital doc has recommended ASAP to evaluate and set a medication regimen for the long term.
OK, finally to the pain scale epilogue.....
I'm convinced the scale is useless now! See, every time I called the nurse to tell her I needed some pain meds (Narco...Vicodin by another name) she would come and ask what kind of pain, any specifics and oh yes, how would you rate it on a scale of 1 to 10? Well......its better than it was on Tuesday but it still hurts enough I wouldn't have called and asked if I didn't think I could take the pain! Friday night the nurse simply gave me Tylnenol....nope, that didn't help. Still gotta take the heavy stuff. The lab culture ID'd Enteroccocus as the offending bacteria, by the way. Its pretty difficult to eradicate, according to the doc. Eradicate the infection, and you eradicate the pain.....till then my rear end is just gonna be sore :imbar
My .02: be careful assuming that a guy's pain is suddenly gonna improve from Vicodin level to Tynenol level (so to speak) with an active infection. If you try to titrate (and mind you, while I don't think the doc had any such order, I can understand the logic of trying to titrate to a milder, non-narcotic agent perfectly well) and the patient says its not working.......it probably isn't. My Saturday morning nurse was aghast that I hadn't gotten any pain med all night and morning even though I'd requested it several times, apparently there had been some kinda 'breakdown' and who knows, maybe the Friday night nurse had been distracted or something. But she said emphatically if I didn't get a pain med in 15 minutes to call again and complain - loudly (alas, I'm the type that would rather suffer than appear to ***** about something).
I need to go lie down now Your responses, rants and rebukes are welcome as always.
Regards,
Tom

haven't seen you post in a while wanted to see if you over the hump painwise...when you are in a hospital you relingquish control over yourself .. something that all adults hate to do .. and it you have a dingbat that doesn't believe you when you are hurting it can really be a bum experiience...you take care of your pts like you would want to be taken care of....

zacarias, ASN, RN · Sep 22, 2004

they have baclofen pumps?????????
and isn't baclofen a centrally acting muscle relaxer?
not the same as an analgesic.....hellloooooooo, knock knock knock anyone home??(knocking on doctor's head)

On the floor I used to work at, we had a lot of SCI folks and they had implanted baclofen pumps. Of course, the first time I didn't know they were implanted so upon hearing that my patient had a baclofen pump in report, I looked all over the room for it and then when I turned my patient, I looked in the bed and was thinking "gosh I hope he pull it out."

**canoehead, BSN, RN** · Sep 22, 2004

I gotta agree with everyone, except I like the pain scale, when it works and the patient understands it. Since I can't get in their body and mind it helps me understand how they are feeling and how well or poorly the meds are working. Of course sometimes you get the LOL who doesn't understand and is too sick to think...and we still have to use it. Then I just make up something and write it as a nurse rating (for all the good that does)

FZ1Tom · Sep 24, 2004

Hi Chatsdale -

yes, its been a few days. I was in the hospital again. When I got home after the first go-round on the 28th things seemed to improve steadily, rested, etc. Back to work on 9/4 and got some N/V, etc. Then I had more pain sitting down again. When the Vicodin Rx ran out Thursday the 16th the pain increased rapidly to excruicating levels, spent an overnight shift lying on my right side. To make a long story short they found out Saturday after a pelvic CT scan I had a big abcess in my prostate. Small wonder I was hurtin' so much. Just spent the last 5 days with a transrectal prostate drainage tube in and a foley along with LOTS of IV antibiotics. Wednesday they put in a PICC line so I can continue taking my antibiotics (Cefazolam, Clindamycin) via IV at home for the next couple weeks. Followup CT scan looks pretty good, only a very little residual and hopefully the meds will help clear that up (culture ID'd it as a very sensitive staph according to the infectious diseases doc, wide range of antibiotics to choose from. So hopefully things should work.

Thankfully, for the first time in almost two months I can sit down something normal - what a relief!

Tom

CHATSDALE · Sep 24, 2004

TOM i am glad that they finally made a dx in your case....but it sounds like the cure was as rough as the problem...i bet this is one thing yhou won't forget in a hurry...draining the abcess along with the antibiotics will give your body a chance to heal...you concentrate on controlling your diabetes and your weight i can tell you from experience that it doesn't get any easier when you get older do it now good luck