Is pain still the "5th Vital Sign"? - page 2

I believe that when we went to using pain as "the 5th vital sign" and began to routinely use a pain rating scale such as "0 to 10", we watered down the effect of self-reporting with a large portion... Read More

  1. Visit  Aurora77 profile page
    0
    Wow, Ashley, that is crazy. I would have to question a nurse that thinks that amount of dilaudid is going to hurt your healthy husband.

    On the same note, why in earth would any doc think dilaudid will last 6 hours?? I give it a lot (I work post op) and in the vast majority of cases it's 1.5 to 2 hours max. We're so terrified of creating dependance that we undermedicate for pain. It's sad.
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  3. Visit  Ashley, PICU RN profile page
    0
    Aurora, I wondered that myself. And once he got admitted to a floor I spoke to the nurse about it and we got the frequency changed- to 4 hours. It was a very frustrating experience. He, in my opinion, needed a PCA since he was on the add-on list for a cholecystectomy and it was over 16 hours before he could be brought into surgery. If I didn't hate what Press-Ganey is doing to hospital systems, I would sure have something to say when we get the survey.
  4. Visit  MunoRN profile page
    0
    I agree that HCAHPS (referred to as Press-Ganey) is a bit of an abomination, but I hate to see that cause us to turn on everything in the survey. The purpose of good pain control actually has very little to do with patient satisfaction. Proper pain control initially actually reduces overall opiate use during an illness and recovery (those who realize we can't be trusted to adequately control their pain will take this responsibility on themselves, becoming what we then call "drug seekers", even though most of those folks are better described as "adequate-care-seekers"). Patients with sufficient pain control also have better outcomes, both short and long term.
  5. Visit  Bezoars profile page
    0
    I think most doctors prescribe way too much pain medicine. These patients think that at the first twinge of "something" they need dilaudid. The big zero pain tolerance of the 70's has ruined this country. All pain cannot be controlled. I always tell my patients the goal of reducing/making managable your pain... not taking it away completely. Working on a mother baby floor right now and occasionally I will have a mom who just had a vaginal delivery ask for Perc 10's. Um, I don't think so. We have created a lot of the drug problem our society has with our no-pain-should-ever-be-felt attitude. It's just not right.
  6. Visit  Ashley, PICU RN profile page
    1
    Quote from Bezoars
    I think most doctors prescribe way too much pain medicine. These patients think that at the first twinge of "something" they need dilaudid. The big zero pain tolerance of the 70's has ruined this country. All pain cannot be controlled. I always tell my patients the goal of reducing/making managable your pain... not taking it away completely. Working on a mother baby floor right now and occasionally I will have a mom who just had a vaginal delivery ask for Perc 10's. Um, I don't think so. We have created a lot of the drug problem our society has with our no-pain-should-ever-be-felt attitude. It's just not right.
    I'm just curious, have you ever delivered a baby? Ever had a third or, god-forbid, fourth degree laceration? If anything warrants Percocet, that does. Unless you know exactly how much pain they are in, you shouldn't be judging them. That's exactly the reason why people fail to report their pain- they are afraid that they will be thought weak, called drug-seekers, and otherwise judged.

    I really disagree that the health care system has "created a lot of the drug problem" by adequately managing pain, and I don't believe that the majority of people who are abusing narcotics (please note the difference between dependence and abuse) are doing so because they are trying to eliminate their pain.
    SoldierNurse22 likes this.
  7. Visit  Rhi007 profile page
    0
    I'm one of those nurses that will ask about pain but when it comes to myself I have to be vomiting from subarachnoid irritation due to pain before I say anything.....plus you can normally tell by looking at a patient
  8. Visit  boggle profile page
    0
    With the "pt satisfation scores" emphasis put on pain rating and relief, I feel we are pressured into the quick fix ( no pun intended) of pain meds. We are rushed as it is...now also pressured about how the floor rated this month. With that pressure, I see less time spent, ( less time available too), on other measures to control pain and increase pt comfort. Pain is real, but made worse by fear, anxiety, muscle spasms, ..... I long for the time to stay a minute or two with a pt, after medicating, to reassure, to teach and explain what effect to expect, to see if adjusting position would help, and all those other measures that really lead to a comfortable pt, and a Satisfied Customer.

    Chronic pain is awful. A person's own goal may be to get down to a 3/10. At a 6/10, you may not see a wince or frown. You can't judge by the way they look. Just listen to your pt please, even if they don't look like that frowny face on the pain scale page.

    I know I am much more emotive, emotional when I have acute pain then when dealing a chronic pain issue. Acute pain...I get scared and feel vulnerable. When in acute pain, i get the eye roll, she's overacting look. When my chronic pain becomes an issue, i get the skeptical look and questions. I don't show that pain much.

    Don't take it personally. Just treat the pt. Thanks for letting me vent a bit here.
    Last edit by boggle on Mar 6, '13 : Reason: Additional idea
  9. Visit  BrandonLPN profile page
    0
    The beauty of the 5 traditional vital signs (plus SPO2) is that they're 100% objective data.

    Pain, on the other hand, is purely subjective.

    Pain is important, but not a true vital sign.
  10. Visit  Nurse_ profile page
    0
    It's still the 6th vital sign.

    Why?
    If a patient is in pain, their HR, RR, and BP can be affected. If you solve the pain issue, you'll get a better picture of what the patient is really going through.

    Overmedication?
    I follow my assessment and doctor's orders. Does it mean overmedication? Not necessarily. If I gave the patient their PRN and they don't exhibit any adverse effect, does it mean I overmedicate them?

    Bottomline, nurses are there to assess and evaluate, to relay to the doctor that the treatment is too little or too much. How can it be then that a doctor can overmedicate when it is still nurses who administer the medication?


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