Quote from ella2990
(**YES THERE ARE PAIN LEVEL PARAMETERS, but this pt is very manipulative and will do anything and I mean ANYTHING to get her beloved pain meds***)
Bottom line, I did not cater to her, I did not give her pain meds EVERY HOUR I made sure that atleast 2 hours has passed before I give her another pain meds.
Considering how you've worded this, can you honestly and confidently tell me that patient safety was the ONLY thing that affected your decisions?
So the nurse from previous shift was basically giving her pain meds every hour!!
How did the patient tolerate this? How were her vitals during the previous shift? Any concerns?
Needless to say, she threw a **** show and threw the biggest tantrum a grown woman could every throw.
A patient addicted to opioids whose postoperative pain is adequately treated but who is craving the next "fix" might display this behavior.
A patient addicted to opioids and craving the next "fix" and
whose postoperative pain isn't adequately treated can display this behavior.
A patient who isn't addicted to opioids and whose postoperative pain isn't adequately treated can display this behavior.
See where I'm going with this...?
I MEAN I KNEW HER TOLERANCE FOR PAIN MEDS ARE HIGH GIVEN HER HX. BUT YOU REALLY NEVER KNOW WHAT WILL HAPPEN. 1 DAY SHE COULD BE FINE THE NEXT 2 FOR ALL I KNOW SHE'S OD from pain meds.
If you are going to administer pain medication according to what might possibly happen in the future, you'll have to quit treating all
your postoperative patients pain. Period. Withhold it all
, you never know what could happen. (I'm obviously not recommending this course of action).
If the patient describes pain that meets the parameters where you should administer the prescribed medication and the patient's vitals permit it, give the med as ordered
. Always follow up on the patient's status after administration. The same rule applies to all
patients whether they are IVDUs (I'm none too fond about referring to patients as acronyms or abbreviations, but that's another story), or not.
Someone addicted to opioids and
who has had surgery will as you've correctly identified normally need higher doses, sometimes significantly higher doses in order to adequately treat their pain, than a patient who is opioid-naive.
Do you even know what her regular intake of opioids is? It's actually possibly that by not giving the patient her prn's when she asked for them (I'm assuming those are the ones you chose to withhold?), you were actually giving her less
than what she normally takes on a daily basis, only now due to her surgery she's experiencing more pain than normal.
From reading your post, I think you really need to do some soul-searching here. Make sure your potential biases against intravenous drug addicts or a fear/dislike of being manipulated, isn't affecting your decisions. You have a patient who has had surgery. The patient's reported pain and vital signs are the only things that matter here.
"Customer" satisfaction isn't in my personal opinion a factor or a priority here, but good control of post-surgical pain, darn well is.