My patient an addict or does he actually need it?

Nurses General Nursing

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So back on the LTC floor I'm on, we have a new admit and the guy is quite a handful. The guy has typical diagnoses for an LTC patient in our facility: dementia, hypertension, and depression. I had to check over the patient's MAR and a few things stuck out to me:

1. The man is on round the clock Oxycontin 40mg every six hours for a diagnosis of "pain management". However, I read the initial pain assessment and the patient claimed to be in no pain. That could be part on the admitting nurse not wanting to do that form since some people can blab for hours about that stuff. But, when I asked the patient what he has pain in he said it was for severe arthritis. But I can't find any supporting diagnosis in his chart to warrant such medication.

2. He gets two different round the clock doses of Xanax.

3. He seems to go: "AHHHHHHHHH PAIN IT HURTS SO *BEEEEEEEEEEEEEEP* BAD I NEED A PAIN PILL." or "I NEED A XANAX NOWWWWWWWWWWW" conveniently 30 minutes before the due date.

4. When #3 happens and I tell him that I'll go out and get it, the jackass presses the call bell as soon as I leave and when I go back to answer it he asks if I have the pills. Of course not I just walked out the room!

Now, I do have patients that are in chronic pain and I won't hesitate to believe them when they ask for relief, but this guy and another lady who also asks for PRN meds round the clock get on my nerves. I want to call them addicts and call them out. What can I do about this?

My supervisor said that the administration is aware of these things going on but they can't do much. What makes it even worse in my opinion these patients are on Medicaid/Medicare so taxpayers are footing the bill for this stuff.

Oh I just realized I put this in the nursing poll section. Could I have this thread moved?

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Specializes in ED, Family Practice, Home Health.

Hmmm. Yes these types of patients are annoying but there really isn't much you can do about it except bring the ordered meds when requested. A doctor ordered the medications after doing an assessment. Even people with legitimate pain develop tolerance and can experience withdrawal. You don't know what that person feels and "pain is what the patient says it is". With this type of patient I try to remind myself that their life is horrible. If pain medication makes it better, either through actual pain relief or through a placebo effect, it's not for me to judge. With someone on long term pain management they are unlikely to be getting high on the doses ordered for them, they have built up a tolerance and are likely staving off withdrawals and/or preventing pain, both legit reasons to give someone meds.

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Specializes in CCT.

Being dependent on and needing a med are one in the same. Opiate withdrawal is ugly if you've never seen it.

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If he says he has pain then treat him for the pain. There is really nothing that you can do that will really help this guy if he is in fact an addict, the illness would continue when he leaves. Everyone feels pain differently and everyone has a different pain tolerance, so just by observation it would be hard to say what they are feeling. Also, even if he is an addict he still deserves treatment for his pain.

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Specializes in PICU, ICU, Hospice, Mgmt, DON.

The answer to your question IS your question...if he is an addict...he really does need the medication...one, he can still be in real pain and two, he will be going into withdrawal without it...so yes, He actually needs the medication.

It is really not your place to judge, so I would just treat him like anyone else and medicate according to what he says his pain is. If he is addicted, hopefully he will get treatment someday, but that is not your concern right now.

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Specializes in LTC.

It's super irritating, I'm in LTC as well, and we have a guy that will wake up from a sound sleep to demand Xanax because he's so "nervous" He's also on a lot of pain medications that he'll demand the same way. The last time he threw a fit because I was in the middle of a wound treatment for his room mate. He started yelling and screaming, ended up calling me "A conservative hussy!". :o

There's nothing you can do if the doc doesn't want to address it. If he needs it, or not, it's still ordered and you still have to drop everything to give it to him so that dang light will stay off. :p

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Specializes in LTF, ALF, Primary & Rhuematology offices.

Psych consult for the xanax if you feel like that is not managing the issue in ltc u usually have that standing order. But if not notified the md of your concerns and let him/her know that u have a pt that u feel anxiety and pain meds are not seeming to control the problems and your observation r/t pain, meds, n comments and ur thoughts of abuse. Reminded them that he is a new admit so u may or may not have the total hx so ask the pt to fill in. Then let them know u would like a psych n pain management consults to help identify other issues. We all know depression causes/ exasperates pain so he may have some pain. But I'd let my in md know what I am noticing never just stop his meds if he has had prolonged use he needs to be weaned off. Ltc is very tricky for pain I had a man taking 50mg lyrica tid, 1mg ativan tid , 20mg oxycodone tid, 5mg ambien q hs all at one time plus percocet 10mg n ativan 1 mg prn q6. He told family he was in pain but told staff she was depressed n just wanted to get her high to get away. We reported it his md dc'd meds to bid n no prn and he got mad and changed md kept requesting to be sent out bc of chest pain. When the er md wouldn't give the meds he wanted and the new said no he and his family called state n he got them. Then when he went to .being so high he couldn't remember if he had stuff or care bc by know he all the old stuff plus fentyl patch 75. His family was mad bc she called them confused all times of the night. they dc'd the patch. This was a person who had documented manipulating behaviors but because he said he had pain he had pain. I think he did honestly have pain but the meds really did provide his with an escape. All we can do is provide the pt, md, rp, a nd administration with the information and document document document. I even refused to give the meds when he was out of it and was reported but bc I documented that he was out of it it saved me from state bc I had another nurse n supervisor document each time always at least one witness.

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Specializes in Med/Surg, Geriatric, Hospice.

Get used to these types of pt's in LTC. They are very prevalent and it will probably never change.

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If he denied pain, maybe it's working? :confused:

If he's not coherent enough to get a real assessment, maybe see what the doc says re: history of painful conditions- if nothing else, so you know why you're giving it to assess for changes in condition :)

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Specializes in Oncology/Haemetology/HIV.

Xanax is a drug that cannot be abruptly stopped or held in a long time regular user. Withdrawal from it is really ugly and can cause seizures.

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Specializes in NICU, ER, OR.

You cant and shouldnt do anything. a physician orderedt he meds, you have to give them....and you are not an addictions coulselor...... even if the patient is not an addict, he has developed a tolerance... and that happens in every person, its not a choice.....

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Xanax is a drug that cannot be abruptly stopped or held in a long time regular user. Withdrawal from it is really ugly and can cause seizures.

Yep. Used to have LTC patients' docs d/c long term benzos and wonder about the new onset seizures :uhoh3:

Opiate withdrawl isn't in itself lethal but can cause some dehydration and electrolyte imbalances that could trigger some nasty issues.

Neither are safe stopped cold-turkey.

:twocents:

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