Pain control in narcotic addicted pt Pain control in narcotic addicted pt - pg.6 | allnurses

Pain control in narcotic addicted pt - page 6

Hello all: In my practice I have encountered several instances of objectively addicted pts being prescribed massive amounts of narcotic medications. May I make it clear that these are not pts... Read More

  1. Visit  ToothFairy(5) profile page
    #65 0
    Quote from BrandonLPN
    Well, why should a nurse be allowed to hold physician ordered pain meds, unless there's assessment data to back it up? Why is that something to say "alas"about? Can you imagine what a slippery slope it would be if a nurse could just say "no, they're not really painful" and withhold the med?

    If it really bugs you so much, look at it this way: when you give a drug seeker PRN narcs you're still treating them. Even if they're not "painful" in the way you or I define the word, they still have something going on physically and psychologically where giving them the med is the most therapeutic thing you can do at that time. You're not working in a detox facility. Deciding unilaterally that it's time for them to go cold turkey is not a very "nursey" thing to do.
    I agree.

    I work in a detox and don't withhold. If the person is due a narc, I give it period. Withholding can have harmful effects. If the COWS or CIWA is still high and the person is not comfortable I call the MD. No one suffers on my watch, period. We never let anyone go cold turkey though.
  2. Visit  Quit Floating Me profile page
    #66 0
    Quote from BrandonLPN
    You're not working in a detox facility..

    Actually, I am.

    And thanks for all the flames. It was getting a little cold here. Remind me to never share my opinion/thoughts on any matter on this website (hey, isn't that the purpose of this website?). You guys are horrible. Thanks for the berating, name calling and downright nasty comments. I forget how nasty nurses could be.
  3. Visit  BrandonLPN profile page
    #67 0
    Quote from Quit Floating Me
    Actually, I am.

    And thanks for all the flames. It was getting a little cold here. Remind me to never share my opinion/thoughts on any matter on this website (hey, isn't that the purpose of this website?). You guys are horrible. Thanks for the berating, name calling and downright nasty comments. I forget how nasty nurses could be.
    OK, my bad. I thought you said you worked med/surg

    But I still think wanting to be able to withold meds becasuse you can "tell" that theyre not really painful is not a good way to go about medicating people. Regardless of setting.

    You have an opinion that, apparently, is not shared by a number of us. Hence the replies. Don't take it too personally.
  4. Visit  Jory profile page
    #68 0
    Quote from dankimal
    Hello all:

    In my practice I have encountered several instances of objectively addicted pts being prescribed massive amounts of narcotic medications. May I make it clear that these are not pts with low pain tolerances, these are confessed addicts with telltale signs and symptoms of narcotic addiction. They will manipulate, exaggerate symptoms, fabricate symptoms, and will go to great lengths to have more meds.

    My question/comment is this: After all physical causes of pain are ruled out, isn't it simply enabling to allow this population to remain admitted with increasing amounts of pain meds to satisfy ever increasing self reports of pain?

    Perhaps our mantra of "pain is whatever the pt says it is" should be modified to "pain is whatever the pt says it is until objective signs prove pt reports of pain to be unreasonable."?
    Rule #1 of pain: The pain is what the patient says it is.

    I don't have a DEA number and I don't prescribe...my responsibility is limited to communicating my thoughts to the prescriber and to make sure that the dose isn't lethal ONLY I am responsible for administering..otherwise, it falls on the pharmacist.

    It is the physician, not the nurse, that has to answer for it. I don't work for a drug rehab center and drug addiction is mostly a choice.

    However, you also have to remember that if an addict has true pain, it will take a much higher than normal dose to get that pain to an acceptable level.

    Other than that, I don't get in the middle of it when I float to adult floors. I communicate and chart what I am supposed to and let the physician make the decision. After all, at the end of the day, all it does is 1) Gets you into trouble if the physician complains 2) The physician gets another nurse to administer the meds. 3) You are still in trouble.

    That is why, I don't argue with it.
  5. Visit  Jory profile page
    #69 0
    Quote from LuxCalidaRN
    Wow! I think there was a misunderstanding...I'm talking about the ones whose pain is NEVER under control because we've amped up the doses and overrun their mu and kappa receptors for 20+ years. When it still hurts on hydromorphone, vicodin and percocet for breakthrough pain, it's time to look for other solutions.

    I was in no way doubting the legitimacy of their pain! They're crabby because their life hurts! And IMO, they're hooked because of us!
    No, they are hooked for two reasons:

    1) Because of illegal drugs

    2) Because of physician's prescribing prescription opiates on an OUTPATIENT basis. Unless someone has been in a burn center or in the hospital an extended period of time (as in, several weeks or months), no, they are not addicted because of a few days of morphine following a surgery.

    I rarely take a Tylenol and had a surgery where the IV meds were not controlling my pain following a major surgery..it wasn't even tolerable. The RN was a little nasty when I kept telling her that what she was giving me wasn't touching it.

    I know what it's like to NOT have a drug problem and have a nurse assigned to you that holds back pain meds. They heard about it during the evaluation.
  6. Visit  Quit Floating Me profile page
    #70 0
    Quote from BrandonLPN

    OK, my bad. I thought you said you worked med/surg

    But I still think wanting to be able to withold meds becasuse you can "tell" that theyre not really painful is not a good way to go about medicating people. Regardless of setting.

    You have an opinion that, apparently, is not shared by a number of us. Hence the replies. Don't take it too personally.
    So I should be Flamed for having a different opinion? I went back and reread my post and I do find my comment stating that I know who is in pain or not is inaccurate and wrong. There really is no definitive way to tell. On that note I would never never withhold medication because I felt like it. I was actually commenting against those nurses That do withhold medication.

    Still the responses that I got to my comment Was like a pack of starving dogs fighting over a tiny morsel of food.
  7. Visit  Quit Floating Me profile page
    #71 0
    Quote from BrandonLPN

    Well, why should a nurse be allowed to hold physician ordered pain meds, unless there's assessment data to back it up? Why is that something to say "alas"about? Can you imagine what a slippery slope it would be if a nurse could just say "no, they're not really painful" and withhold the med?

    If it really bugs you so much, look at it this way: when you give a drug seeker PRN narcs you're still treating them. Even if they're not "painful" in the way you or I define the word, they still have something going on physically and psychologically where giving them the med is the most therapeutic thing you can do at that time. You're not working in a detox facility. Deciding unilaterally that it's time for them to go cold turkey is not a very "nursey" thing to do.
    I am. I work on the a dial diagnosis unit so I get clients with mental illness and/or addictions along with detox. I have handed out my fair share of Librium for etoh WD and clonidine for opiate wd. I do not hold meds just because and I am sorry my message came across that I did. That is appalling!!
    Last edit by Quit Floating Me on Jul 23, '13
  8. Visit  BrandonLPN profile page
    #72 2
    Quote from Quit Floating Me
    I am. I work on the a diagnosis unit so I get clients with mental illness and/or addictions along with detox. I have handed out my fair share of Librium for etoh WD and clonidine for opiate wd. I do not hold meds just because and I am sorry my message came across that I did. That is appalling!!
    Ok, thanks for clarifying.

    I agree that working with people with narcotic addictions can be very draining. Especially on a busy shift. And then there's that sinking feeling when you see a frequent flier return.

    I think most nurses know what that's like and can sympathize with the feeling of frustration.
  9. Visit  Esme12 profile page
    #73 0
    This thread is TWO years old and it is always good to revisit these topics we need to remember that we all do not work the same areas and that the goals of treatment are different.

    Allnurses promotes
    the idea of lively debate. This means you are free to disagree with anyone on any type of subject matter as long as your criticism is constructive and polite. We also ask to please refrain from name-calling. This is divisive, rude, and derails the thread. Our first priority is to the members that have come here because of the flame-free atmosphere we provide. There is a zero-tolerance policy here against personal attacks. We will not tolerate anyone insulting other's opinion nor name calling.

    Our call is to be supportive, not divisive.
    We can all agree to disagree without being disagreeable.

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