Pain Management: The 5th Vital Sign

[Zizka]

It's a PITA (pain in the ass) but let's treat it!

Any PRN work is chore.

People use any excuse to put off PRN's.

Let's not be judgemental or puritanical and use this as an excuse not to give pain medication because it means we have to do even more work..

PAIN is considered to be the fifth vital sign. And for good reason.

Because in the past, pain was being neglected, and not being treated.

[Antikigirl, ASN, RN]

Oh no...I didn't mean to come off mean...I just deal with this toooooo much! I get a freaked out CNA or RN that gets all mad at me for not calling a code basically if someone is at 92% pulse ox...and I have been written up and had to take time to actually clarify my actions by showing them pt history, trends, and other clinical information I obtained. And I have yet to be wrong on any of them....and infact after about 3 of these, I am going to do an inservice in the hospital "Treating the patient not the machine".! That should be a good one!

But no one gets upset if we have a pt that is 10/10 pain and scared out of their mind...maybe because that doesn't show up on a machine in a number range we are trained to treat????

BTW...Thank you Earle! You have awesome advice there too!!!!!!!!

[Antikigirl, ASN, RN]

Off topic but I'd really like some opinions. I had a lap chole last week. However, I'd had an adrenal tumor removed a few years ago and had considerable scar tissue that made it difficult for the surgeon. I awoke with severe nausa and apparently had vomited. The wonderful nurse in recovery worked her tail off getting different orders for IV Zofran, changing from Demerol to morphine, etc. When I got to my room, the nurse on the floor got a bit testy when I didn't want oral pain meds. I KNEW there was an order for IV morphine or oral meds. She got kind of snotty saying "You'll get just as nauseated whether you take it PO or IV." I was just too darn tired to argue and took took the PO. What a mistake. Then she came and gave the IV Zofran that was the only order she had for nausea. What would you have done? I'm so mad at myself for giving in to her pressure and starting the misery all over again. I'm one of those that phenegran gives the kicking, jerking reaction.

I would not give PO till you are ready for it physically and emotionally! I would have (now me personally) would have called the MD and asked for an order if possible of Phenergan instead. People either react to zofran or not..and I find NOT being quite common (I work med/surge ortho and deal mainly with post ops and have to advance them...diet and all!). I would keep you NPO except sips or ice chips till the nausea went away...and I would be checking on all your medications with the MD to see if perhaps you are senstive to any of them (on top of a very stressful surgery...go figure you were nauseated!).

Now that is for nausea! I also would have asked for something different than morphine for pain IV. Morphine does tend to make folks nauseated...and dilaudid does a bit better in my experience, or even a duragesic patch to help :) (which is becoming more popular thank goodness). Perhaps something for anxiety too because wow...what a surgery! Also looking at muscle spasms...if those are causing the pain and nausea..why not treat them with flexeril or even valium (which will help with anxiety too).

Can't treat pain till you find the foundation of it...being nauseated, anxious (even if just a little...it hits the body harder than it mentally feels sometimes), spasms, or what not...got to treat that too!

[Tweety, BSN, RN]

I agree that it is necessary and good that pain is focused on and treated now.

BUT don't like the terminology "vital sign".

Pain assessment is not a vital sign. It is not simply asking for a number on a scale or having the patient point to a drawing os a face.

I've been at hospitals where the aide, often not certifies, will document the level of pain. Sorry, this is an assessment for the nurse to perform.

Of course I want to know if the patient c/o pain.

I disagree. Techs are certainly capable of asking a patient "are you in pain, rate it on a scale of 1-10" and notifying us. Then we perform a more in depth assessment as to what, where, how and why, quality, cause, etc.

Respriratory Therapists now ask for level of pain. And of course so do the OT's and PTs.

The responsiblity for treating pain falls on nursing. It's becoming more of a liability because RT's and PT/OT's are writing "nursing notified....." and that the techs are documenting it with their vital signs.

:)

[Tweety, BSN, RN]

Off topic but I'd really like some opinions. I had a lap chole last week. However, I'd had an adrenal tumor removed a few years ago and had considerable scar tissue that made it difficult for the surgeon. I awoke with severe nausa and apparently had vomited. The wonderful nurse in recovery worked her tail off getting different orders for IV Zofran, changing from Demerol to morphine, etc. When I got to my room, the nurse on the floor got a bit testy when I didn't want oral pain meds. I KNEW there was an order for IV morphine or oral meds. She got kind of snotty saying "You'll get just as nauseated whether you take it PO or IV." I was just too darn tired to argue and took took the PO. What a mistake. Then she came and gave the IV Zofran that was the only order she had for nausea. What would you have done? I'm so mad at myself for giving in to her pressure and starting the misery all over again. I'm one of those that phenegran gives the kicking, jerking reaction.

I would have given you morphine if you asked, given the circumstances. However, you must know that a lap. chole. is a day surgery and nurses are encouraged to move to p.o. meds quickly to get you out of there. The nurse however, should have taken your unique situation into consideration.

I'm sorry for your experiences.

[leslie :-D]

I disagree. Techs are certainly capable of asking a patient "are you in pain, rate it on a scale of 1-10" and notifying us. Then we perform a more in depth assessment as to what, where, how and why, quality, cause, etc.

:)

this is my 2nd post?

what happened to my original/1st post?

why was it deleted?

let's try this again.

i agree with spacenurse that nursing should be responsible for doing the pain assessments.

there are far too many pts who deny pain, so further assessment is indicated to explore pt's fear, reluctance, knowledge deficit.

i'm very appreciative of techs/nsg assts who report that they think a patient is in pain, but is not saying anything.

that is my cue to go in and see what i can do.

leslie