Pain shots are us, not this nurse! - page 6

Are you ever enraged by patients who really show no visual signs of pain but say that their pain scale is 10/10 and demand their pain shot every time it's due (thinking that they should know when it... Read More

  1. by   clemmm78
    Quote from Tweety
    I think the original poster did come back and clarify that rather than "engraged" she/he meant "somewhat annoyed", which I took as them acknowledging that "enraged" was a bit strong. See post #14 and decide for yourself.
    Yes, but she specifically asked if we got enraged and many of us are saying absolutely not.
  2. by   jimthorp
    Quote from TeleRNer
    Are you ever enraged by patients who really show no visual signs of pain but say that their pain scale is 10/10 and demand their pain shot every time it's due (thinking that they should know when it is due, as if it was a scheduled med not PRN).
    :icon_evil: :icon_evil: :icon_evil:

    Enraged? Are you serious?

    When someone asks me for their PRN narcotic pain med I assess the pain first. Based on the assessment I may try alternative interventions before giving the med.

    If someone has a narcotic PRN ordered say every q4 and they ask for it that often I will ask the doctor for a long acting med like MS Contin.
  3. by   IamRN2345
    It's their pain, their meds and their call. If it is a PRN med and it is time for them to request it and they do, then it is time to administer it. I'm a nurse in acute care. I'm not a doctor who has ordered it, a specialist in addiction nor a police officer. It's not my job to decide how much pain they are truly having. Patients have rights and one of them is to be given their medication as ordered and if PRN, as requested in a timely manner.
  4. by   MrsWampthang
    Ok, I agree that pain is what the patient says it is. I have to admit that I was ashamed of my reaction yesterday to a patient. But let me explain. This young patient wants morphine every two hours IV, benadryl every four hours IV push, is on methadone 120 mgs every 12 hours, and has oxycondone 10 mgs PO ordered PRN as well as the morphine. Yesterday I thought that I would try the oxy instead of the morphine explaining to her that it was more potent and would last longer. Of course, she was not happy and when her mother came in, asked me why I had done what I had done, which I told her the same thing I told the patient. I told the patient to give the oxy an hour and see how it does. Well, low and behold, an hour on the nose, she wanted her morphine because the oxy "wasn't really working very well." In other words, she was getting pain relief, but not as much as she wanted. So, it was time for her benadryl as well, so I got her the morphine and PO benadryl. When I took it to her,she asked why she was getting the PO benedryl. (same dose), I started to explained to her that it would last longer, but she broke in and started whining that it didn't make her feel the same and it was going to take longer to start working. I think it was the whining that ticked me off. I told her fine, put her morphine in her medserver, (I'm ashamed to admit I shut the door harder than I meant too), and I went to find the charge nurse because I had to get the IV benadryl out of the cabinet that only she has access too. Needless to say, she had to wait longer than she would have had to to get her medicines because I had to walk up the hall to get what she wanted. When I went back in the room she was on the phone to her mommy so I'm sure I will hear about it when I go back to work. I didn't withhold her pain control, all I did was try give her something that would last longer, even though it would have taken longer to work. To me, and maybe I'm wrong, but if the patient would rather have an immediate IV pain shot rather than a longer lasting PO med, the then patient simply wants the buzz rather than the true pain control. I think that it's wrong to encourage the need for this feeling, and like someone else said, we should work on alternative ways to manage pain instead of getting patients hooked on that feeling of euphoria. OK fire away with the flames, I don't like feeling like I am just a narc waitress, there waiting anxiously for the next call lite to go off so I can spring to the narc room and triumphanty bear the holy vial of pain relief to the patient's room, waking him/her up to give it to them. I am so sorry for the vent, but we have had the most demanding patients and families lately that are just sucking the life from all of us at our facilty that I guess I am just feeling the stress. Please don't shoot the flames to hot at me!

    Pam
    P.S. and how was everyone's holidays?
  5. by   JPine
    Quote from GardenDove
    I think the use of the word 'enraged' was an exaggeration in order to express frustration. Just like pts have different pain thresholds for pain, nurses have different thresholds for pains in the tushes.
    No. I think "enraged" is exactly what was meant. There were a myriad of other words or phrases the OP could have used (ticked, miffed...) and even went so far as to punctuate his/her "enraged" state by throwing in childish red blinking-eyed santas. The OP wasn't just "annoyed" when it was written. So, to answer if I ever get "ENRAGED" no, I don't get enraged and guess what? I don't even get annoyed.

    Perhaps if this is causing the OP or anyone else some grief, in the future it will be in his/her best interest to choose a word that is better suited to his/her state of mind instead of simply pulling out a list of assumed synonyms and picking any word that is a remote cousin to the one you actually feel best describes your state of mind.
  6. by   RGN1
    I have to say that in truth it does it grate me that I can have a patient who clock watches for pethidine for abdo pain but tucks into a HUGE Chinese take-away brought in by a relative!! Then as soon as you give the shot wants to go out & have a cigarette!!! This is no exaggeration of a frequent flyer we have.

    I know that pain is what the patient says it is & all that jazz & I don't deny the pain relief either but yes, I do wonder!!! In truth it does annoy me a little because I have better things to do than mess around organising controlled drugs for someone who really cannot be in that much pain!

    However, I want to stress that I do fill the order because if that's what the doc wrote & that's what the patient wants then I don't feel I have the right to deny it but hell yes I complain about it in the staff room!!
  7. by   clemmm78
    To me, and maybe I'm wrong, but if the patient would rather have an immediate IV pain shot rather than a longer lasting PO med, the then patient simply wants the buzz rather than the true pain control.

    Yes, you're wrong. When I'm in severe pain, I can't handle trying to wait for the PO med to kick in - the pain is too severe and often makes me nauseated. I can't take the chance of puking up the PO med and then having to have to go through it all over again, when an IM, SC or IV would have done the same thing but more effectively.

    I don't understand the reasoning that PO lasts longer. A med has a certain half life, regardless of how it is given. One just starts working faster than the other.
  8. by   GardenDove
    The OP said it was an exaggeration, why don't you just believe what she says? She said it was an overstatement.

    People will believe the 10/10 claims to pain by every scruffy, tattood from head to toe pt, but won't believe a hardworking nurse's statements? I think that's unreasonable.
    Last edit by GardenDove on Jan 3, '07 : Reason: sloppy typing
  9. by   shelly_oncRN
    How about the patients that actually set their cell phones to wake them up every 2 hrs overnight so they can receive their 12mg Dilaudid. (off course they also need the benedryl and reglan to go with it.)
    Then the patient who was caught having sex with his girlfriend in the hospital bed, discharged then readmitted the same day and medicated q 2 hrs for "severe" pain.
    There are some genuine and some not so........
  10. by   GardenDove
    12 mg of Dilaudid? That's a hefty dose!
  11. by   shelly_oncRN
    Quote from GardenDove
    12 mg of Dilaudid? That's a hefty dose!
    Not for the sickle cell patients on my last unit - and it was not unusual for the "crisis" to last several weeks - despite no raise in retic or LDH.
    Who am I to comment - the Drs don't want to hear it.
  12. by   Tweety
    Quote from clemmm78
    Yes, but she specifically asked if we got enraged and many of us are saying absolutely not.
    I said I don't get enraged either. I then took into account the milder version of "annoyed" in the post that came after and examined my true self and decided that yes I get annoyed with certain patients. I'm not Mother Theresa.


    I think we need to give the OP the benefit of the doubt with her/his correction is all I'm saying. We need to move beyond the presumption that the OP get's enraged (which they later said they don't) at patients in pain and look at how these patients make us feel. Some of us feel empathy and nonjudgemental compassion. 99% of the time I do too, but every blue moon there is a challenge. Like most of us, 100% I treat their pain regardless of my inner feelings.

    Let's please however stick to the topic and not each other.
    Last edit by Tweety on Jan 3, '07
  13. by   MrsWampthang
    Quote from clemmm78
    To me, and maybe I'm wrong, but if the patient would rather have an immediate IV pain shot rather than a longer lasting PO med, the then patient simply wants the buzz rather than the true pain control.

    Yes, you're wrong. When I'm in severe pain, I can't handle trying to wait for the PO med to kick in - the pain is too severe and often makes me nauseated. I can't take the chance of puking up the PO med and then having to have to go through it all over again, when an IM, SC or IV would have done the same thing but more effectively.

    I don't understand the reasoning that PO lasts longer. A med has a certain half life, regardless of how it is given. One just starts working faster than the other.

    No, I'm not talking about someone in obvious, nauseating pain. I'm talking about someone who had had 10 mg of oxycodone an hour before, and was sitting on the bed in no visible distress. I know pain is what the patient says it is, but when a patient is whining to me about benadryl IV vs PO then I have to wonder if the patient wants the immediate high or the overall benefit of the medicine I am administering and she was getting (and did get) her morphine like she asked for so I wasn't withhold her IV PAIN med. I'm no one's servant, that's not why I went to nursing school and it seems like society has turned expectations people have of nurses, into we're happy to bend over backward to please you, stepford nurses. It sickens me sometimes and the biggest reason that I don't miss ER at all. And no, I usually don't show it in front of the patient, but yes, I and my coworkers do plenty of griping about it in the nurse's station and my coworkers agree wholeheartedly with the way I feel. Are we an uncaring lot? No, just sick and tired of being jacked around by patients that think we have nothing better to do than run up and down the halls chasing their prn narcotics when we have 6-7 other patients that we are supposed to be taking care of. And yes, I did admit that I was ashamed of the way I acted; there was no excuse for that, and it won't happen again.

    Interestingly enough, I have been taking care of another patient who requests his dilaudid every 3 hours. Rather than wait for him to ask for it and not have time to get it and have him get mad, I just try to watch the clock myself and get it to him. It makes him happy, and it makes my life easier because he knows that he will get the dilaudid in a timely manner and if I'm a little late with it, he's ok with that. I'm probably the only nurse in the building that will do that for him, but as I tell them when I give report, he won't ask for anything if you just keep his dilaudid on time. Inconsistant, I know, but even though I get along great with him, he is in the group of patients that none of us can take care of for more than two days in a row because of all the wants and needs. They just suck the life from us and make all of us feel like we are drowning all day. I had had this group for several days prior to my run in with the first patient, so I probably was a little on edge about doling out narcotics.

    Oh well. Again, sorry for the vent. Hope everyone is starting the new prosperous.

    Pam

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