Pain shots are us, not this nurse! - page 7

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   P_RN
    Never enraged. If they ask, they get it. I believe the most dilaudid I ever gave was 10 mg q 2h.
  2. by   leslie :-D
    i had a pt as a nursing student, who according to staff and my instructor, was extremely med-seeking.
    when it was time for his meds, my instructor gave him a vicodin instead of his usual 2 lortabs.
    he immediately became inquisitive, and i didn't know what to say-since i was against this act of deception.
    my instructor told him this vicodin was stronger than the 2 lortabs.
    he stated "i think not" but took it anyway.
    an hr later, I was scolded by the doctor, who told me to never deceive a patient like that ever again and furthermore, WHO AUTHORIZED YOU TO GIVE HIM THE VICODIN?
    it was a horrible experience.
    i didn't say a word but waited for my instructor to speak up.
    and she did.
    i was vindicated but ever since then, i don't care if someone is med seeking or not.
    if i can anticipate their needs, i'll give them their prns.
    and i don't care how many addicts there are.
    i need to ensure that everyone is getting their due, esp those that do suffer and are afraid to speak up, because of this ubiquitous stigma we have against pain sufferers.
    if someone is truly an addict or med-seeking, my withholding a prn isn't going to do diddly in the grand scheme of things; but it will agitate and invoke much undue anxiety....and for what?
    because we play God and judge those before us?
    not my style.
    not good for my bp.

    leslie
  3. by   SuesquatchRN
    Quote from earle58
    ....ever since then, i don't care if someone is med seeking or not.
    if i can anticipate their needs, i'll give them their prns.
    and i don't care how many addicts there are.
    i need to ensure that everyone is getting their due, esp those that do suffer and are afraid to speak up, because of this ubiquitous stigma we have against pain sufferers.
    if someone is truly an addict or med-seeking, my withholding a prn isn't going to do diddly in the grand scheme of things; but it will agitate and invoke much undue anxiety....and for what?
    because we play God and judge those before us?
    not my style.
    not good for my bp.

    leslie
    Right on, earle!
  4. by   Tweety
    Quote from earle58
    i had a pt as a nursing student, who according to staff and my instructor, was extremely med-seeking.
    when it was time for his meds, my instructor gave him a vicodin instead of his usual 2 lortabs.
    he immediately became inquisitive, and i didn't know what to say-since i was against this act of deception.
    my instructor told him this vicodin was stronger than the 2 lortabs.
    he stated "i think not" but took it anyway.
    an hr later, I was scolded by the doctor, who told me to never deceive a patient like that ever again and furthermore, WHO AUTHORIZED YOU TO GIVE HIM THE VICODIN?
    it was a horrible experience.
    i didn't say a word but waited for my instructor to speak up.
    and she did.
    i was vindicated but ever since then, i don't care if someone is med seeking or not.
    if i can anticipate their needs, i'll give them their prns.
    and i don't care how many addicts there are.
    i need to ensure that everyone is getting their due, esp those that do suffer and are afraid to speak up, because of this ubiquitous stigma we have against pain sufferers.
    if someone is truly an addict or med-seeking, my withholding a prn isn't going to do diddly in the grand scheme of things; but it will agitate and invoke much undue anxiety....and for what?
    because we play God and judge those before us?
    not my style.
    not good for my bp.

    leslie
    Good post.

    You're instructor was definately wrong. I work with a nurse that gives placebos sometimes without an order, she admitted it, but I haven't caught her in the act, but if I did, I would report her.

    I also don't believe labels put on a patient given by coworkers, at least three times a patent has been labeled, but was actually in serious trouble internally.

    I don't play with people's pain medicines, either and always believe them. It's safer and more ethical, and more peaceful to how my days goes. I still allow myself to get irritated at the patient that says with a smile "you're going too slow, push it faster.......". Sorry, I'm still not Mother Theresa.

    If someone wants to call me judgemental, so be it.
    Last edit by Tweety on Jan 3, '07
  5. by   GardenDove
    I think you have to be really careful being too judgemental, esp in report. I've gotten some really negative reports on pts that seemed more of a personality conflict between the previous nurse and the pt, nothing more. Better to stick with the facts and not make too many assumptions. I can't imagine messing with someones meds. I may have my opinions, but if they complain of pain, I report it and let the doc deal with it.

    Regarding Mother Teresa, I've heard that she was a saavy, tough woman who told it like it was. She was no pushover...
  6. by   smk1
    As a student, I don't have enough experience to say really say what I would and wouldn't do. However pain is a vital sign and I would want to treat it as such. If I have a patient with no outward signs of pain at all, and is getting high doses of narcotics at a regular interval and they constantly say their pain is at a "10", I would have to be concerned that the patient is getting high doses of a drug that is not actually helping them. If a B/P was constantly at 170/110 and didn't go down significantly after medicating the patient with "XYZ" drug, then you would switch to another type of antihypertensive most likely, or at least add another type to their med load. Same for a person with tachycardia or a low o2 sat level. If pain is a vital sign, then I would want to treat it as such. I probably would voice my concerns over the patient continuing to be in so much pain, with no improvement, and let them no that I would be talking to the doctor about alternatives to their current analgesia.
  7. by   TrudyRN
    Quote from chenoaspirit
    Yeah, I do know what you mean. BP and HR WNL with no facial grimacing. I have had patients fall asleep within the length of time it took me to go to the OMNI to get the meds and walk back to their room. I know that pain is subjective and we need to medicate accordingly and I do. I always medicate PRN and as doc orders, regardless of what I "think". But there are some patients who arent drug seekers 'per se' but enjoy the added benefits these drugs provide. I had one patient tell me he would give me half his dose if I would call and get him some percocet Another patient was getting a HUGE amount of morphine via PCA, was upset because doc wouldnt increase his dose AGAIN. He said he was leaving AMA because he could medicate himself better at home. 3 weeks later he was busted for selling drugs. Another patient wanted his pain meds, I asked him to rate his pain on pain scale, he said "0, but I still want my pain meds" and smiled. Just as we shouldnt judge the patients we treat, we also shouldnt judge the nurses who express their feelings. Granted, most patients are truely in pain, but there are some who abuse the priviledge of being treated. And I think those are the ones the OP is referring to.
    Being treated is a privilege? I pay huge bucks for insurance and I think I have a right to medical care.
  8. by   TrudyRN
    Quote from earle58
    i had a pt as a nursing student, who according to staff and my instructor, was extremely med-seeking.
    when it was time for his meds, my instructor gave him a vicodin instead of his usual 2 lortabs.
    he immediately became inquisitive, and i didn't know what to say-since i was against this act of deception.
    my instructor told him this vicodin was stronger than the 2 lortabs.
    he stated "i think not" but took it anyway.
    an hr later, I was scolded by the doctor, who told me to never deceive a patient like that ever again and furthermore, WHO AUTHORIZED YOU TO GIVE HIM THE VICODIN?
    it was a horrible experience.
    i didn't say a word but waited for my instructor to speak up.
    and she did.
    i was vindicated but ever since then, i don't care if someone is med seeking or not.
    if i can anticipate their needs, i'll give them their prns.
    and i don't care how many addicts there are.
    i need to ensure that everyone is getting their due, esp those that do suffer and are afraid to speak up, because of this ubiquitous stigma we have against pain sufferers.
    if someone is truly an addict or med-seeking, my withholding a prn isn't going to do diddly in the grand scheme of things; but it will agitate and invoke much undue anxiety....and for what?
    because we play God and judge those before us?
    not my style.
    not good for my bp.

    leslie
    Did the instructor tell you to give Vic without an order?
  9. by   leslie :-D
    but that's just it skm1, pain shouldn't really be the 5th vital sign as it is not an accurate indicator.
    people with chronic pain have stable vitals.
    one time i had a hospice pt who vehemently denied his pain.
    i forgot specifically what he was on, but it was around 150mcg of fentanyl td;, 2 vicodin hp q4h; and roxanol 20mg sl q2h prn.
    his legs were contracted in a knee to chest position.
    his bp was low, as was his hr (60's).
    granted the meds were likely causing the drop in vs but he would look you in the eye and tell you he wasn't in pain.
    he'd sleep alot too.
    the nurses (yes, hospice nurses) outrightly told the medical director that he never took the prn and refused the vicodin.
    i was the only nurse who would beg him to take it....and he did.
    you could always tell when he felt better, because he'd start singing aloud, blues songs.
    conversely, if any nurse or doctor approached him, he'd get this look of fear in his eyes as if "what are you going to do to me?"
    the med dir ended up dc'ing the vicodin hp and the prn roxanol.
    it was interesting to see the differences in nurses notes when i was scheduled vs. my days off.
    you could see the pain pattern of much worse when i wasn't there.
    finally when the vicodin and roxanol were dc'd, even my notes couldn't state any sort of relief.
    i was furious at my colleagues as well as the med'l dir.
    the med'l director ended up ordering roxanol sl 20mg q3h and vicodin hp 2 tabs q2h prn.
    i persuaded this pt to admit to his pain- tell the nurses.
    he shared with me that some of them made him feel "shameful"....hospice nurses!!! this man was lingering in his deathbed.
    i told my don that inspite of our specialty, there were sev'l who needed a refresher in pain mgmt.
    some nurses it helped, others it did not.

    boy i just went off on a tangent, yes?
    my apologies.

    anyway, pain is whatever the pt says it is.
    and pain is also whatever the pt says it isn't.

    leslie
  10. by   leslie :-D
    Quote from TrudyRN
    Did the instructor tell you to give Vic without an order?
    you know, i was in my first yr of nsg.
    and clinicals were very anxiety producing to me, so i didn't even think to ask.
    if an instructor asked me to do something, i jumped....in my first yr.
    i believe it was my 2nd year i started doing the "hmmmmm" thing and in my third year, i'd been known to tell the instructor(s) to do it themselves, if it was something unethical or illegal.

    leslie
  11. by   TrudyRN
    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:

    When I had surgery, I asked for my shot q3h, even though I wasn't necessarily in pain yet, because I knew it would take time for the nurse to get the keys, get the shot to me, and time for it to work, and by the time all that was done, I would actually be needing it.

    On postop day 3, I was switched to po something and it helped a whole lot more than the shots. Why? Probably because the idiot doc didn't order a large enough dose (ignored my size and just ordered his usual dose) and/or the nurses chose to give me a lower dose, since it was ordered as 50-75 mg. and they picked the lower range. Or were they skimming some of my medication? The doc was amazed that I got better relief with the pills but it was so.

    Maybe you have never been in pain or been dependent? Flat on your back and scared and expected to take yourself to pee the very first time after surgery and a spinal and you were weak and dizzy and nearly fainted/fell? Maybe you never had a spinal headache and were told by your idiot nurse that "You've had all the medication you can have." Boy, did I let her have it. I told her if she didn't call the surgeon or the DON right then that I would do it myself. Within 10 minutes, the surgeon and nursing supervisor were at my side and I was treated properly and the nurse was educated on proper management of spinal headaches. She was probably one of the same ones who gave me the lower shot range. I was expected to lift my baby right after being sliced open (c section), give my own enema, and otherwise do all for myself. Which I preferred but was too sick, weak, and in pain.

    Try to understand that not everyone is faking or trying to mess with you. Try not to judge. Also, I don't get why you'd get enraged. Puzzled, confused, yeah, ok. But enraged? Why?

    Oh, and I am quite stoic and independent. And maybe my VS didn't indicate pain. But a little common sense would tell any decent nurse that a fresh post-op was going to have pain, especially when having to care for self and baby with almost no help from family or staff.
    Last edit by TrudyRN on Jan 3, '07
  12. by   dansamy
    I don't think a patient has ever enraged me. I've felt empathy for those with inadequate pain relief, knowing that I've already called the doctor and I can't get anything else and what's already ordered isn't working. I felt pretty powerless, because I could see clues that my patient was truly in pain.
  13. by   chenoaspirit
    Quote from TrudyRN
    Being treated is a privilege? I pay huge bucks for insurance and I think I have a right to medical care.
    Obviously some of us are focusing on one word rather than the meaning behind the entire post. Some agree, some dont, but we are here to support each other.

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