Pain shots are us, not this nurse!

Nurses General Nursing

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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:

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 :nono: 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.

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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?

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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

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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

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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.

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Specializes in Going to Peds!.

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.

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Specializes in Med/Surg, Home Health.
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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Specializes in Med-Surg.
I think this response was needed here. Thank you.

You're very welcome. We might as well keep it real.

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Specializes in Med-Surg.
No, I'm not lying when I say I can't relate to someone else who becomes "enraged" at their patient.

I'm not saying that you have to have been "enraged" to be able to relate to the OP. And besides, the "enraged" was an exaggeration on the part of the OP. She or he was exaggerating because it felt good to do so. She was venting here. Nothing wrong with that. It is very frustrating, and like I said, i believe that is what this poster was trying to convery: frustration.

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Specializes in Med-Surg.
I don't need anyone to apologize for me. If I need to apologize, I can do it well on my own, thank you.

My post, and many others, were to point out that you CANNOT decide yourself if a patient is in pain because they don't act the way you think or feel that they should.

And, no, I'm not lying. I have never become enraged at a patient, nor would I use that term to emphasize a point. I have become annoyed and frustrated from time to time. But please, don't ever apologize for me.

Well, since you didn't have the humilty to apologize for bashing the OP, I did it for you. Now, will there be anything else? If not, have a good day.

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Yeh, it can be time consuming to get that pain med to the patient every 2 hours, but:

1) it helps keep your time paced for the day (wow, 2 hours have gone by ALREADY?!!!)

2)If that's the least you can do for that person that day, hey, piece of CAKE!

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Specializes in Med-Surg.
if by chance this was directed at me, i don't need anyone to speak for me. i can and do speak quite well for myself, thanks. also, just for the record, i, personally, was not "judging" the op for her comment. i was simply stating my opinion regarding the subject. when a person comes to a forum such as this they can't and shouldn't expect every other person to agree wholeheartedly with their statements. nor was i "lying" when i said i had never been enraged at a pt who requested their prescribed pain meds. sure we all get stressed out from time to time when we have too much going on, but "enraged," not me.

pts who are in the hospital "who have no other problem except unresolved pain" have just as much right to expect adequate nursing care as the next person. their physician likely admitted them to determine the root cause of their unresolved pain and attempt to relieve it, that's where we nurses come into play.

my post was also to point out that many ppl don't wear their pain on their sleeve, and may not display visible outward signs of pain. while at the same time my have vitals wnl and still be very painful. not everyone is going to curl up in the corner writhing from pain. people in general have varied levels of pain/pain medication tolerances. the whole concept of pain management is to find a therapeutic level of meds, along with treatment modalities to allow the pt to function, and have some sense of normalcy in their lives.

someone else said it's sad that pts feel they need to act a certain way in order to get their prescribed pain meds, i definately agree. it's very sad, indeed, that people have been programmed per se to display certain actions to make their pain appear believable. as far as others who may be talking to people, watching tv, walking around, doing puzzles, or whatever, perhaps they are doing such things to distract themselves from their pain. distraction can be a very good coping technique to many. as i said before, pain is what the pt says it is, plain and simple. it is not our job to pass judgement on our pts. it is our job to give good nursing care and comfort our pts with whatever means we have available to us. if that involves giving them prescribed pain meds when they request them, so be it.

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:yeah: go gators!! :yelclap: sec champions!! :yeah:

:w00t: national championship bowl bound!! :w00t:

i didn't say it was you, but if the shoe fits, then wear it. i'm not going to sugar coat it at all. if you had something negative to say in regards to the original poster's comment, then i was talking to you, too. it's quite simple.

and the question here isn't about adequate nursing care. adequate nursing care is taking care of all your patients. so, that means, someone being on the light every hours doesn't have the right to take away my time from a critically ill person. if all you want to do is pass out pain pills and pain shots, then go work at the pain clinic. an inpatient bed is not the place for this, it just isn't. too bad if that statement ruffles a few feathers. it's the truth. we have sick people who really do need inpatient beds that are not admitted because we have people that need "pain management". pain can be managed at home or on an outpatient basis. so, i don't want to hear any more excuses. just because someone has a problem with it and you do not, does not make you a better or a more caring nurse. because the truth is, deep down inside, you're tired of them, too.

as for physicians admitting them for the unresolved pain, this is most likely not the case. how about them coming to the er looking for a legal fix, how about that? they never were seeing a doctor before that, they just got assigned one. it doesn't matter, they're getting a smorgisborg or drugs. most people have sense enough to know a drug-seeker when they see one and people that have other problems that are causing their pain.

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