Pain shots are us, not this nurse! - page 9

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   leslie :-D
    Quote from lashes
    LIGHTEN UP! YOU HAVE NEVER BEEN UPSET AND OR FRUSTRATED KNOWING THAT THE PT YOU ARE MEDICATING IS AN ADDICT SEEKING ONLY "THE ADDED BENEFITS" ( AS ONE RN PUT IT) OF NARCOTICS? I'VE BEEN UPSET A NUMBER OF TIMES AND UNFORTUNATELY, WORK IN HOSPITAL WHERE ADDICTS ARE REPEATEDLY ADMITTED ( CARDIAC UNIT.. DRUGS= ARRTHYMIAS ETC ) . EVEN CAUGHT A PT DOING BLOW IN HER ROOM WITH HER BOYFRIEND ... RAZOR BLADE IN HAND AND ALL. FEELING ENRAGED IS SOMETIMES SIMPLY A NATURAL REACTION TO THESE KINDS OF EVENTS TRANSPIRING WAY TOO OFTEN!! IM SURE THE PT STILL GOT HIS HIGH SO IT STILL HELPED HIM AND IN THE END, IS HELPING THE RN WHO BEGAN THIS THREAD BECAUSE VENTING IS CATHARTIC ..
    i agree venting is cathartic.
    yelling is not.
    for yrs i worked in an in-pt hospice facility.
    the pts with AIDS were tucked away in a corner unit.
    no one wanted to care for them because a couple of them were addicts.
    i recall one whose room i walked into, his huge glass bottle of iv acyclovir had smashed to the floor, his nose was profusely bleeding and had blood all over his hands.
    he had been snorting coke and ended up making a huger mess than expected.
    i gowned up and swept the glass to one side (the maintenance guy had given the broom to me ).
    i rushed to get all my supplies right in his room and cleaned him from head to toe.
    i had him pinch his nose closed while i cleaned.
    no one wanted to help me.
    i do recall the nm suggesting i wear 3 prs of gloves, as she stood out in the hallway.
    after i got him in bed, all he did was cry.
    he just wanted to have a few more good times before he died.
    how does one get angry at that?
    i spoke with the doctor and suggested a strong anxiolytic.
    the pt loved its' effects.
    i don't know why, but i just can't get angry when i deal w/an addict.
    i do get upset with overly demanding pts but that's why i try to anticipate their needs.
    it saves the both of us a lot of heartache.
    i remember wanting to cry, just for the fact that these AIDS pts were dying alone in a hospice unit.
    staff remained fearful and ignorant.
    and this pt cried for many different reasons.
    and although it wasn't cocaine, i did make sure to get him something that would make him feel he didn't have a care in the world.

    so by all means, vent away.
    but keep in mind, everyone has a story to tell.

    leslie
  2. by   chenoaspirit
    To all who have posted in this thread, we are supposed to be here to support each other, to allow each other to vent. This somewhat prevents us from venting toward our patients. We should NOT be venting AT EACH OTHER. I love this site. We all have hangups at work with which we need to deal with and this should be the perfect place to allow that. Some of our statements in this thread have been taken too literally. Some have focused on one word in an entire post rather than trying to view the person's point of view. We all have something to contribute and we all have alot to learn. Let's keep that in mind.
  3. by   SuesquatchRN
    Quote from earle58
    he just wanted to have a few more good times before he died.
    how does one get angry at that?
    i spoke with the doctor and suggested a strong anxiolytic.
    the pt loved its' effects.
    i don't know why, but i just can't get angry when i deal w/an addict.
    i do get upset with overly demanding pts but that's why i try to anticipate their needs.
    it saves the both of us a lot of heartache.
    i remember wanting to cry, just for the fact that these AIDS pts were dying alone in a hospice unit.
    staff remained fearful and ignorant.
    and this pt cried for many different reasons.
    and although it wasn't cocaine, i did make sure to get him something that would make him feel he didn't have a care in the world.

    so by all means, vent away.
    but keep in mind, everyone has a story to tell.

    leslie
    You have a big, loving heart, Leslie.
  4. by   CaLLaCoDe
    Kudos ChenoaSpirit!

    We are taught in nursing school not to have a bias regarding a patient's subjective pain, however not taught to look at the surrounding circumstances...ie. multiple tattoos, no significant signs of pain on a scale of 10/10 and confusion as to where the pain may be coming from!
    Sometimes the reality is heart breaking! But do give the med is correct action...it is ordered, you have no say, really!
    A healthcare system on the brink of collapse...it's expensive to harbor an individual just to satisfy his/her addiction.

    Again...this old OP is grateful for all the diverse opinions and thanks for supporting my cathartic venting!
    :typing
  5. by   JPine
    Quote from TeleRNer
    Kudos ChenoaSpirit!

    We are taught in nursing school not to have a bias regarding a patient's subjective pain, however not taught to look at the surrounding circumstances...ie. multiple tattoos, no significant signs of pain on a scale of 10/10 and confusion as to where the pain may be coming from!
    Sometimes the reality is heart breaking! But do give the med is correct action...it is ordered, you have no say, really!
    A healthcare system on the brink of collapse...it's expensive to harbor an individual just to satisfy his/her addiction.

    Again...this old OP is grateful for all the diverse opinions and thanks for supporting my cathartic venting!
    :typing
    Thanks for reminding us all about the multiple tattoos. I always forget to take that into consideration when I choose to believe if a patient is in pain or not.

    ***the above is sarcasm***

    As a person who has multiple tattoos, I hope no nurse makes this part of his/her assessment for goodness sake.
    Last edit by JPine on Jan 4, '07
  6. by   Tweety
    Quote from earle58
    ...........but keep in mind, everyone has a story to tell.

    leslie


    Very true. We must be mindful and respectful of each other's stories, the one's who get frustrated with the drug seekers using the system to get high and are able-bodied, and the nurses who find frustration with a system that doesn't adequately treat pain in those that truly need. We all have a story to tell.

    I can't imagine myself or anyone being frustrated with a dying lonely patient needing/wanting medication. No point in that. But I do have some other stories, like the guy who broke into his PCA and gave him an injection that put himself into respiratory arrest........and no he wasn't looking to relieve uncontrolled pain...trust me on this.
    Last edit by Tweety on Jan 4, '07
  7. by   PANurseRN1
    Quote from Traumamama59
    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?
    All I can say to this is that you really need to brush up on pharmacology, and why someone might prefer IV to PO (and it's got nothing to do with "buzz.") Also, please learn about equianalgesia.
  8. by   leslie :-D
    Quote from Tweety
    .

    I can't imagine myself or anyone being frustrated with a dying lonely patient needing/wanting medication. No point in that.
    wanting prescribed medication is not synonymous with feeding a habit- cocaine at that.
    i suppose by virtue of dying, it makes us all more tolerant.
    but aren't we supposed to be treating everyone equally?
    yes, i understand that we are indeed, treating all equally; that we are merely venting here on the bb.
    it's not as if i don't get frustrated with certain types of pts.
    as i said, i try and anticipate their needs.
    and if that doesn't work, good, old-fashioned limit-setting often does.
    and please believe me when i tell you, there are more than a handful of exasperating hospice pts also.
    perhaps we should look at ea pt as if it were there last day on earth?

    leslie
  9. by   GatorRN
    Quote from saharaonyxrn
    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.

    as i said before, one can't come here and expect 100% agreement from others that respond. i didn't say anything negative, i simply stated my opinion.

    you stated, "adequate nursing care is taking care of all your patients." if you are blowing off your pts who are suffering in pain due to some preconceived misinterpretation of the pts right to have pain relief, then in your own words, adequate nursing care is not being given. not everyone is drug seeking and all pts have the right to expect adequate care. i have no problem taking care of my critically ill pts right along side of those who need pain meds. so, before you tell me to go work at the pain clinic, how about you get more experience under your belt than the one year that you have, work on your time management skills, maybe take a pain management seminar, and come back and talk to me in about 10 yrs or so. an inpatient bed is the place for all pts who need care. too bad if that statement ruffles a few feathers. it is the truth.

    not all pain can be managed at home or on an outpatient basis. there are those that come into the er with unexplained abd, chest, head pain etc...that need further diagnostic testing done and pain relief in the meantime. they can't all be kept down in the er until a definitive cause can be found. i never said that i was a better or more caring nurse, those were your words. isimply have empathy for pain sufferers, and believe they have the right to relief without being put on the back burner so to speak. in addition, i'm not one who's quick to label a pt a drug seeker. also, i seriously doubt that a highly educated, experienced physician is going to admit someone with no good cause, just for a "legal fix."

    i can only deduce that you have no personal experience with severe and/or chronic pain. consider yourself lucky in that aspect. if that day ever comes for you, you better hope that you have a nurse with empathy and a clear understanding of the importance of adequate pain relief. now, if you are finished with your personal attacks and are through hijacking the ops thread, have a nice day.


    _________________________________

    go gators!! sec champions!!

    national championship bowl bound!!
    Last edit by GatorRN on Jan 5, '07
  10. by   GatorRN
    Quote from gardendove
    lol, right on sahara. tell it like it is! legal fix, that's a great term. sorry, but some of this pollyanna talk on this thread is just too much. and also, it's not nice to bash people's nursing abilities just because they don't swallow hook, line and sinker the sarah bernhart performances that some pts put on to get their fix.

    we're entitled, at least, to our opinions without getting scolded.
    you're absolutely correct, we are entitled to our opinions without getting scolded or attacked.


    ___________________________________

    go gators!! sec champions!!

    national championship bowl bound!!
  11. by   Tweety
    Quote from earle58
    wanting prescribed medication is not synonymous with feeding a habit- cocaine at that.
    i suppose by virtue of dying, it makes us all more tolerant.
    but aren't we supposed to be treating everyone equally?
    yes, i understand that we are indeed, treating all equally; that we are merely venting here on the bb.
    it's not as if i don't get frustrated with certain types of pts.
    as i said, i try and anticipate their needs.
    and if that doesn't work, good, old-fashioned limit-setting often does.
    and please believe me when i tell you, there are more than a handful of exasperating hospice pts also.
    perhaps we should look at ea pt as if it were there last day on earth?

    leslie


    Leslie, I think we are definately on the same page here. However, I don't equate being frustrated with a certain type of patient and being intolerant of them. They still are a human soul that is suffering and deserve my compassion as a health care provider. Hope that I'm not sounding too full of myself, because as I've posted, I'm no Mother Theresa by no means.

    This thread is not about us judging patients and witholding pain medicine and not treating pain.....for me it isn't anyway.........it's about the real human feelings we feel when dealing with certain types of patients.

    Working in med-surg trauma, treating pain is what I do 99% of the time, there is no denying a person's pain. A person in pain will not progress, they won't ambulate, won't participate in ADLs, they get depressed, they get complications,e tc. There's no denying pain in a trauma unit.

    I often get drug addicts with gunshot wounds and facial fractures from drug deals gone bad, as well as alcoholics busted up from drinking and driving. My job is to take care of them, keep them safe from complications and get them well. Obviously I see a lot of pain and give a lot of pain medicine.

    I take an approach similar to you. I understand that when they first come in more than likely I'll be talking to the doctors several times to get adequate pain control because once they sober up they need more pain medicine to control their pain than the average person. I also anticipate their pain by brining prn's around the clock when they are due, or at the very least offering it, because it's so much easier to keep them under control rather than waiting until their our out of control.

    Besides myself, the tech, the RT's, the OT's, and the PT's all assess pain and "RN notified" in their charting. So I'm well aware of a patient's pain.

    For the rare, and they are rare, drug seeker using pain medicine only to get high, I medicate as ordered, if they state their pain is unrelieved and out of control, I cover my butt and notify the MD. Rarely do I diagnose a patient as "drug seeking", but being older and wiser I do know they are out there. And not being Mother Theresa, sometimes they suck the life out of every coping mechanism I have within me, especially if we're short staffed and I'm busy and stressed already.

    Fortunately, these types of patients are few and far between.

    I wholehearted agree with the clarifications of others that just because a patient is walking around the unit, smiling, laughing, and sleeping doesn't mean that they are not in pain.

    Sorry, didn't mean to ramble on.
    Last edit by Tweety on Jan 5, '07
  12. by   clee1
    Quote from Fgr8Out
    Never been enraged by a patient expecting to be medicated as prescribed by the physician... it's their pain, not mine... and I have no right to judge. Give them their medication and go read up on pain management.
    Exactly right. Pain is subjective, and the pt is the subject.
  13. by   leslie :-D
    Quote from Tweety
    Leslie, I think we are definately on the same page here.
    me too tweets.
    so i shall bow out gracefully with:

    :Melody: here i am
    at a code again
    there i am
    stuck in my wage.
    here i go
    pushin' too far again.
    there i go
    turn the page...........:Melody:

    love and kisses,

    leslie seger

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