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- Jun 13 by MunchQuote from subeeYou know what I mean...a legit medical issue that warrants the treatment with narcotics. My uncle was the perfect example(not to air my families dirty laundry)..had turned his trading office on wall street into his own drug factory of sorts..he was a self-proclaimed drug fiend(his words, not mine)...not only did he sell and make the stuff, he absolutely loved it. Long story short...he was watch by the DEA and the FEDS, got busted, was out on bail till his court date, got cancer and was in the hospital for the rest of his miserable life. If he had been denied medication because he was under the watch of the federal government, that would constitute cruel and unusual punishment. He had two medical problems...his love for controlled substances(of all kinds..ups and downs) and cancer. Sorry but cancer supersedes the addiction and thankfully the doctors didn't even pay attention to the latter, but more of the former."Drug fiend"? Really? One cannot be a "drug fiend" and not have a medical issue. It IS a medical issue - among psychological and spiritual deficits.
Now how do you treat someone who has his/her jones on for opiates when they don't want to be treated? and my apologies if my wording offended you..not my intent... I just try to cut to the chase and not beat around the bush and use euphemisms.
- Jun 13 by MunchQuote from EGVnurseWhere I work we also have patients with PCA pumps and around the clock IV and or oral pain meds...especially some elderly people that have fallen and have gotten a TBI as a result..it's a fine balance with the pain meds and the blood pressure issue. I know it's not much of a tip, but a couple of co-workers on my floor carry a vial of narcan with them at all times...and they've had to use it more than a few times for the very reason, of a bottomed out BP or respirations or both...after that happens we get the MD to re-write for a lower dose and hope that helps...discontinuing all pain meds is inhumane of course especially if they are fresh from surgery...were on narcotics BEFORE the surgery long term..the narcan is really going to hurt them unfortunately...it's a necessary especially with someone who's never had an opiate history before and they come out with a PCA...I know some of our surgeons and anesthesiologists tend to be more liberal with the pain meds, which most of the time is a good thing..but sometimes patients have a low tolerance for the meds and it backfires.I've been working on a 30-bed orthopedics unit for a little under a year...so I am very familiar with pain assessments. I had a doc explain to me that bone pain is one of the worst types of pain and I took that to heart. Many of our patients come out of surgery with epidurals, perineurals, PCA pumps (dilaudid, fentanyl), Q pumps, around-the-clock pain med administration, etc. But I worry sometimes about causing low BP and respiratory depression. In our older patients I have that fear of delayed renal function. I once administered PO pain med and then breakthrough IV pain meds as well as oxycontin, to a patient post-op day #1 hip replacement; she was a&ox4, RR WNL. She also received BP meds in the AM; her BP and HR were WNL. But then the physical therapist came to get her out of bed and her BP plummeted. We put her in reverse Trendelenberg and bolus-ed her. Fortunately her LOC didn't change throughout. But it really worried me about administering pain medications in addition to BP meds & PT. Any advice or tips or experiences regarding safe pain medication administration? Thanks!
- Jun 13 by Steve123It's not our place as healthcare providers to decide what a patient's pain really is. We need to look at our patients as whole people and assess carefully.
This kind of theories are written for us by those who wants us to be primitive drug pushers...
- Jun 17 by montinurseSteve, I agree with you 100% I think it all boils down to people doing these studies and the ones who invented the pain scales sit in a different world (non clinical) I would like to see a pain scale that includes the nurses assessment. The problem with our society is that we feed the addictions and everyone knows it. Luckily some of the doctors I work with listen to me and value my opinion. Some don't. Anyways, with the psych eval and EDO, that person will be back next week for the same problems. The hospital is a safe haven for homeless, socially inept drug addicts.
- Sep 27 by cadawaspI am going to weigh in on both sides. I am a hospice nurse that now works in the office due to chronic pain secondary to spinal stenosis, so I have been on both sides of this issue. As a hospice nurse I frequently needed to work with a report of "a little, not too bad, to the worst ever" I always believed my patients and sometimes needed to convince them to take the pain meds. One thing that was not mentioned was the use of adjunctive medicines such as neurontin or Lyrica for nerve pain, Cymbalta or Elivil for nerve pain, NSAIDs or steroids for bone pain. The use of these in addition to the opioids or even alone can help with pain. This is one of the reasons that knowing where the pain is and a description of the pain needs to be asked to help find the type of pain and how to medicate the pain.
Now as a chronic pain patient. I have taught classes with a pain level of 10, no one else to teach the class and able to "fake comfort". People who knew me could tell but not a group that did not. I have been taking either neurontin or Lyrica (moving from one to the other and back) for about 10 years now. My pain doctor added Cymbalta at some point for both nerve pain and depression. During this time I have been using Vicodin ER for breakthrough pain. I have also had three surgeries on my back during this time and have used a PCA pump post surgery of dilaudid. I did find myself unable to just stop the Vicodin after the surgery recuperation and needed to decrease it so I could return to prn use.
We need to look at many aspects of our patient's to understand their pain needs the cause of the pain, type of pain, what has worked in the past and what has not to name just some of what we need to know. Realistically that is hard to do with the time constraints in the hospital but knowing severity, cause, and description can help to see that our patient's are cared for in the best way possible.