I work in an LTC. Most of our residents are quite young...most of them are under age 70. We have a few residents who have a long history of severe pain and receive narcotics on a regular basis. We have a new nurse who has been there less than a month who doesn't believe that they are in pain and is working to get their mediations reduced. One of the ladies has a long history of abdominal pain to to benign cysts and abcesses...she has had over 20 surgeries, but the cysts and abcesses continue to come back. Apparently, the cysts are back and causing her a great deal of pain. I have no idea if she is really hurting or not. There is no obvious change in vital signs, but she does become diaphoretic, guards her abdomen when she walks, and grimaces. So..since she stated she was getting no pain relief, I talked to her doctor, who increased her pain meds until she can see her surgeon on Monday. The new nurse is really upset that I did this. She told me that she does not believe for a minute that the resident is having that much pain and that when she is distracted by activities that she doesn't request pain meds. She makes the resident wait an 30-60 minutes before giving PRN meds that are due. She also told another nurse that I am just a sucker and that the residents can talk me into anything...she says that she is going to tuirn me in to the state.
I'm not sure what to think about this...I really don't know if this lady is having that much pain or not. She acts like she is having that much pain, but she has a long history of narcotic use (abuse?) and is probably a good actresss. She is not sedated, gets very poor sleep, walks with a steady gait...I just don't know. I am starting to question whether I should be giving the meds or not...I am concerned that I am just feeding an addiction rather than trying to treat her pain...I am concerned that I may be putting my license in jeopardy. I would hope that if I were out of line in giving meds when residents say they are in pain, that someone would have said something to me by now, but maybe it just takes a new set of eyes to see that I am messing up.
My manger is really no help...I've asked her point blank whether I am overmedicating the residents and I've never gotten an answer...she just says things like, "If you have an order, you should be OK."
Feb 15, '07
OH btw, on pain being pain...yes and no. If you have someone that is not able to make medical choices for themselves they are not in the right state of mind also to make pain assessments. So going only by word of mouth is incorrect. Go by symptoms too! Read that body folks...don't automatically say NO they aren't because they are sleeping..watch them as they sleep..are they twitching, do they look exausted from pain and passed out? Lots to consider!
Body language for me is key to pain..when I am in pain (which I have a high tolenance to and don't like meds myself)...my left ankle moves alot! Don't know why..but if that sucker gets moving...it will increase to the leg and eventually me clawing like I am trying to leave my body with skin and such behind! (when I am at a 10...it is serious...I loose my mind at 8!).
Some stoic people also show pain...showing expressions is a key to a stoic pt, twitch, blinking, not being able to sit in one position for more than a few minutes! Even post stroke pts show signs!
Learn your pt, learn their 'tells' (like in poker! You can tell)...and try to help..that is all we can do!
But to automatically assume a patient is in pain because they say so...naaaa...I don't go by that alone. I mean...would I assess someones cardiac condition by them saying only "I don't have chest pain"...NO! So pain is no different..you just have to be a bit more open to signs!
Also there are cultural stereotypes for pain as well...watch for those! Some maternal women don't want themselves to be seen as weak and unable to care for their loved ones and will hide it no matter how it hurts. Some men would rather walk that admit they have a broken hip! Watch for that too..it is all part of the story! Heck, even people with low tolerence will seem like they are in pain all the darn time and say such, but there is a point where pain relief is hazzardous...so you have to be careful!
I will typically have a small convo on pain with pts..see what their history is...best way to tell if something is wrong...see the way it has been so far for them! AND I discuss a pain plan WITH the pt doing comprimise for best results always having them know that I can add or subtact as they need! That takes care of some of the anxiety..which is a large part of the pain path!
Last edit by Antikigirl on Feb 15, '07