Yes, I'm in pain!

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    Patient is resting quietly with eyes closed, no c/o pain. What nurse has never, ever, in their career documented something along these lines? I know I am guilty of this in the past, but I also know that if a patient is sleeping this does not mean they are pain free.

    Yes, I'm in pain!

    I just awoke and opened my eyes for only a split second to barely be able to make out the face of my recovery nurse. I feel so weak and powerless right now, the anesthesia must not have worn off yet. She just asked me if I want to see the gallstones I had removed; of course I want to see them, I'm a nurse and that's what we do.

    The only thing I really want to do right now though is die, this crushing pain in my chest is so unbearable. I want to tell this nurse so badly, but I just can't find the strength to open my mouth.

    I just had my gallbladder removed and this pain feels just like the worst gallbladder attack I had a couple weeks ago. The nurse does finally ask if I'm in pain and I shake my head yes, but I don't open my eyes because I just can't. I'm sure she thinks I'm fine because I'm resting, but this is the worst pain I've ever had in my life.

    I finally get moved to a room on the floor where my husband and 1 month old son are waiting for me. I'm more awake now and able to voice my complaint of crushing chest pain.

    The nurse quickly gives me 3 mg of morphine which never really does anything to make me feel better.

    Once at home I'm able to take my Percocet and finally I am pain free and able to relax. It seemed like that pain would never go away. I am no sissy when it comes to pain, I gave birth 1 month prior to this with no epidural, no spinal analgesic, and no IV pain meds. My drug free natural vaginal delivery was a breeze compared to the pain I had after surgery.

    I returned to work about a month later and as I took over care of a patient in recovery the nurse told me, "she wakes up every few minutes and says she has pain but she goes right back to sleep."

    I quickly let this nurse know that just because the patient is sleeping does not mean they are without pain. As soon as the patient was all settled in and checked the orders for some pain medicine. Next time you begin to document that the patient is sleeping and without c/o's, please reconsider if you truly know what the patient' s pain level is.
    Last edit by Joe V on Jan 10, '15
    somenurse, nitenite, teeniebert, and 11 others like this.

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    About nkochrn

    I am an RN and mother of 2, I worked for 6 years in a rural hospital, where I worked in OB, ED, and the Med-Surg floor. I started working in the IT department in 2011 at the same hospital, which has allowed me to be home with my family every evening.

    nkochrn has '5' year(s) of experience and specializes in 'ER, OB, Med-Surg, Geriatric'. From 'Kansas'; 30 Years Old; Joined Jun '08; Posts: 292; Likes: 251.

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    15 Comments so far...

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    Interesting point you make. I am definitely guilty of saying " they ask for pain meds, but then I have to wake them to give them the pills, how much pain could they be in?". Of course, when I had surgery, post op I was in so much pain all I did was sleep... ironic I never applied how I felt to my patients. Thank you for bringing this up. I will definitely keep it in mind.
    GrnTea, Esme12, and nkochrn like this.
  4. 1
    Agree with you! A few days in the hospital after a craniotomy have made me look at every one of my patients differently. The biggest thing for me was how badly my throat and chest hurt to cough, and I was only intubated a few hours for surgery. I can't imagine some of these little ones ( I work peds) how they must feel after days to weeks of being intubated. And my cough lingered for weeks! My actual surgical pain wasn't that bad after the first day or so, but man, the throat and chest pain. I won't forget it!
    Esme12 likes this.
  5. 2
    Thank you so much for this! Yes, you can sleep when in dreadful pain. I think it is a defense mechanism for the body. That doesn't mean we shouldn't medicate!
    applewhitern and Esme12 like this.
  6. 2
    The college of nursing in which I am currently enrolled has made it hugely clear to every single one of us students that just because the patient is sleeping does not mean that they are not in intractable pain. It's so sad that some of these patients don't get treated when they should.
    applewhitern and Esme12 like this.
  7. 2
    That's what a PCA pump with a basal rate is for-now if you could just get that across to some surgeons. I don't get the reluctance to use PCAs with a lot of doctors.
    teeniebert and Sugar Magnolia like this.
  8. 2
    Thank you. I never would have caught this. This is probably something you can't understand until you've been there.
    nkochrn and Esme12 like this.
  9. 5
    People will shut down when faced with pain and adversity. Like the depressed person who sleeps to escape the world. When you are experiencing pain a defense mechanism is to shut down to a place to try to make it bearable. I think being a patient makes one a better nurse.

    Well said!
    teeniebert, cp1024, tnmarie, and 2 others like this.
  10. 0
    I had a necrotizing fasciitis in an episiotomy due to a misplaced suture (never have a baby in a university hospital in early summer) and never had such pain before or since (including HNP and back surgery). I will never forget the nurses whow would not medicate me when I couldn't even move in bed. Made a difference in my practice, though.
  11. 2
    A good reminder.Thanks. I noticed in PACU , keeping a check on HR was often a good cue into how much pain a pt was really in even if they appeared groggy.
    nkochrn and Psychtrish39 like this.

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