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
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    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.

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  3. by   artsmom
    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.
  4. by   umcRN
    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!
  5. by   monkeybug
    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!
  6. by   silmaril123
    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.
  7. by   fakebee
    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.
  8. by   NurseDirtyBird
    Thank you. I never would have caught this. This is probably something you can't understand until you've been there.
  9. by   Esme12
    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!
  10. by   nurseprnRN
    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. by   echoRNC711
    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.
  12. by   CapeCodMermaid
    Always better to err on the side of giving the pain med. Sometimes people in excruciating pain are dozing because they are exhausted.
    I don't show pain on my face and have a high tolerance to most kinds of pain, but I get cellulitis every so often and am in agony. Luckily I have a fabulous doctor who writes for what I say works and the nurses for whatever reason don't argue if I tell them I need 2 percocet every 4 hours the the first 16 hours and then PRN.
  13. by   Perpetual Student
    My mindset is to look for reasons to not give pain meds, not reasons to give them. Those reasons are rather exceptional--completely unresponsive, denies pain completely (even then I'll give something PO before transferring the patient and continue to reassess), respiratory rate less than 8 or otherwise completely inadequate such as with sleep apnea, maybe BP if it's really lousy but I'd just treat the pain then correct the BP most times. Otherwise, I consider it my job to give as much relief as possible without unduly compromising safety.

    I'd rather have a patient that's too sleepy than one that hurts too much. I can always let 'em wake up a touch prior to transfer if necessary.

    Some folks fail to consider how often the patient may be drowsy due to drugs such as benzos, antihistamines, or even lingering gas if it's shortly after arriving in the PACU, etc. yet have uncontrolled pain. As mentioned, you can look at the heart rate, but don't forget that it's just one piece of the puzzle. You might not see much of a bump in the beta-blocked patient, nor will the tachycardic patient necessarily be hurting. Also, in chronic pain there generally isn't much change in heart rate.
  14. by   *LadyJane*
    Some patients may be trying to practice self-hypnosis, or trying to escape into a painless part of their mind. I have done this when a patient, post surgery. A nurse came up, put her hand on my forearm without saying anything, to see if I was awake, I opened my eyes and looked at her, so she asked me how I was doing. I said, a lot of pain! She was puzzled because I was so still. (I was so still, because I was trying not to breathe because it hurt so bad to breathe), and was excruciating to move in the slightest, so I was perfectly still.

    She would have thought I was resting quietly, except she put her hand on my arm, and asked me. Thank god she did. She called the doc, and got the PCA order turned up. God bless her!