Poochiewoochie 5,558 Views
Joined: Aug 1, '11;
Posts: 181 (45% Liked)
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When I had surgery, I asked on the dot. Because the meds weren't actually covering my pain all that well. Complaining about being in pain before the meds were due was a waste of time, so I called when they were due, trying to at least keep the pain reasonably at bay. I waited longer than that and I was in excruciating pain.
Are there seekers? Obviously yes. But I'd rather medicate a seeker that doesn't "need" the medication than NOT medicate someone in pain.
If it's ordered, and the patient is breathing, I give the medication.
This has been a very enlightening thread and an extremely interesting discussion. As at least one nurse wrote, there seem to be two camps, one who believe you should medicate as long as the vitals are WNL and the pt isn’t somnolent and the others who feel that it is appropriate to withhold medications until...? My own views are apparent in the post I’ve already made, but I’ll restate them for clarity. I believe if a patient is due for medication, anything from a stool softener to narcotics, they should receive them when they are requested. Not on the Nurses schedule, but when they are requested. Pain is pain, whether real or imagined, it is still pain. Pain is subjective, on a scale of 1/10 what may be a 9/10 to your patient, may only be a 3/10 to you, but that doesn’t matter, you aren’t the patient and you aren’t the one in the bed. It is your job to medicate the patient, not judge him or her and you don’t get to decide if he or she is drug seeking either. That isn’t your role in this situation, so just do your job and give them the patient care you were hired to give them, which includes providing them their pain medications that the Physicians ordered on a timely basis.
If you are so driven to judge those who are drug users, go get a job in a Drug Rehab Center where you will do the most good, meanwhile, simply provide the best care you can give while you are at your current job. Your Patients deserve no less. If they are truly in pain that pain will be relieved and if they are drug seeking, their itch will be scratched for another 4-6 hours. As has been said several times already, if they are drug addicts, the minimal time they will be under your care is hardly enough time to Detox and cure them of their addiction, so if you feel so strongly of your views simply document it in the Patients chart or even discuss it with the Physician if you must, and your job will be done when the Patient is D/C. In my opinion the word addict is used much too loosely here. We have to remember who it is that allowed this habituation to manifest itself to begin with here, and approximately, seven times out of ten, that finger will point right back at the medical community. The Patient may not ne a true addict, more of a habituate user. It may appear to be splitting hairs, but the habitual user will have an easier time getting off the drug than a true addict. I’ve seen this from my time working in a Detox Center. Habitual users can usually just be weaned from the root drug where-as addicts need to given other drugs to be detoxed and it requires a longer period of time. Also, their mind set is quite a bit different from someone habitually using a narcotic.
Anyone with a long-term history of Pharmaceutical abuse is under most circumstances an addict, I’m not saying that, but it’s your job to treat them as any other patient. Simply provide them with their medication as it is called for on the Doctor’s Orders. If they say, it isn’t working, treat them as you would anyone else, put a call in to their Physician and follow his or her orders, that is all you can do. In other words, BE A NURSE. If you can stand in front of a mirror every morning and say, “I will be the very best Nurse that I can possibly be today. “ and when you get home at night or what every shift you work, and go over your day and take an inventory to decide what you did right and what you did that you could possibly do better on tomorrow, it’s a good way to finish off your day. I’ve done it for over 25 years and it works wonders. I still do it today, even though I’m retired and out to pasture, it’s still a good way to end the day.
Pain is subjective, so it's never up to the health care provider to judge whether the patient is "drug seeking". As long as their vitals are within normal limits, I'm not concerned. Furthermore, in order to avoid breakthrough pain, it is best practise to administer pain meds round the clock. If the patient can receive their narcotic q6h, and they request it q6h, I give it. Of course, I will do an assessment, and ask them to rate their pain also. Remember that mild pain to you or me could be excruciating to another.
I pretty much disagree with everything you wrote. I don’t believe it is your job to second-guess the Physician in as far as anything s/he does. If you are having that difficult of a time with following the Physician’s orders, perhaps you need to transfer to a less taxing area of the facility, where the Physicians orders are a bit more mundane and won’t arouse such phlegmatic difficulty. You are a Registered Nurse on a floor in a Hospital. Unless I’ve misread, that doesn’t make you a distinct part of the Pain Team, responsible for deciding his or her Pain Regimen and unless his or her Doctor has specifically asked for your input on the matter, it really isn’t any of your business, with the exception of following the medication orders on whatever shift you might happen to be working. People/Patients experience pain in very different ways. Pain is strictly personal. What hurts you, I may be able to flick off without so much as a thought. On the other hand, I may be devastated.
My big reference has always been, Labor and Delivery. I say that if men were consigned with the job of delivering children instead of women, there would be far less children because it would likely be only one child per family. I don’t see too many men going through the pain and agony of labor and delivery more than once. And yet there are some women who say that their pain was minimal. You tell me how to get a 6 or 7-pound baby through the birth canal and out that little bitty hole without pain or with minimal pain. While it may be your job to assess pain levels and the effects of medications, it isn’t your job to decide the worthiness of your patient to receive the medication already ordered by his Physicians. You took a pledge as a Nurse to “aid the Physician in his work and devote yourself to the welfare of those entrusted to your care.” You started off your post with “I have a hard time with the drug seekers” How is it exactly that you differentiate between the drug seekers and the actual patients in need of pain meds? Or are they all drug seekers in your view? Pain is pain regardless whether it is real or imagined and if a person is an addict, then the drugs they seek are in fact a medication they indeed need, especially if they are addicted to opiates. If you have never witnessed the withdrawal of an opioid addict, it isn’t pretty and is quite dangerous and life threatening. By being judgmental you are taking that patients life into your hands and you should be certain that’s what you want to do before you do it.
The concern regarding my first thread is being lost on the dosages of medicine mentioned. I struggle to continue to administer medication to pts setting alarm clocks to receive it vs those that are suffering and apprehensive to take meds.
I don't understand the point of withholding pain medication. I once asked a hospice pharmacist "so if they are a drug addict would you still withhold giving them pain medication?" and he replied "no". And I 100% agree. What would be the point? I wouldn't want the patient to go through withdrawal. I don't see the point of purposely trying to torture the patient. Even if they were addicted, withdrawal has significant side effects as we all know. And if its killing the patient you are worried about, it takes a significant dose of morphine to do so. As a previous poster mention 2mg of morphine and 8 mg of dilaudid isn't that much.
I have a hard time with the drug seekers like a lot of other nurses. Some things that help me out:
If it is ordered and the patient is requesting it they get it IF it is due. I always go over the pain scale with patients. If they tell me their pain is a 10/10 I correlate that with mild, moderate, severely, extremely severe. I had a patient who kept telling me her pain was a 4 and it turns out she was actually experiencing mild pain. Well that would be a 2 or 3 so it required reeducation on the pain scale.
If a patient has norco and iv pain meds ordered and they are refusing the po I tell the doc. A lot of times that will have the doctor getting rid of the dilaudid/morphine.
If you are taking vicodin/norco at home and you are not in the hospital for an exacerbation of a pain crisis I really don't understand why you are requiring dilaudid just because you are in the hospital. If your pain is at the level it is when it is at home and you are at your goal we are all good.
People who have chronic pain do cry when their pain is so out of control. People who say that doesn't happen...well everyone is different.
Many (not all) patients with chronic pain need limits so they are not monopolizing all of your time. I let them know when there next meds are due. I find it extremely frustrating when they go on the call light 1 hour or more before they know their next pain med is due. I don't understand why they do it and there is nothing I can do about the timing of the pain medication. It is ordered by the doctor and If they are getting their dilaudid every 3 hours well I don't need you to start calling me 1 hour, 45 minutes, 30 minutes, 15 minutes before you can have your dose. I will give it to you 3 hours after you had your last dose because that is then it is ordered. Many of these patients have an extensive psych history and are on multiple psych meds. Sorry but these are things that make me go hmmm. These people need to find other methods of pain control besides iv narcotics. They really need to open their minds to other methods of pain relief.
I believe we as nurses should second guess a pain regimen with a doctor. As nurses we receive much more education than they do. Ordering morphine/dilaudid q6h is ridiculous when it has a short half life. I recently went to a conference and learned doctors are lucky if they get 1 hour of pain education in school.
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