While out of town on vacation this summer my husband was doing some exercising, sit ups to be specific. One day while doing these sit ups he said he felt as if he pulled something but was able to carry on with normal daily activities except now avoided doing more sit ups as it hurt too badly.
We continued riding bikes and swimming for a couple days after this but as time went on he seemed to get more sore.
Then later on the second night after he'd felt the initial muscle pull he woke up in the early am hours in pretty severe pain with some minor palpable swelling in his left lower quadrant. The pain was much worse than when he had the initial pull. He actually said he hadn't slept much at all which is highly unusual for him.
He has a history of diverticulitis and DVTs and is on coumadin therapy. We both thought maybe it could be a diverticulitis flare but most likely the muscle but just weren't sure. Who really wants to go to the ER at all though especially in the middle of the night?
He went ahead and took some ibuprofen even though he is really not supposed to due to being on coumadin but was hurting enough that he took three 200mg caplets and was able to sleep for a couple hours but woke up still in pain. I then decided to drive my husband to the ER that morning after he had slept a few hours as he was still having pretty severe left lower quadrant pain and now his color looked a little pale.
To try and make a long story short he was diagnosed after a CT scan with a torn abdominis rectus muscle or abdominal sheath with a subsequent 4 cm blood clot within the tear due to his history of being on coumadin therapy.
The ER physician said anyone else would have torn the muscle and be sore for a while but since he was on coumadin there was bleeding along with the tear which created the 4 cm blood clot from which he could see no signs of further active bleeding.
Upon assessment during the ER admission process via triage he told the nurse when asked his pain level was at 7-8 on a scale of 10, and had been in pain throughout the night before coming to the ER.
The ER physician came right in and ordered a pain med and a CT scan. Meanwhile the nurse started his IV, drew some blood and we thought gave him some pain medicine as he did some kind of flush with a clear solution in a syringe before my husband was taken for a CT scan of his abdomen where he was asked to scoot from stretcher to table, and of course back again.
When he arrived back from radiology department my husband said to me, "This pain medicine is not working...I'm still really hurting." I called the nurses station and asked for more pain medicine. I could see the physician at the desk from our room with a look on his face like, Really? He hasn't got his pain med yet? which I understood more clearly shortly thereafter.
I thought it might just be some breakthrough pain from going to radiology and from scooting back and forth from stretcher to table.
When the nurse finally came back in the room he states, " He hasn't had any pain medicine yet. I had to go on lunch break or I wouldn't have got any break at all."
Being a nurse myself I certainly understand the concept of missing a break. No it's not healthy. No it's not fun. No management doesn't like it sometimes regardless of what's going on. Sometimes however it is necessary in order to provide the proper and compassionate care needed for our patients.
At this point we'd been there in the ER patient room for at least over 30 minutes now and as noted above he even went to CT without any pain med. Maybe you could ask another nurse to give it in your absence?
As an ER nurse or any nurse for that matter, don't you think it would be a priority or should be a priority to medicate your patient for pain before going to lunch given the above scenario or any similar such situation?
Just wondering what other nurse's opinions are on this matter. What would you do? Would you make sure your patient got their ordered pain med before they went to radiology in pain or would you go on to lunch and give pain med that has already been ordered after you get back for fear that you'd get no break?
