You make the decisions on YOUR shift and I'll make the decisions on MINE - page 5

by CrazierThanYou

7,258 Views | 49 Comments

Here lately, I've had a couple of situations where the oncoming nurse didn't agree with choices I made on my shift regarding patient care. Usually, it is regarding pain medication. In nursing school, I was taught that it... Read More


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    OMG! Seriously?! I suppose you don't give money to the homeless because you prejudge that they might buy drugs instead of food, thus leaving them homeless AND miserable. If a doctor orders pain medication and the patient asks for it, if the patient's vitals and cognition permit, then GIVE IT! They are NOT going to become addicted to it in the short amount of time they are in the hospital. When I see a nurse judge a patient so harshly It seems as though they are jealous that the patient can have pain medication and they can't. What other medication causes such contempt from nurses? And for what reason? Because they are afraid the patient might undeservingly "get high"? Do us all a favor and stop playing God.
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    The biggest complaint that I have is when a pt is on chronic pain management. Then we admit them to the hospital or they have surgery, then give the pt less or the same as their maintenance dosage

    My other one is they suddenly cancel antidepressant or anxiolytics. Withdrawal cold turkey from those meds is BRUTAL!
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    i think alot of nurses think they will accidentally od the patient and maybe the apprehension is a guise for anxiety over potentially overdosing the pain med seeker (although how opiate naive would many 'fakers' be really). but overdosing a patient is a real possibility that we should not ignore. especially a patient who is chronically ill with a host of renal/liver/lung/cardiac issues. i have seen it happen. the med is given 'as ordered' to keep a semi verbal patient 'quiet' and "pain free;...only to have narcan given after 'as ordered STAT; am i advocating for letting people writhe in pain; no but the expectation is as comfortable as we can make a person while towing the line of too much of a good thing.but cancer patients/burn patients i do feel are certainly different in terms of pain control right
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    Crazierthanyou, I have a hard time understanding other nurses (bad) attitudes about a lot of things.
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    Quote from eric3
    OMG! Seriously?! I suppose you don't give money to the homeless because you prejudge that they might buy drugs instead of food, thus leaving them homeless AND miserable. If a doctor orders pain medication and the patient asks for it, if the patient's vitals and cognition permit, then GIVE IT! They are NOT going to become addicted to it in the short amount of time they are in the hospital. When I see a nurse judge a patient so harshly It seems as though they are jealous that the patient can have pain medication and they can't. What other medication causes such contempt from nurses? And for what reason? Because they are afraid the patient might undeservingly "get high"? Do us all a favor and stop playing God.

    Lol, while I don't withhold pain meds, even when I think the patient is drug-seeking, I refuse to give cash to homeless people. Tell me you want money for food, I will bring you somewhere and buy you a meal, heck, I'll even buy you extra for later. But if I want my hard earned money spent frivolously or on dumb things, it will be by me! :P
    tewdles and DeLanaHarvickWannabe like this.
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    I m generous with the pain meds, but I don't give money to the homeless either. I do however give them some food or drink if I have any on me.
    tewdles and DeLanaHarvickWannabe like this.
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    I don't understand why you cannot give a pt morphine if the po pain med did not work. You shouldcontrol the pt's pain. It is all nursing judgements and experience. The truth of the matter is that pain is what the pt say it is but at the same time you should be looking at the pt's age, dx, and hx. I have seen where a pt pain was not managed and the nurse just kept giving all the pain meds available to the pt and the last dose that made the pt comfortable was the dose called for narcan. Like I said the pt's dx, hx, and age should come in to place, and pt education is important. Some patients will be patient when you tell them you gonna have to wait to get pain med cause " your bp is 80/39 and HR is 59, and you want them to be still breathing.
    The thing is start low, go slow. If the md ordered 20 -40 oxy prn and this is the first dose it will still be a good nursing judgement to give the pt 20 oxy first instead then addid anothe 20 instead of giving 40mg just because the pt pain is a 10/10 .
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    Quote from Btts
    I don't understand why you cannot give a pt morphine if the po pain med did not work. You shouldcontrol the pt's pain. It is all nursing judgements and experience. The truth of the matter is that pain is what the pt say it is but at the same time you should be looking at the pt's age, dx, and hx. I have seen where a pt pain was not managed and the nurse just kept giving all the pain meds available to the pt and the last dose that made the pt comfortable was the dose called for narcan. Like I said the pt's dx, hx, and age should come in to place, and pt education is important. Some patients will be patient when you tell them you gonna have to wait to get pain med cause " your bp is 80/39 and HR is 59, and you want them to be still breathing.
    The thing is start low, go slow. If the md ordered 20 -40 oxy prn and this is the first dose it will still be a good nursing judgement to give the pt 20 oxy first instead then addid anothe 20 instead of giving 40mg just because the pt pain is a 10/10 .
    Generally speaking, this is usually not a bad idea. But if the patient is telling you that their pain isn't controlled with PO AND they're an oncology patient, that's a totally different animal.

    I've been known to give the lesser strength med (perc) in combination with the stronger med (morphine) in order to get a synergistic effect for better relief. You'd be amazed how drugs in combination with different mechanisms of action work to relieve uncontrolled pain.
    Spidey's mom likes this.
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    If a patient wants pain medication I give it to them. If a pt is painful they deserve pain control. If they are a "drug seeker" it is not my job to "change" them and in the amount of time they spend in acute care it isn't possible anyway. The only thing I consider is if the person is to be discharged the following day I try very hard to use every other intervention I can besides giving IV pain medication as they need oral pain control to discharge.
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    Quote from Mommy&RN
    The biggest complaint that I have is when a pt is on chronic pain management. Then we admit them to the hospital or they have surgery, then give the pt less or the same as their maintenance dosage

    My other one is they suddenly cancel antidepressant or anxiolytics. Withdrawal cold turkey from those meds is BRUTAL!
    YES! They always do this. At home they were taking two percocet 10's for fifty years. Now you've ripped apart their body and ordered two norco 5's. Not going to cut it. I'll be paging your rumpus all night.

    Loved the patient who would take two norco 10's every hour at home. He would fall asleep with a heating pad on his back and was too sedated to feel his skin being burned by the pad, leaving burn scars all over his back.

    When he came in for his lumbar fusion, it was pretty much impossible to get his pain under control and he didn't understand why he couldn't have norco every hour. When I paged the doctor for additional IV pain medication, the physician said, "he's a drug addict, I'm not ordering anything else." Made for a great shift. NOT.


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