One of our pet peeves

Nurses Rock Toon

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Specializes in CCU, Geriatrics, Critical Care, Tele.

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We've all heard it, "pain is what the patient says it is." Hard to believe when they are on their cell phone, eating a bag of chips and watching TV. We've also all learned about guided imagery, meditation, breathing techniques to relieve pain. What have you suggested to a pt to relieve pain?

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I suggest they actually allow sufficient time to let the pain medication work.

One of my pet peeves is when a patient is riding the call light five to ten minutes after I administered the analgesic medication to say, "Those two Percocet pills you gave me aren't working. I'm gonna need something else, sweetie."

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Specializes in ortho, hospice volunteer, psych,.

My husband is the other way around. This afternoon, he was grading papers and said he had a headache. I suggested two Tylenol. About ten minutes later, he looked up and said. "I wish Tylenol weren't so strong! It's making me so sleepy I can hardly concentrate!"

I told him they were still dissolving!

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Specializes in pediatrics, occupational health.

One of mine is when parents bring their child into the ED to get a prescription for Tylenol!

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Specializes in Med nurse in med-surg., float, HH, and PDN.

Lacking my magic wand, there's always the velvet sledgehammer..........

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Another pet peeve of mine is when patients claim allergies to lower strength analgesics to ensure the doctor orders the more potent ones.

"Honey, be sure to tell the doctor that I am allergic to everything except Fentanyl, Morphine, Oxycontin, Demerol and Dilaudid."

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Specializes in Med nurse in med-surg., float, HH, and PDN.

Demerol, morphine and Oxycontin make me hurl and retch violently for prolonged periods.

When I broke my ankle, (tri-malleolar fx with tendon bundle tear) right after surgery they had me on a morphine drip. I had to lay very,very,very still, with my eyes closed to stop the visual whirling of the room, and breath in shallow short breaths and even that didn't work. If someone spoke to me and I was required to answer, I couldn't stop retching. At one point a nurse said to me, "Honey, you're going to have to stop this." Uh, don't you think I would if I could?" Someone took away the morphine, what blessed relief! I always wondered why she also said they couldn't give me anything stronger!!! Commuter, when I read your above post, the penny finally dropped in the slot. When daylight came and the next nurse asked about my pain level and mentioned the morphine, I groaned "Don't EVER give me any of THAT stuff again. I'd do fine with a Tylenol #3 and an ice pack!" I don't know about Dilaudid, but I'd be afraid to take it after the Morphine episode! I HATE throwing up like that, my eyes were bloodshot for days!

As for Fentanyl, I'll wait for the hospice nurse if it ever comes to that.

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Pain is defined as what the patient says it is occurring when the patient says it does. That is a fact. While we as nurses have a tendency not to believe the patient that is asking for pain meds while on the phone, doing her nails, and reading a magazine....or listening to music, or playing a video game....the list goes on. I know that especially in the case of chronic malignant pain the patient distracts from the pain with so many different activity just to get to the point that it is time for the medication that can provide some relief. Additionally, the chronic pain patient knows that the medication needs to be taken before it gets out of control. These patients have been doubted so often when they describe a pain level of a 4 or 5, that they may exaggerate the number in order to get the attention that they need to obtain the medication that will control the pain.

I will not say that no patient gives a false pain report just to get a stronger medication. But my statement is that just because a patient is doing other activities while claiming to be in pain is not the reason to doubt their report. It is reason to request more details about the pain. Patients that are in pain can provide descriptors about the pain including what it feels like, where it is located, where does it radiate to, and how long has it been hurting.

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Specializes in Med nurse in med-surg., float, HH, and PDN.

I agree. A doc told me once that it was easier to stay on top of the pain, than to wait until it was so bad the next dose was ineffective for that degree of pain.

Besides there is nothing wrong with enjoying the buzz that is an intrinsic part of the pain relief medicine. Where people get in trouble is when they want the high,only.

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Really, the problem lies in how "pain" is defined.

While you may define pain as a sensation that might impair ones ability to function, or cause visible distress, your patient may define it as that feeling you experience when you are not impaired. So, they really may be experiencing 10/10 pain when that Percocet wears off.

Its just that we may speak a different language than the patient.

Logically speaking, we know that even if a person was in so much pain (as we define it) that they could not talk, let alone text, eat, and giggle, their pain could increase significantly. So, mathematically, that can't be a 10/10. Otherwise, setting them on fire and stabbing them in the eye would cause no increase in their pain.

The traditional pain scale works well for some people. For example, a regular person with a regular job who drinks occasionally, doesn't use recreational drugs, and just had a surgery after a car accident.

For other folks, we should use a pain scale they can relate to:

On a scale of 1 to 10, with one being just a slight buzz, and 10 being all the narcotics in the hospital, how would you rate your pain?

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Specializes in High Acuity StepDown Critical Care.

" Mr. Doe... I am noticing that every time you call your wife, you complain that your head ache, chest pain, and stomach pain is a 10/10 even after IV dilaudid. I think for the time being, we should turn off your phone, dim down the lights, and give you some peace and quiet. You need to rest, and the arguing with your wife about the type of dog food she needs to buy, what socks to bring, and where the check book is can wait because its making you feel worse." 30 minutes later with the lights off, TV off, phone disconnected, and door closed.... sleeping patient with BPs back down to 130/85 after being in the systolic range of 160-170 for 5 hours. 2 hours later, awake with no complaints of pain. Patients sometimes don't realize that everyday stress...can make new issues much much worse and bring on some awful pain right along with it.

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Specializes in ortho, hospice volunteer, psych,.
Lacking my magic wand, there's always the velvet sledgehammer..........

Have you lost your magic wand again, you silly girl?:x3:

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