Not staying on top of pain - confusing orders - myths?

Anne36, LPN · Jan 3, 2011

What an awful experience. What did your regular Doctor say when you saw him?

I can relate to some extent. I went to the Emergency Room for unbearable ear pain last year and was told I had the worst ear infection they had seen, a blister on my ear drum no less and was sent to a specialist but the only thing they gave me for pain relief was useless. Motrin. whoopee! I tried talking to the nurse and got the same story, Motrin would work wonders, NOT

Biogirl4 · Jan 3, 2011

My doctor didn't get there till day two and by then I was told my meds were taken care of. He didn't really react to my recount of events except to say he was sorry. Crazier still, both residents wrote orders for meds, the nurse threw one set out when she saw it and sent me home with meds that didn't work. By then the surgeon was on vacation and his emergency number wasn't working.

Kind of a crazy experience, I ended up with an impaction to boot. I've just been crying all day and recounting all that has happened and vowing as a nurse to never let someone go through what I have. I still hurt, I still can't pee - ha ha. Not really funny, but I'm just sad. I have to start classes again in a week and I don't feel ready to go back. I see the surgeon for the first time tomorrow since the surgery. He will get an earful.

I just felt like posting. Because for goodness sakes, where were my nurses?? We are the front line, the patient advocates! :) At least that's what I hope we are. :nurse: I just keep wondering why they didn't do a better assessment?

halkogirl · Jan 3, 2011

I am so sorry that you had to go through that. I had a hysterectomy in May and the nurses were great about my pain meds- my doctor made sure that I was well taken care of. However, one nurse wouldn't listen to me about my catheter- I told the nurse my bladder was full (two hours post-op) and something was wrong and she told me I had urine in my bag so that it was fine. I told her that I have had a catheter before and I knew something wasn't right. She told me that I needed to relax, that it was just in my head. When she left the room, I had to sit up (painful right after abdominal surgery) and I found that the catheter was kinked between my legs. It was such a relief after my bladder was finally emptied! She came in a few minutes later and I had almost 900cc in my bag- no wonder it hurt! Apparently the doc had put me on a diuretic and we all know what happens then! I told her that next time she should take a minute and listen to her patient, it would have taken her all of twelve seconds to help me.

Sometimes the squeaky wheel gets greased, if you know what I mean. If you are in pain, don't wait for the nurse to come to you, ring the call light and keep ringing until someone comes. I don't like to be a bother, but the second I started feeling pain I put on my call light and asked for meds. Besides the one nurse, I had some really great nurses.

2goodhealth · Jan 3, 2011

I'm so sorry to hear what you went through. Do you have a Eurologist? I'm not sure what I can say legally.

I am not recomemding and am only sharing a story.

A Eurologist (bladder & urinary tract doctor) was a God send for my friend. .

I have a friend with intetstycial cystitis. She needed help urinating, she had a lot of pain, and all her other doctors would treat her for just a bladder infection. It took a while before she was referred to her Eurologist who helped her to properly urinate with medication. She had something called IC (Interstycial Cystitis). This Dr even sent her to a physical therapist that specialized in helping her to properly use her core mucles to help her to urinate. I don't know if any of her story is helpful.

lifelearningrn, BSN, RN · Jan 3, 2011

I think that hospitals and doctors have such a purist attitude when it comes to pain medication. Oh no, someone might abuse it, better not use it at all!! It's ridiculous. There are medications out there to halt pain, if a patient is in pain, TREAT it! And so what if you do have a low threshold for pain? Does that mean the pain isn't real?

I'm not a fan of most prescription pain meds, I hate the side effects. I took toradol and 800 mg Motrin for my c-section in the hospital but rarely took anything by the time I got home. I absolutely refuse codeine based meds. But I'll tell you, I'd be downright ****** if a doctor or nurse downplayed pain if I were in it, simply because they don't want to prescribe a drug that is commonly abused by drug seekers.

Unfortunately, this is all a byproduct of the 'war on drugs'. You can't even get proper pain management because someone might be or become an addict.

nursej22, MSN, RN · Jan 3, 2011

I am so sorry for your experience. I can relate somewhat having had an abdominal hysterectomy. I thought I was prepared because I had already had 3 C sections, but that was pain with a capital P!

And I too have had a severe ear infection, resulting in a ruptured eardrum, "wow, that must really hurt!", yeah, genius that's why I'm here. 3 nurses mentioned something about a topical analgesic before they irrigated the pus out of my ear, but it was never used. I did a get Vicodin once they were done irrigating and digging.

Unfortunately, some nurses get complacent about care and forget about the individual, sort of like that movie "Doctors" with William Hurt.

I am sure you will use this unfortunate experience in your nursing practice.

Please take care.

lifelearningrn, BSN, RN · Jan 3, 2011

OMG- the ruptured ear drum.. holy cow! I actually have a pretty high threshhold for pain.. but one night I woke up with the worst ear pain I'd ever experienced. (and as far as I remember, my first ear infection ever) I could feel pressure building up.. It was excruciating. I almost made my hubby take me to the ER lol.. after about an hour of pure agony.. a huge BAM of pain, then it was over.. My ear drained fluid for two days though. I can honestly say, without a doubt, that was the worst pain I'd ever experienced.

GHGoonette, BSN, RN · Jan 3, 2011

I'm so sorry to hear what you went through. Do you have a Eurologist? I'm not sure what I can say legally.
I am not recomemding and am only sharing a story.
A Eurologist (bladder & urinary tract doctor) was a God send for my friend. .
I have a friend with intetstycial cystitis. She needed help urinating, she had a lot of pain, and all her other doctors would treat her for just a bladder infection. It took a while before she was referred to her Eurologist who helped her to properly urinate with medication. She had something called IC (Interstycial Cystitis). This Dr even sent her to a physical therapist that specialized in helping her to properly use her core mucles to help her to urinate. I don't know if any of her story is helpful.

Honey, sorry I just had to respond to this... Normally I don't worry about spelling mistakes but this had me laughing so much....

It's Urologist, no "e" in front. I can only assume a "Eurologist" is an expert in European monetary systems...:)

OMG- the ruptured ear drum.. holy cow! I actually have a pretty high threshhold for pain.. but one night I woke up with the worst ear pain I'd ever experienced. (and as far as I remember, my first ear infection ever) I could feel pressure building up.. It was excruciating. I almost made my hubby take me to the ER lol.. after about an hour of pure agony.. a huge BAM of pain, then it was over.. My ear drained fluid for two days though. I can honestly say, without a doubt, that was the worst pain I'd ever experienced.

Oh my, have I been there, done that! Yes, that is horrendously painful! Your description takes me right back to that night! Do you think Murphy waits for the wee small hours before inflicting this on people?

OP, I think you have been a victim-let's be charitable-of total ignorance, because the operation you describe requires far more aggressive pain intervention than PO meds. At the least, you should have been on a combination of anti-inflammatories, combined with IV opiates. Preferably a PCA pump. Whoever did your anaesthetic should be inflicted with the same kind of pain you had to endure; perhaps he/she would be more considerate in future, and ensure that his or her patients are on a more effective regime.

RNOTODAY, BSN, RN · Jan 3, 2011

I'm so sorry to hear what you went through. Do you have a Eurologist? I'm not sure what I can say legally.
I am not recomemding and am only sharing a story.
A Eurologist (bladder & urinary tract doctor) was a God send for my friend. .
I have a friend with intetstycial cystitis. She needed help urinating, she had a lot of pain, and all her other doctors would treat her for just a bladder infection. It took a while before she was referred to her Eurologist who helped her to properly urinate with medication. She had something called IC (Interstycial Cystitis). This Dr even sent her to a physical therapist that specialized in helping her to properly use her core mucles to help her to urinate. I don't know if any of her story is helpful.

UROLOGIST

jzkfel · Jan 3, 2011

It sounds like pretty terrible care. Your pain threshold really isn't the issue. How well your pain is controlled, how well you are breathing, are there any complications that are causing the pain... those are the issues. I would follow up with the hospital. Having something in writing that is very specific about things like how long you waited for medications after reporting pain, and things that were said to you by nurses and residents is helpful in getting their attention and focusing the conversation on the problems with your care.

If you are interested in going into surgical nursing, I would look for facilities that have and utilize a pain treatment service that is separate from the surgical service. Surgeons are not necessarily good at pain control. They also don't always make it a priority.

tewdles, RN · Jan 4, 2011

I am a first year nursing student who just finished a class about pain management. We were taught, that everyone has an individual pain tolerance and it should be treated if the patient expresses their pain. Fine. I was afraid when I was going into my lady partsl hysterectomy, cystecele repair, rectocele repair combo surgery about pain managment. Everyone assurred me that the hospital would take care of it. The morning after my late afternoon surgery, I was told that I 'shouldn't be in so much pain', "I must have a low pain tolerance", the nurses told me there were no orders for anything but advil and oral diladid. I begged for pain medicine. The 'doctors' (who I found out later were 4th year residents) told me "some women have different pain thresholds and that mine must be low". Every single one of these people looked for my incisions on my abdomen when they did their brief assessment. By the end of that day, the residents and nurses finally realized that I had a lady partsl hysterectomy with as one put it 'wow you had a lot of extra work done - we must have gotten behind on your pain medicine'. Finally they put me back on IV diladid. But wait - the nurses were so busy that they didn't stay up on my pain schedule. I waited three hours past the time for my meds and I was sobbing when my husband came in.
Can ANYONE explain to me how this can happen? Apparently my surgeon wasn't able to follow up with me that morning because of a snow storm. Not one nurse assessed my pain, not one nurse asked where I hurt, what the pain was like. Everyone just kept looking at me like I had a third head. And get this, when I asked the nurses and the resident to check my catheter because it hurt really bad - no one did. Finally, I lost my mind and yelled and insisted. The resident literally came over and said something about 'pain tolerance' and jerked on my catheter - which sent me through the roof and he said 'see that shouldn't have hurt - you must have a low pain tolerance'.
It has now been three weeks since surgery and guess what - I still can not void on my own. That's right. I have severe pain down my left leg, and left perineal area. And I still can't pee. I am in nursing school and I can think of many things a nurse could have done for intervention. Much of what happened can also be placed on the ridiculous actions of the residents, but couldn't the nurses have been more proactive????? Any comments?

You should file a formal complaint with the hospital. It would be in your best interest to consult an attorney to insure that someone is looking out for your best interests.

You have every right to question the actions of the nurses who "cared" for you. I did not look at your profile, so I do not know where you received care geographically, but in my neck of the woods that is sub-standard care.

As for the resident "jerking" your catheter...that qualifies as assault in my book. He should have KNOWN better. Since when is jerking on a drainage tube from a surgical site part of any patient assessment?...especially a pain assessment!?! I am certain that your surgeon will be very interested to know about that little detail while he considers why you cannot urinate post operatively. I will repeat here, if you are in the US you should talk to an attorney to protect yourself.

I am so sorry you have experienced this! Holy Cow!