Narcotics administration - Page 4

Just curious...is the cancer patient white and the SSC patient black? Just curious.
Is suspicion of drug seeking ever driven by a patient's race?

Just a reminder...Med-Surg nurses are charged with treating the patient's medical conditions, not addictions. Unless you are working in a drug-treatment facility, you are not equipped or trained to treat the addiction. You must treat an addict's pain like you would any other patient's pain, which is to the point of reasonable relief.

AGREE. It SUCKS to be in pain. You are pre-occupied with how you are going to get out of pain. I am not a rehab nurse, and I don't want to be, but I do not ever remember being taught , required or expected to diagnose, and then subsequently order treatment for addiction. And really. What is withholding a dose of pain med going to do to treat someone's addiction to pain meds? It's just the same as withholding lunch from an obese person because you don't think they are really hungry at their scheduled meal time. Is my judgement that someone is not in pain worth the risk that I am letting them lie there in pain? I don't want my patient grimacing or groaning or hyperventilating before I give them meds. I want to keep them from getting there, just like I'm not going to wait for someone's scheduled BP meds until their BP is sky high.

I wonder how the difference in attitude relates to having been the patient. I have been in severe pain many times with a flare up of a chronic condition and have been eternally grateful to the nurses who were agressive with pain care.

I just doubt that a patient's pain is 9/10 when they are eating chips and chatting on their cell phones. I understand that pain is subjective, but seriously, if your pain is so bad, you'd show it. You wouldn't desire to eat fried foods and text message your friends. Isn't that an assessment? I've charted it before. "Pt reports pain 9/10. Requests medication and a snack. Patient currently watching television and talking on the phone. No guarding noted...." blah blah.

I understand your area of concern and was once faced with this in my nursing career. Later, I then realized, if these people are drug seeking and "setting a clock" which some of them do, lol. The doctor wrote an order for it, and until the order is discontinued, or the patient is somnolent from too much pain meds, I have to give it....Yes, it can be super annoying. I have found it to be sad actually, that some people depend on a drug to function.

100% agree with KatePasa. Whether it is safe to administer the medication in question should be the only consideration. On a medsurg unit you are NOT treating addiction, and what purpose does it serve to get into a power struggle with your patient? It makes me very sad how differently mental illness is viewed than physical. You have no place judging any patient or denying PRN medications that have been ordered by a provider because you feel like their addiction is inappropriate or you feel like they are lying to you about pain, etc, etc. If they are opiate dependent, it IS going to take a massive amount of medication to get legitimate pain under control as well.

Just curious if anyone has actually spent time exploring the "frequent flier"'s (hate that term) life history or what led up to their addiction. My patients have been very forthcoming with me when I've asked some basic questions and I have heard some sad, horrifying stories. It may help to realize that these patients are people like everyone else, and most folks don't decide to choose a life of addiction because it seems like a fun idea at the time. In my experience, they have had hard, hard lives and end up substance abusers either self-medicating a mental condition or out of desperation. We nurses are viewed as one of the most compassionate professions...it's time to live up to that reputation and be compassionate to EVERYONE, not just those whose lifestyles we approve of.

I work in Med/Surg in an area that has a high volume of drug addicted, ETHO, suicidal,mental illness and so on type patients. We do not have the resources in this community to fix or help these patients. I always review previous admission documentation, H&P, discharge summaries, I verify the home medications as best I can with the information they provide. If the MD prescribes the narcotic and the patient states they are having pain, I give the medication as prescribed. I know that I can not fix them, I always hope that they are quickly discharged, but while in my care I make the best of the worst.

I think that the medical profession in general have become too judgemental of the chronically ill in our society. The ill and disabled are far too often treated as disposable insignificant humans. I think that there should be a lot less judging and a lot more tolerance toward the chronically ill.

Of course there are those frequent flyers who we ALL know are seeking meds for the meds.....but we, as nurses need to be very careful to understand that the chronic nature if someones pain does not signify addiction and "seeking" behavior. I have a family member with metastatic CA to the bone......everywhere and a nurse recently worried about addiction to the pain meds.

My response to her was.....yes he maybe addicted to the meds and he will take that addiction to the grave with him!!! Of all the crazy things to say!!!!

This is a hot topic amongst nurses and MDs about the use of emergency rooms for pain.....pain clinics.......but my expereince has been that pain is way under treated due tothe assumption that someones pain isn't that bad and they are seeking.

It has no bearing on race and I think it is a reflectionof society itself on the uselessness of the chronically ill..

But we need to stick to the topic and not call each other names. We can agree to disagree without being disagreeable(Gerald Ford).

A reminder to everyone!!!!

Allnurses promotes the idea of lively debate. This means you are free to disagree with anyone on any type of subject matter as long as your criticism is constructive and polite. Additionally, please refrain from name-calling. This is divisive, rude, and derails the thread.
Our first priority is to the members that have come here because of the flame-free atmosphere we provide. There is a zero-tolerance policy here against personal attacks. We will not tolerate anyone insulting other's opinion nor name calling.

Our call is to be supportive, not divisive. Because of this, discrimination, racial vilification and offensive generalizations targeting people of other races, religions and/or nationalities will not be tolerated.

Lets please keep to topic.

Really? Then I don't see how you can ethically remain as their nurse.

Once you're addicted, it's a choice? That raises some interesting questions about free will.

Biology is not best understood through moral reductionism.

In fact, there are heroin addicts who have traumatic accidents and surgery who feel pain the way everyone else does. The difference is that they've built up a tolerance to opioids. And unlike other most (but not all) other patients, they are subject to withdrawal symptoms, which can be severe.

I'm not sure that you should be treating anyone addicted to drugs. Apparently you'd just as soon see them dead.

These people?

I don't think you know much of anything about the epidemiology or physiology of opiate addiction. There are normal-looking and normal-functioning people all around you who are hooked on opioid pain killers, and have been for years, sometimes decades.

You might want to explore what is at the root of your intense bitterness toward drug abusers. Really, there are bigger fish to fry for a nurse than to obsess over whether a patient is getting more Dilaudid than he really needs.

Pain med administration, OH what a subject.

Having been a nurse for 38 years it is quite clear, if it's ordered by the physican, the pt. c/o pain, the proper nursing assesment is made and vitials are WNL I administer the medication as prescribed leaving all personal judgements about addiction aside. It is not or has never been my job to prescribe the medication, therefore I administer as ordered and requested by the patient. If a pt's need for pain medication is questioned, as many times myself and my co-workers have discussed, assessment and documentation are a must.

Many times a pt. will request increasing or decreasing a prescribed dose. As we all know we can educate the pt. reguarding pain med administration and titration then document our findings, this will ultimetly assist the physician in making the decision in what is best for the patient. That is what we all want as medical professionals, that which is best for our patients. For me personally the comfort of my patients is a primary concern, especially in an area of rehab. The more comfortable and pain controlled the patient is, the greater cooperation and recovery. I have even encouraged a pt. to take his/her prescribed pain meds to enhance their participation in therapy, therefore many times expiditing their recovery.

On the other hand I have seen aquaintences, Dr. shop or make unnecessary trips to the ER to obtain pain meds. This ticks me off. Not only are they wasting the medical staffs precious time, but they totally make fools of themselves. The ER staff pretty much know who the frequent flyers are and those who are only there to seek pain meds. I have seen many a pt. leave the ER in a huff when they are not given the meds they wanted when they came in. When the so called patient is in the ER, VS WNL, sitting up, asking for food because they have been there for hours and not given anything to eat then when asked what their pain is on a scale of 1-10, and it is "10" I have to laugh to myself.

But then too communication and documentation is key. The look on their face when nothing is found and they leave the ER with a recommendation for APAP q4 or a script for Motrin is PRICELESS.

In any event, as much as we all hate all the documentation we have to do it and do it well...documentation is our friend, and can protect us in questionable situations!