It always amazes me when I get patients from the hospital who are in horrific pain. I really don't understand. Usually report will include something along the line of "patient is uncooperative with care, hitting, scratching, biting." Then they come rolling in on a gurney and I can hear them screaming from the door to the floor. Do some people not understand when confused little old ladies are in pain they will fight like heck when they are touched. I have driven home crying when I see the sores on some of these people and then find out they were on....Tylenol. COME ON! So with a new season of student graduating, I am going to give you some advice, as a hospice nurse, on non-verbal signs of pain. What we look for when our dying patients cannot tell us they are hurting.
Now, what to do? TREAT. THE. PAIN!!! I cannot say this enough. Be an advocate for your patient. Call the doctor, explain to him I think my patient is in pain. It is 2011 NOBODY deserves to be in pain. If used properly, Morphine is a very effective medication. I can't tell you how many times I have had people come in completely combative and confused, who once pain medication on board, will calm, become clearer and be able to communicate with their families. Many times, I have family members say I can't believe how calm they are, why can't they do this at the hospital? PLEASE, I beg you. You wouldn't let someone having a heart attack go without Nitro or someone with shortness of breath go without breathing treatments would you?
One last thing. Pass the word. Morphine does NOT kill people when given properly. I have given doses of morphine to patients with blood pressures 70/p and they don't die and sometimes when they are comfortable their bodies actually stabilize. Study after study has shown the effectiveness of Morphine and that it does not kill people when given properly, yet that myth persists.