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.
1) Facial grimicing- BIG CLUE, you know that little furrow in the brow?
2) Tense body language- If you try to take someone's blood pressure and they are so tense, you can't pull their arm up? Think pain
3) Moaning- BIG CLUE
4) Them saying- "I hurt everywhere" Another big clue.
5) Sleeping all the time. Yes, even if someone sleeps, they could be in pain. I can't STAND when I hear someone say, Well, they were comfortable because they were sleeping. Guess what? I almost slept through the delivery of my son, had him 18 minutes after I got to the hospital, because I slept when I was in labor. When I hurt, I sleep.
6)Combative with care. Think about it. You have someone who is very confused and they are hurting. You are going in to touch them or try to do care. They don't know who you are or what you are doing, all they know is that they hurt and you touching them hurts more. Worse, they can't SAY they hurt because they cannot articulate the sensation with words.
7) Elevated respirations/blood pressure/heart rate ALL indicate pain
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 hospitat? 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.
shay, you know i strongly agree with you, but still feel it's a lost cause.
not only is the myth going strong and pervasive, the knowledge deficit is a forerunner as well as fear.
and keep in mind that depression/hopelessness is also r/t pain, and not only their terminal dx.
pts will often deny their pain for whatever reason, and nurse writes "denies pain" without doing an assessment...or, doing an assessment that says otherwise.
a while ago, this ltc facility wanted to have their own hospice within their facility, and i did the inservice.
had to do the inservice on pain, 3x...to no available.
i got feedback that not one pt, got the prn's available to them.
not one nurse felt it necessary, yet the notes told a completely different story.
we can yell til the cows come home, and very few will still believe it.
when i observe nurses looking the other way (STILL telling themselves that THEY won't be the one to kill the pt.), it is at that point i wish the pt to just die.
anything is better, than living in ignored and agonizing pain.
but i do appreciate your shout-out.
Last edit by leslie :-D on Jun 3, '11