If it's assumed that the patient's pain is ALWAYS what they say it there are two major questions that arise. The questions arise because they are real-life situations.
1. A patient has had surgery that isn't expected to be painful. The patient has had 4mg of Dilaudid for pain that is reported as 10. The patient has a goofy grin and says: "I'm going to say that my pain is a 10 because I like pain medicine." (This actually happened)
Do you continue to administer Dilaudid in this situation? Do you take his report of pain at face value?
I was advised by my co-workers to send the fellow home and I did so.....He left smiling......Did we do the wrong thing?
2. A patient is close to being in a Dilaudid coma after receiving 10mg of Dilaudid. The patient appears very comfortable and, when awakened, rates his pain at 10. (This actually happened)
Do we have a pain emergency here?
(I've seen many situations that are clearly pain emergencies but this one doesn't seem to be a pain emergency.) Can you in good conscience send the patient to the floor with a pain of 10 under these circumstances?
O.k.....I asked more than two questions but the other questions are tied to the main ones.
^ Esme makes a very valid point; even with the scenario and additional information you have presented; I still would have to make a comprehensive assessment in order to get the big picture.
Do you have a comprehensive assessment to determine if the patients had a sensitivity to the opioids? Were they still having the effects of the anesthetics??? Possibly post OP delirium??
Most people don't know they have sensitivities to opioids or anesthetics.
I'm posting this article as a means in hoping that there is info that can help guide an answer: http://www.learnicu.org/SiteCollecti...20Delirium.pdf
Edit: I also found this article as well:
Last edit by LadyFree28 on Nov 24, '13
There's something hauntingly familiar about this thread
As in the last thread, OP, you are oversimplifying.
I get that you believe that the inappropriate prescribing of opioids contributes to addiction.
The problem is that you keep trying to blame what you refer to as "experts" for creating the problem. Our point - at least my point - is that the real experts have nothing to do with the kind of knee-jerk throw-a-drug-at-it response you describe.
Addicts are the population we love to hate ... with very good reason. No one likes the manipulation, lies and thievery that they use to get their drug of choice. You seem to have been badly burned by this dynamic.
Blaming the attempt to manage their pain for their addiction is not a useful approach.
Last edit by heron on Nov 24, '13
: Reason: expansion
Nov 24, '13
..it is your personal opinion that these patients were mishandled in some way.
I don't think there are right answers in the two examples. I think it's a question of making the best guess.
The two patients were in my care.
Have I not medicated a patient because they are smiling and state they like pain meds...NO, not usually.
The patients were Medicated.....The smiling one had been given 4 mg of Dilaudid and the semi-comatose one had recieved 10 mg of Dilaudid.....The question is whether they should have been given more. Do you think they should have received more Dilaudid?.....Pain rating of 10, smiling and looking very pleased, states that he's rating the pain at 10 because he likes pain medicine, vitals are perfectly normal......What would you do?
Semicomatose after 10 mg of Dilaudid looks extremely comfortable states that his pain is 10 when you wake him up......What would you do?
Last edit by SocratesJohnson on Nov 24, '13