Using our judgement

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    I am soon to be an RN graduate in two months. In my studies and clinical rotations, I have found the issue of pain management to be extremely frustrating. We are taught to be advocates for the patient. So how are we being an advocate for a patient that is obviously rating their pain as excrutiating while they appear to be fine, and medicating them with large doses of narcotics and so on? It seems contrary to being an advocate when we know that these narcs are addicting, and possibly could be ruining this person more than it is helping. I'm no expert in the field of psychology or even medicine at this time, but I don't understand what my role really is when it comes down to this issue. Any of you well seasoned nurses have a thought for me?
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    FIrst of all, Suzy CSI, you will not be medicating these patients without an order from an MD or other primary provider. Pain is a subjective measure even with the pain scale. Is it your job as a nurse to become a lie detector? I would rather take the chance of medicating an addict than allow one patient suffer from needless pain. My opinion. YMMV.
    KaroSnowQueen likes this.
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    Quote from MSADN
    FIrst of all, Suzy CSI, you will not be medicating these patients without an order from an MD or other primary provider. Pain is a subjective measure even with the pain scale. Is it your job as a nurse to become a lie detector? I would rather take the chance of medicating an addict than allow one patient suffer from needless pain. My opinion. YMMV.

    Good point. And of course you don't medicate without an order, I just wondered if you would try and use your judgement at that time and, say, give one vicodin, rather than two, if it's ordered "1-2 Vicodin Q 4 hr. prn pain"?
    -Suzy_CSI
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    Suzy--YOU will not be medicating your patients w/o an MD order. Remember, pain is subjective. One thing I've noticed over and over is that most docs tend to UNDER medicate. It's very frustrating, as a hospice nurse, to admit a patient with CA and have them rate their pain @ 9 and see they are on Lortab 7.5/100 Q 4-6 hours PRN. I agree with MSADN, except that I would MUCH rather medicate ten addicts than let one person have uncontrolled pain. Good luck in your studies!
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    Pain is what the patient says it is. Not everyone carries on and writhes about when they are in pain. If I am in excruciating pain I try to stay as still and as quiet as I can. You might not think I was anything but relaxed.
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    Pain is what they say it is. Chronic pain patients often do not exhibit the same signs and symptoms as those in acute pain. Chronic pain sufferers often feel that it is part of life, but they still feel the pain. Those in acute pain will show alot of emotion. However, some people are taught to not show pain ( culturally ). I had a patient like this, he said his pain was a 8 out of 10 or a 9 all the time. But he was watching tv and looked relaxed. We knew he was there with an acute pain issue. So none of us believed him to be in such pain. Well, I got on the floor and after a first assessment, I stepped out of the room. The previous nurse said " He is exadurating and does not understand the pain scale". It was night so I was able to use the window to see him. He di not know I was watching and I saw pain behavior! Wow! I'll never ever make judgements again. I was on the phone to the doc so fast and after several tests we discovered he had internal bleeding complications from his surgery. It was caught just in time. I now think to myself, what if I had taken the other nurses word for it?
    ncaissie likes this.
  9. 0
    I have very bad chest pain. It's inside like a knife ans aslo a crushing pain like my lungs are exploding and there isn't enough room in my chest.

    I don't show the pain most of the time but it doesn't mean it's not there.
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    As you are learning one of your primary functions as a nurse it to perform an assessment. So.you assess the pain complaint,where it it,referred or not.causes,level.last time med given,was it effective,other s/sx with the pain. You get the picture. Then based upon the MD order you medicate the pt and monitor the response. I refuse to judge my patient,I just believe them.What you need to do is a little research b/c with a lot more knowledge and experience you will begin to feel more comfortable.


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