Wake up...Are you in pain? - page 3

Ok, so what is the consensus here? I was taught that one can be in pain and be asleep. So do I wake up my PACU patient every 15 minutes to question them, or do I chart "pt sleeping"? We must chart... Read More

  1. by   LesJenRN
    Looks like someone backed out of this discussion? The tone has softened a bit.... This reminded me of back when I was just out of school..... My postop little old lady had lots of pain, she fell asleep and I did not want her to wake up in pain....so I pushed that PCA button whenever I went in.....she almost didnt wake up....thank God for BVMs and Narcan....
    Now I know why we Wake them up to ask!
    Many years later....why arent these docs medicating appropriately for pain?! It's either "may you suffer in pain!!" or "lets kill an elephant".........
  2. by   KMSRN
    It depends on why the patient is on pain meds and what they are getting. I would have no problem waking a relatively healthy post op patient with an acute pain issue to ensure continuity of pain relief. If it is someone with chronic pain or a palliative patient, that would be unacceptable. It would mean their long acting medication is inadequate or they should be on continuous IV medication.
  3. by   Tweety
    I take it on a patient by patient basis. For people who have been in severe pain, or have chronic pain and I wake them up. I confess to not waking up a stable post-operative patient, or someone who hasn't been taking much pain medicine. I'm a night nurse and I'm usually waking them up for something anyway, that's a good time to assess pain.

    If a pain med is ordered around the clock, I don't hold it for sleep, I definately wake them up for the reasons stated above.
  4. by   Dave ARNP
    Quote from KMSRN
    It depends on why the patient is on pain meds and what they are getting. I would have no problem waking a relatively healthy post op patient with an acute pain issue to ensure continuity of pain relief. If it is someone with chronic pain or a palliative patient, that would be unacceptable. It would mean their long acting medication is inadequate or they should be on continuous IV medication.
    You're close, but not quite there yet.

    Chronic and pallative patients still need to be checked for pain according to the schedule the medication is ordered. Some patients, particularly the elderly, need to stay away from long acting medication. Some patients do fine not taking a long acting, but still need breakthrough coverage. You'll not know they need it if you don't ask.
    Patients getting a PRN for breakthrough, in addition to their long acting medication, also need to be awoken. Breakthough meds are given in the event of b/t pain, and are best given in the early stages. Pain may be onsetting during sleep, and if given early, less medication will be needed. They could be sleeping to avoid the pain, thus they'll need their medication. More and more and more reason, but you get my general idea.

    Very good logic, though. I totally see where you're comming from~!

    -Dave
  5. by   fab4fan
    If I'm the "someone" who supposedly backed out of the discussion, then that asssumption would be incorrect. I was out of town at a conference and didn't have access to the net.

    Dave: You might find this interesting. I had a very vivid dream once that someone was beating me over the head with a baseball bat. When I woke up, I had a full blown migraine.

    Hmmm...sleeping people don't feel pain?
  6. by   Dave ARNP
    Quote from fab4fan
    If I'm the "someone" who supposedly backed out of the discussion, then that asssumption would be incorrect. I was out of town at a conference and didn't have access to the net.

    Dave: You might find this interesting. I had a very vivid dream once that someone was beating me over the head with a baseball bat. When I woke up, I had a full blown migraine.

    Hmmm...sleeping people don't feel pain?
    That is very interesting Fab! I've heard similar things from patients, and I would love to know more about the whole reasoning of it. My mother who is a psychiatrist, tells me that her theory is the brain is creating a dream which would explain for the pain that the body is feeling. That's what I go by

    Dave, welcoming a click member back to the thread :uhoh21:
  7. by   fab4fan
    Hmmm...you'll have to ask her sometime about "inherited" dreams (not sure what they're really called).

    My mother used to have a recurring dream that started in her early 20's and lasted until her mid-30's. As God is my witness, I started to have the same dream when I was in my early 20's, and it lasted until my mid-30's (I used to work in psych, and according to the one psychologist there is a name for this, but I've forgotten what it's called).

    Sorry, didn't mean to get off-track.
  8. by   Gldngrl
    Quote from MD Terminator
    And YES. THE NURSES WAKE MY PATIENTS UP. I KNOW FOR A FACT THAT THEY DO! I ask my patients "did you get your pain medicine, did you get woken up for it?".

    -Dave
    This statement concerns me, because I believe that staff should be communicating and working with one another...my physician resident colleagues come to me and ask about my patients, look at the flowsheets, and discuss the night's events, then go into the patient and talk w/ them. I wouldn't appreciate a staff provider who goes in and talks w/ the patient who may or may not respond truthfully, and then the nursing staff is placed in a defensive position, thus creating "staff splitting." The majourity of our patients are on PCAs postop, our staff takes pain very seriously and we have a pain service to consult as well. Our feedback has been positive regarding staff response to pain control and our patients do not wake up screaming in pain (then again, they generally do not get much sleep due to freq. monitoring)
    Unfortunately, with discussing issues via computer, it is difficult to ascertain one's intent so I don't mean this posting as a beratement. Just presenting a different perspective based upon my working experience.
  9. by   fab4fan
    But if you are doing frequent assessments on your pts., you probably are addressing their pain needs.
  10. by   Gldngrl
    Yes, but that's not the intent of my post. I posted to indicate that pain control should be a team effort and that I hope service providers are directly communicating with their staff, instead of asking patients if their nurse has been doing her job.
  11. by   Dave ARNP
    Quote from Gldngrl
    Yes, but that's not the intent of my post. I posted to indicate that pain control should be a team effort and that I hope service providers are directly communicating with their staff, instead of asking patients if their nurse has been doing her job.
    It's not a matter of going behind anyones back. That's soo not it.
    I trust the nurses 100% to wake the patients up and give them the meds as I have ordered them. The only time things come into question is when a patient has a c/o pain, which wasn't covered by medication. THEN, since I am already in the room, I do ask the patient.

    Afterwards, I contact the nurse, who in every instance but once, tells me that the meds were given as ordered, and can point to the screen to show it was. The one instance was actually a whole other story that's best not gotten into. We'll just say the nurse had some problems documenting (kinda hard to when you inject the dilaudid into yourself).

    -Dave
  12. by   Gldngrl
    Thank you for clarifying your statements. Medication diversion...well, that's a whole different issue for discussion
  13. by   kyti
    Ok Dave I need your help on this one. I work in the pacu. Wakeing pts up and assessing pain is my job. I want to give my pts the best pain control possible. My problem is with our TAH pts. This is a very painful surgery. We generaly use fentanyl and or dilaudid. Now if I have given someone anywhere from 250-500mcg of fentanly and/or 1-4 mg of dilaudid and they are sedated from the pain med (and anestheisa still on board), takes tactile stimuli to wake them, resp rate 10 and o2 sat 92% on 3-4l nc o2, and when I wake them they still rate their pain a 10 what can I safely do? (they generaly get 30-60 of toradol intra-op if not contraindicated) What should I do for these pts. I don't want to see anyone in pain, this could be me someday.

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