adequate pain mgmt for the patients

  1. wow, what a wonderful idea. ok, i'll go first.

    when i was a new grad and started working full time, the facility did not give any thought to adequate pain mgmt for the patients. my first horror i had encountered was a female pt. with end stage metastatic bone cancer, with stage 4 decubs on bil ankles. they had her on ultram and that was it. being the stoic, proper irish woman, she groaned and grimaced as quietly as possible but was clearly suffering. i approached my DON who thought the patient seemed 'ok'; i went over her head, called her doctor and demanded he come in to assess his pt. ultimately she was put on duragesic and scheduled morphine with prn for breakthrough pain. this was truly a novel experience for this facility and i personally took it upon myself to ensure pts. got proper pain mgmt. a new administrator came along (former nurse) and decided to make part of our facility soley dedicated to hospice care with me being the hospice nurse. some of us got certified and the rest is hx....

    but inspite of all the pain control education, there were still nurses who would chart "pt. heard groaning from hallway", in spite of prn orders that still weren't given!!!! so yes, big accomplishment that i am proud of, even if i did step on quite a few toes.

    leslie
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  2. 7 Comments

  3. by   VivaLasViejas
    Good work, Leslie!!

    I'm amazed at how far we've come in pain management just in the 7 years I've been an RN. When I started, we had patients come to my SNF with fresh total hips and total knees......and only plain Tylenol for pain!! Regular strength, too! The docs would get SO pissed at me when I called at night for a patient who was literally screaming in pain.....one of them even yelled over the phone, "So what do you want from me?" and I yelled right back: "Some REAL pain meds, dammit!!"

    We still have a long way to go, of course.....still too many doctors AND nurses who worry the patient will become "addicted" to narcotics. Excuse me, but when you've got a stage IV tumor that's literally eating you up from the inside out and you have nothing but misery to look forward to during the last few weeks or months of your life, who are we to withhold pain medication for fear you'll get hooked?! Of course, I can understand that physicians might be afraid to prescribe adequate amounts of narcotics, what with our omniscient Attorney General, who seems to think he knows more about medicine than they do, blustering about the 'sanctity of life' and threatening prosecution if a patient dies with opioids on board.

    But in this society, we don't allow our PETS to suffer the way we allow our fellow human beings to suffer.......and while I don't believe in assisted suicide, neither do I believe it's OK for people to be in pain when we have so many ways to alleviate it, including medical marijuana and morphine pumps.
    JMHO.
  4. by   Farkinott
    I think too many nurses impose their own beliefs on suffering clients when it comes to adequate pain relief. I am a great believer in being pain free. It is proven to assist in healing and more rapid recovery. If you client has a prn pain order give it! If it is inadequate, get it changed! It cheeses me off when I come on shift and one of my clients has been in pain all day. They might have been given paracetomol instead of pethidine. Of course you need to use professional judgement. iI remember looking after a builder who did his back in in a major way and was in agony. I came on shift, gave him some narcotic (another paracetomol patient) and fifteen minutes later he was coming down the hallway wanting to go home for a few hours! Of course a BIG NO! but it is good to have in your power to ease someone's pain.
  5. by   leslie :-D
    my Lord marla, we DO have such a long way to go. there is absolutely no excuse in the world for letting anyone suffer. and it's so ironic that we nurses use the dx of 'knowledge deficit' to our pts. and then proceed to teach.

    disclaimer: i'm going to give in to my ADD impulsivity and distract for one moment:

    marla- what year did you graduate, oh twin sister? i'm from the class of 1996.

    we will now return to our regularly scheduled thread.

    so how many of you nurses do use pain as the 5th vital sign???

    leslie
  6. by   VivaLasViejas
    I graduated in '97 (hence, my user name).

    Pain is the first thing I ask patients about, after I've introduced myself as their nurse and asked them what they like to be called. I don't ever want it said about me that I'm not proactive about pain, even though (realistically speaking) it's impossible to please some patients......think ages 30-50, female, with vague 'abdominal pain' that has NO discernible cause despite repeated hospitalizations and thorough workups, yet always rates a 10/10 and renders them helpless to reach the drinking cup on the bedside table :stone I'd rather give them everything on the 'menu' and be scorned by the oncoming shift nurse for "giving in" to their demands, than risk being accused of not being aggressive enough in treating their pain.

    Now, we all know that sometimes it's a choice between the lady and the tiger: guess wrong, and you've had it. A nurse can get into big trouble for under-medicating as well as for over-medicating patients......and even if I think the amount is rather excessive, I also realize that my perception of 'excessive' is far different from that of someone dealing with severe, chronic pain. I can't even take a couple of Vicodin without turning into mush, but that has nothing whatsoever to do with the fact that Mrs. Smith in room 205 takes 80 mg of OxyContin twice a day along with about 1200 mg of Neurontin, and six or eight Percocets on days when her pain is really bad, and she STILL manages to work fulltime as an engineer at Hewlett-Packard. It's all a matter of where the pain is, its origins, the patient's pain threshold, and his or her tolerance for medications. I just wish more doctors would tell the government to go to hell and prescribe what they know is appropriate for their patients......and I wish more nurses would remember what we were all taught in school: "Pain is whatever the patient says it is, when the patient says it is occurring".
  7. by   Farkinott
    Quote from mjlrn97
    I graduated in '97 (hence, my user name).

    Pain is the first thing I ask patients about, after I've introduced myself as their nurse and asked them what they like to be called. I don't ever want it said about me that I'm not proactive about pain, even though (realistically speaking) it's impossible to please some patients......think ages 30-50, female, with vague 'abdominal pain' that has NO discernible cause despite repeated hospitalizations and thorough workups, yet always rates a 10/10 and renders them helpless to reach the drinking cup on the bedside table :stone I'd rather give them everything on the 'menu' and be scorned by the oncoming shift nurse for "giving in" to their demands, than risk being accused of not being aggressive enough in treating their pain.

    Now, we all know that sometimes it's a choice between the lady and the tiger: guess wrong, and you've had it. A nurse can get into big trouble for under-medicating as well as for over-medicating patients......and even if I think the amount is rather excessive, I also realize that my perception of 'excessive' is far different from that of someone dealing with severe, chronic pain. I can't even take a couple of Vicodin without turning into mush, but that has nothing whatsoever to do with the fact that Mrs. Smith in room 205 takes 80 mg of OxyContin twice a day along with about 1200 mg of Neurontin, and six or eight Percocets on days when her pain is really bad, and she STILL manages to work fulltime as an engineer at Hewlett-Packard. It's all a matter of where the pain is, its origins, the patient's pain threshold, and his or her tolerance for medications. I just wish more doctors would tell the government to go to hell and prescribe what they know is appropriate for their patients......and I wish more nurses would remember what we were all taught in school: "Pain is whatever the patient says it is, when the patient says it is occurring".

    Well said.
  8. by   Jamesdotter
    Several years ago I, a postpartum nurse, was floated to peds and assigned to care for a 13-year-old girl with a fractured femur (she was handicapped and had fallen getting off the school bus). At that time she was in Buck's traction. I asked her if she was hurting, she said "yes" so I went to get her pain med. She'd been in the hospital since the evening before and no one had given her anything--not even a tylenol--for pain. She had T-3's ordered, "1 or 2". Well, she was a little bitty thing, so I gave her one. When I checked with her later, she said it had helped, and she had certainly brightened up! I was sent back to peds again the next day, and discovered that she was now being medicated for pain regularly (maybe I told her to ask for it?), and her Dr. had changed the order to one tablet.
  9. by   nightingale
    Assessing Pain is now considered a 5th vital sign by JACHO.

    I applaud all of you for addressing this very basic need for our pt. I would be proud to have any of you as my nurse.

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