These pts are on tons of dilaudid....then no wonder several days later they come back sweating, crying, with mysterious abdominal pain. The only thing that works is more dilaudid.
Are these pts addicted? Or are they faking?
How to know?
If we got them addicted, don't we have the responsibility to UN addict them?
Is the best way to withold pain med? Or wean them down? Give them diluted pain med?
What to do???
This seems to be a real problem at our hospital.
These pts drive me crazzzeeee!!!
All they do is beg for pain med.
Help me know.
Other nurses want to withold.
But I'm left with the whining, begging, crying all day. (theirs and mine!)
And the dr. deals with it by prescribing the desired pain med. Help!
I'm only a student, but isn't it appropriate to bring the patient into this conversation? "Many people who use these types of pain relievers find they have a difficult time stopping the medications," etc. Speaking frankly about it may encourage the patient to talk about addiction vs. pain issues.
yes, the pt should be brought into it, but not like that. if pain is the issue they are not going to want to talk about addiction.
This is a pet peeve of mine. Why isn't dependence being discussed here? Many patients are dependent upon medications but are not (((addicted))). When their dose is reduced or stopped they may feel terrible, and yes, it is relieved by more meds. That doesn't mean they are addicted. There is a huge difference between dependence and addiction. Both cause withdrawal symptoms to a certain extent.
Here's good info regarding distinguishing between addiction, dependence, and tolerance.
Could the abdominal pain ever possibly be from constipation r/t dilauded use? Or cramps r/t the stool softeners and laxatives given to someone on these strong types of pain control?
I'm a new grad but I recently had a pt who was on dilauded long term d/t his disease and was going through withdrawls. He was not a drug seeker by any means but had a horrible long recovery and needed the pain meds. He did wonderfully on methodone to get off the pain meds. Don't pts who use these strong pain meds often get put on methodone to wean off toward the end of their therapy?
At my facility we have a pt who has been deemed a "frequent flyer drug seeker." She comes in like every 3 weeks c/o SEVERE abdominal pain and that only Dilaudid will relieve it. So we give it to her around the clock, Labs are drawn, CT's, the whole nine. Everything comes back negative of course. She rates her pain as a 10/10 even though she shows no clinical signs of pain. Pain is subjective, however, I remind myself to not be judgemental and to just medicate her according to protocol. Sounds familiar to you?
For the 12yr old maybe a discussion with the MD about having a conversation with the parents is in order. This patient may benifit from a psych eval then again she may have a to date undx'd condition either way it needs addressed.
I believe that pain is what the pt says it is. Giving the lowest dose and misleading the patient to think they are recieving a higher dose is unethical. If your coworkers are that judgemental and unethical that they are causing you distress if you don't conform to their way of doing things maybe this is not the place for you to be. You sound like a caring, compassionate and ethical nurse please don't allow yourself to be jaded by the others.
We have a pt on the floor right now that c/o ab. pain rated 9/10 and unrelieved by any pain med we have given up to this pt, which includes Dilaudid q1hr, pt had an epidural for 2 days and he said that it didnt work, morphine iv, Lortab elixer, and the list goes on and on. This pth has had numerous tests that have all come back negative and frankly Im at the point where SOMEONE needs to get this pt out of the hospital and into rehab somewhere IMO. I asked the pt the other night if the Dilaudid iv helps and he said no not at all so my next question was" if it doesnt help then why do you want it?". He just looked at me and said "so you think im a seeker too". I didnt say it but thats exactly what I and every other nurse on the floor feels. Im going to talk to the Manager and see what can be done about this cause this has been going on for 3 weeks and frankly we are just feeding into this guys addiction. In this case we are the "enabler" and that is just not right.
For the 12yr old maybe a discussion with the MD about having a conversation with the parents is in order. This patient may benifit from a psych eval then again she may have a to date undx'd condition either way it needs addressed.
There have been several multi-disciplinary meetings with parents, patient, psychs, etc regarding this issue as this is her 46th admit. She was even once on hospital hold and the parents were not allowed to take her home pending a thorough psych eval (at the time she was only 9). Nothing has seemed to work with her. We are at our wits end! I am a VERY FIRM BELIEVER in the notion that "pain is subjective," however I care very deeply about this troubled young lady and do not wish to contribute to what MAY be a possible drug addiction problem.... its a catch 20 either way
TazziRN, RN
6,487 Posts
yes, the pt should be brought into it, but not like that. if pain is the issue they are not going to want to talk about addiction.