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!
Specializes in Acute Med, Pediatric Hematology-Oncology.
just putting forth my i do believe you cannot become addicted to pain meds if you are in pain, simply because of the mechanism of action involved. its when you go above the required dose and take the medications when you dont need them. having said that, you can become dependent on the medication. when i worked in same-day surgery, the post-op instructions we gave to the clients were to take the medications on a strict schedule (for instance, two Tylenol #3, every 3-4 hours, with prns for breakthrough). then we told them to wean themselves off, going to one tablet every 3 hours for a day, one tablet every 4 hours for a day, and then just prn. seemed to work pretty well for the patients.
also on the surgical floors ive been on, it seems like a pretty similar format with regards to pain management (but with slightly stronger meds). i guess my point is that if you're giving a patient so many mgs morphine every 3-4 hours and then stop abruptly, they're gonna have withdrawal symptoms because their bodies rely on it for pain relief. but if you wean them off and give them prns for breakthrough, it seems to me that the patient has an easier time coping.
my hospital has recently started an initiative that "pain is the 5th vital sign" and has focused alot on proper pain management. it deals with a lot of this sort of education for the doctors and the nurses as to what is appropriate pain management and what is not.
One of my instructors told us about a kind of pseudo-drug-seeking behavior that is caused by patients who have been kept waiting too long for pain meds. Because they fear that they will not get the drugs quickly enough when they really need them they ask for them all the time.
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?
hmmm
I work in a Peds unit...
And this patient is 12...
Just out of curiosity, has this pt. ever been worked up by an OB GYN? If the pt. is coming in every three weeks, it makes me wonder if she is having menstrual cramps.
Southern: I am truely sorry for you with regards to losing your husband. I meant no disrepect to you personally and my comments were not directed to you or your family. Again I am sorry for your loss..
I didnt think you did and I'm sorry I made it seem that way! Pain is a sensitive subject to me because of him and I got a little melodramatic there, sorry. Sometimes I dont know when to keep my mouth shut!
The nurses were giving the lowest prescribed dose in the prescribed range.
So, what they were doing was fooling the patient into thinking she was getting a higher dose.
Except it didn't work for me.
I may sound like a moron to you.
But, I'm really in a quandry.
I don't want to alienate the other nurses. They aren't happy when they take over and have to give pain med right on the minute, hour after hour.
Some of our patients have even set their watches to alarm when their meds are due!
Is it EVER right to tell a patient no when they ask for pain med when it is due?
And what if you think they are addicted? (they deserve compassion too)
I like the idea of a hospital having a pain management committee.
Being a new nurse is hard.
I want to learn. Teach me. (and thank you for your answers- I think you guys are awesome)
I agree with Tazzi, you're not a moron. You seem like you want to be the best nurse you can be. But, ultimately, the patients are your concern. If the doctor ordered that med for the patient and the patient requests it, you have an obligation to give it. Hospitals and nurses have been sued for inadequate pain relief. Granted, I'm sure there are some patients who are addicted but what about the person who is feeling pain. How can you tell if they are "faking" Ultimately, it's not the job of those nurses on your floor to "withold" medication....and it's not your job to treat their addiction if they have one. By all means, discuss your concerns with the doc if you want but no, you can't deny a patient a prescribed med. Those nurses sound like they are unprofessional and judgemental and I'd be really careful about taking advice from them regarding proper nursing practice. Do the right thing by your patient and to heck with them if they get mad at you. They are upset when they have to do their job? I smell an eventual lawsuit here.....
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nursesarah
109 Posts
just putting forth my
i do believe you cannot become addicted to pain meds if you are in pain, simply because of the mechanism of action involved. its when you go above the required dose and take the medications when you dont need them. having said that, you can become dependent on the medication. when i worked in same-day surgery, the post-op instructions we gave to the clients were to take the medications on a strict schedule (for instance, two Tylenol #3, every 3-4 hours, with prns for breakthrough). then we told them to wean themselves off, going to one tablet every 3 hours for a day, one tablet every 4 hours for a day, and then just prn. seemed to work pretty well for the patients.
also on the surgical floors ive been on, it seems like a pretty similar format with regards to pain management (but with slightly stronger meds). i guess my point is that if you're giving a patient so many mgs morphine every 3-4 hours and then stop abruptly, they're gonna have withdrawal symptoms because their bodies rely on it for pain relief. but if you wean them off and give them prns for breakthrough, it seems to me that the patient has an easier time coping.
my hospital has recently started an initiative that "pain is the 5th vital sign" and has focused alot on proper pain management. it deals with a lot of this sort of education for the doctors and the nurses as to what is appropriate pain management and what is not.