Day surgery patient stays overnight...

z's playa · Mar 26, 2005

Sounds strange to me having been through a few day sugeries with post op pain.....sent home with Motrin. There must be something that would help her PO or a mixture. I'll let you know after I actually work a shift in med/surg. :)

I'm interested to see what the RNs here have to say about that.

rn29306 · Mar 26, 2005

It is absolutely absurd to feed this type of behavior.

The ER docs have this down pat, you should see the type of crap some patients pull and what the nurses/docs handle it. This sounds like a MD allowing the nursing staff to babysit what (s)he is too chicken to face.

Long Term Care Columnist / Guide · Mar 26, 2005

I know, it doesn't seem fair, but the doc's not really 'feeding the addiction' by allowing drug-dependent patients to stay overnight following a so-called day surgery. These patients really do have a harder time with pain control than the average person, and what works for you or me doesn't even touch their post-op discomfort. That's why they end up being admitted for pain management.........and for what it's worth, I get lots of day-surgery patients on my floor who are NOT drug-dependent, because their pain and/or nausea isn't being adequately controlled with PO meds. We admit them for overnight observation, and yes, they can be quite a lot of work because they're in severe pain, throwing up, can't pee etc., and they generally feel miserable. But geez, what are you gonna do when insurance companies insist on making so many procedures such as lap choles and laser lithotripsies "drive-thru", despite the fact that vital organs are involved and the patient feels like hell afterwards?

Trauma Columnist · Mar 26, 2005

It seems to me that BEFORE surgery, they would attempt to wean her off narcotics or at least substitute methadone and then wean from that.

rn29306 · Mar 27, 2005

Neither myself or the OP was speaking of non-addicted patients running into unforseen problems post-op. What I believe he or she, myself included, was speaking about is the patients who:

1. Have their narcotic timing down to the second,

2. go to multiple places in search of narcotics,

3. consistently rate their pain a 10/10 while 5 seconds ago soundly sleeping, hr in 50s or 60s (no beta blockers mind you), and normotensive BP. While we cannot rely on VS alone, the complete picture paints itself of nothing but plain BS. You know what I'm talking about.

I am not a mean nurse. I have personally gone up to the floors after a questionable sickle cell patient comes into the ER and the blood work is indeed indicative of acute crisis and spoken with the nurses, letting them know the patient's (frequent flier) IS legit and not just a drug seeker.

I have cared for cancer hospice patients who get admitted for some reason or another and have compassionately worked to achieve pain control. The dosges these people can tolerate of PO Oxycontin and IV meds is absolutely astounding.

I talking of the BS patients and how I hated to "feed into the addiction" because some whiny doc was too chicken to face the problem in the first place and thus made the RNs babysit these people, often in the units for reasons of "closer observation" while some acute chest pain pt has to camp out in the ER. These pts are a waste of society's and the hospitals resources and while they do have an addiction, it is not my place or the hospitals to buy into it.

meownsmile, BSN, RN · Mar 27, 2005

We see these cases too, get SDS patients for pain control to the unit. They do have a higher tolerance for the pain medication so the po stuff doesnt really work. They do watch the clock, they know when its due and they know what antiemetics meds will enhance their pain medication. Problem is our pain assessments tell us each patient has a different pain tolerance and if the patient says they are having pain its not up to us to judge whether they are in fact in pain or not. You wont ever get them within their comfort level without knocking them out.

However, we dont mollycoddle them,, we let them ask for pain medication, if its due,, we give it,, if its not, we dont. They usually go bye bye the next day because they know can control their pain better at home with whatever they have,, or by overuse of what they are sent home with. When they realize we arent going to knock them out with IV pain medicine,, they are usually more than ready to get outta there.

We get regular surgical patients who are about just as demanding with pain medication. Problem there is they are told by the doctor we will control their pain. Which we do,, but they think they should feel nothing. Hello,, you just had your belly cut open and half your intestines removed,, you arent going to feel like you did when you walked in the door.

sharann, BSN, RN · Mar 27, 2005

We love when the ortho surgeons tell patients they will have minimal pain

(yeah with their knee replacement). "The nurses will give you something if it hurts which will take all the pain away". UGGGGGHHHH. How about the lumbar lami who is surprised their back hurts? The doc said there would be "no pain". Do you think they really tell patients this? I see this every day, surgeons take on addicts then prescribe a PCA with the same dose they give an opioid naive 97 year old skinny lady. We are not the rehab center so we just do our best. The pain is real(to them and for us!)

nurse96 · Mar 27, 2005

Our facility actually has a pain control policy. I doubt any of the pts have read it, our the nurses would really be in trouble. The policy states the every pt has a right to be pain free! Whoever wrote this obviously has never had surgery or dealt with some of these physicians. I've had a pt with no pain have 3 different narcotics ordered and then a dying cancer pt have tylenol. How's that for right to be pain free? When some of the physicans are called d/t pain, they sometimes will make my blood boil by saying, I've given them all I'm going to given them, the pain is all in their head."