Dealing With the Patient in Pain

diane227, LPN, RN · Aug 31, 2009

When I have this problem I do a couple of things. I sit down with the mar and the patient and we discuss what he/ she is on in detail so we can both get it correct in our minds exactly what they have had and when. We might be able to just change the schedule around some to get more prolonged relief. I also check the PCA pump to make sure that it is working, if they are on a PCA. If the patient has had chronic pain for a long time, they will require increased doses of pain medications. This is not the time to be asking the patient to start rehab. The next thing I do is consult with the pharmacist on duty. They know more about these drugs that the doctor does believe me. So I try to get suggestions from them as to what medications we could start/stop that might be helpful. After that I call the doctor with the pharmacists recommendations. I have this problem all the time on my ortho floor because some of these ortho doctors do not know anything about pain control for a patient with long term narcotic use. Also, they flat absolutely refuse to recognize the need for something to help the patient with anxiety which is a big part of their pain issue at times.

CoffeeRTC, BSN, RN · Aug 31, 2009

When I have this problem I do a couple of things. I sit down with the mar and the patient and we discuss what he/ she is on in detail so we can both get it correct in our minds exactly what they have had and when. We might be able to just change the schedule around some to get more prolonged relief. I also check the PCA pump to make sure that it is working, if they are on a PCA. If the patient has had chronic pain for a long time, they will require increased doses of pain medications. This is not the time to be asking the patient to start rehab. The next thing I do is consult with the pharmacist on duty. They know more about these drugs that the doctor does believe me. So I try to get suggestions from them as to what medications we could start/stop that might be helpful. After that I call the doctor with the pharmacists recommendations. I have this problem all the time on my ortho floor because some of these ortho doctors do not know anything about pain control for a patient with long term narcotic use. Also, they flat absolutely refuse to recognize the need for something to help the patient with anxiety which is a big part of their pain issue at times.

Great post. I do the same thing too. Since I work in LTC, we have a good bit of docs who either don't know or don't want to order adequate pain meds. Looking at the whole pic and involving the pharmacist helps.

vivacious1healer · Aug 31, 2009

After all you had done and the patient still continued to complain, then its time to have the doctor order a pain consultation. Good documentation will also back the need for further intervention.

Daytonite, BSN, RN · Sep 5, 2009

a question for anyone...

i'm a nursing student in my last semester of my

rn

program, and i'm still trying to perfect my communication with, sometimes difficult, patients. in a clinical situation, i was helping care for a patient in pain. already on a pca pump with morphine, the patient continued to report their pain level at 8 and up. the patient was also already receiving medication for nausea, but

continued to ask for something

or surely be sick.

i tried explaining that we had already given all we could at the time.

no more pain medication or anti-emetics could be given...and i was at a loss for words while this

patient continued to report severe discomfort

. i even tried repositioning, relaxation, distraction, anything.....any thoughts on how best to manage pain such as this?

how to communicate to someone that nothing else can be done for the time being?

did think the patient was lying about their severe pain? continuing to ask for pain medication is an indication that the chosen analgesic or its dose isn't adequate. the patient should have been assessed and the doctor notified. explaining that we had already given all we could at the time is an inappropriate and unresponsive reply and ignored the patient's problem of unrelieved severe pain. our jobs as nurses is to solve problems not sweep them under the rug. it was inappropriate and unsympathetic to tell this patient that nothing else could be done for the time being. that is something for the doctor to determine. it would have been better to report this to your instructor (for guidance), the patient's nurse, the charge nurse and keep going up the chain of command to the manager if necessary to get some action and tell the patient that while you can't do anything directly because you are a student you have notified their nurse. i'll bet that patient when discharged will be telling everyone about her "bad" experience with nurses who wouldn't believe how bad her pain was. you should have tried putting yourself in the patient's place and tried to reason this out a little better. i hope you know that now.

assessment and description of pain includes the following:

where the pain is located
how long it lasts
how often it occurs
a description of it (sharp, dull, stabbing, aching, burning, throbbing)
- have the patient rank the pain on a scale of 0 to 10 with 0 being no pain and 10 being the worst pain
[*]what triggers the pain
[*]what relieves the pain
[*]observe their physical responses
- behavioral: changing body position, moaning, sighing, grimacing, withdrawal, crying, restlessness, muscle twitching, irritability, immobility
- sympathetic response: pallor, elevated b/p, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, diaphoresis
- parasympathetic response: pallor, decreased b/p, bradycardia, nausea and vomiting, weakness, dizziness, loss of consciousness