sickle cell crisis...when enough is enough....

[FreshRN05]

Yesterday at work, I was really worked up with one of my patients who has a sickle cell anemia..She's 24 years old and had been dealing with it since she was about 4 years old...According to the other nurses at my work, she's a frequent flyer and a non compliant with her care management...she comes to the hospital almost evey other month...she's been almost in all the med-surg floor in the hosptial and almost all nurses and doctors has dealt with her in the past...Yesterday was my first time to care for her...Anyhoo, this poor lady is in so much pain (mostly joints and back) that she's been asking for her pain medicine every 2 hours on the dot (Dilaudid 6 mg IVP every 2 hours, together with benadryl 50 mg IVP)...She complain that 6 mg is not giving her enough comfort that she's wanting more...Her reticulocyte is at 6 (indicative of crisis)..So, I placed a call to the admitting Doctor and stated 6 mg is more than enough, instead he gave her Norco 1 tab PO for breakthrough pain...but still she was not satisfied and was still in pain...She's also on IVF and refused oxygen...she sats 96% on RA...During the shift another Doctor came and assesed her and discontinued her Dilaudid IVP to VICODIN ES itab q 4 hours PRN and discontinued her IVF as well...I asked the Doctor and said that this patient is taking advantage and knows how to use the system and that the patient is noncompliant..so they are not going to tolerate it anymore and will nol onger give her any IV pain meds. He also stated that if the patient is not happy about how they manage her care, she can leave the hospital AMA and look for another provider. I was in shock and in dismay...The patient is in pain for crying out loud! I've learned from school that if someone's in pain, you don't question them...you have to acknowldege it..sure this patient might have been a frequent flyer but with this sickling disease that no cure hasn't been found..how can you just stand there and say enough is enough...

[leslie :-D]

living w/sickle cell is a horrible way to exist.

what we perceive as non-compliant is often the pts' way of knowing what works and what doesn't.

and the treaters don't listen.

one time yrs ago, i had a very minor injury.

for awhile, there was an ischemic process that caused me alot of pain.

i couldn't believe that something so minor could be so painful.

i just can't even pretend to imagine the pain of a sickle cell crisis.

i say, whatever it takes.

and to get this population ongoing,effective and reliable treatment.

leslie

[TinyNurse, RN]

standard.........walking in the door we give

10 mg morphine every hour for the first 2 hours

with 15 mg morphine on the 1/2 hour.

then we go to a pca pump in the ED.

( yes it's crazy i know)

I've seen 4 people intubated in the last 6 months on this protocol.

[twinmommy+2, ADN, BSN, MSN]

Sorry but even hard drug users are treated for pain when they are in pain. Some health care providers I think have a hard time dealing with people in sickle cell crises, it can come across as someone just being drug seeking. These people are truly in pain that most of us really don't understand.

Feel sorry for her condition, but she is a hardened addict and that has complicated her condition and put the doctors in a compromising position.