"Your patient in 520 is in pain!" - page 3

You know what bugs me? You have a clock watching, narcotic loving type patient who is, well, whiney and somewhat manipulative. He's been on the light frequently. So, you're super busy and along... Read More

  1. by   Duranie
    Quote from SharonH, RN
    Chronic pain is very misunderstood and I used to find that the people who laid on the light frequently were fearful that they would not get their drugs in a timely manner and they were usually right.
    I agree. Sometimes it is also because they are not getting enough med to really relieve their pain fully, and are afraid of even worse pain if they miss any at all. Most often these are pts who are opioid-tolerant and are getting doses recommended for opioid-naive pts -- nowhere near their baseline dose @ home. {Why don't surgeons look @ that & figure it out, call pharmacy for help with appropriate dosing, or get a pain consult!?}:angryfire (Happened to both my mom & my sister when they had terminal cancer.)
    Or... it could be that the pt. is finally on top of their pain and desperately don't want to have it get bad again.

    I know when I've had surgery, my biggest fear/concern is waking up in pain, either immediately post-op, or later on the floor. This most often happens when my pain is relieved, I fall asleep, and wake up later having missed my next dose. Invariably, the nurse will come in & say "well I just checked on you 1/2 hour ago (or 45 min ago, or whatever) and you were sound asleep. Now you are telling me your pain is at an 8," and do one of these:icon_roll. I'm like "yeah... I'm sure 1/2 hr ago when my pain was just coming back, I was able to sleep but I guess in that time it finally got bad enough to WAKE ME UP!!! Please get me my shot..."
    I:heartbeatthe nurse I had after my bladder reconstruction who (after I asked if she could) came in to give me my IV pain meds on time all night so I wouldn't have that happen. She came in quietly, and I would open my eyes to see her there and smile and whisper "Thanks," and go back to sleep. Iher - she was an.
  2. by   FireStarterRN
    I actually wasn't talking about the techs here, they are usually with the program. It's other personnel, who don't really have a clue about the med orders or much else that's going on, such as the example of the EKG tech, a social worker, dietary aide, RT or someone other ancillary.

    The CNAs are part of the nursing team, they are usually pretty on top of what's up.
  3. by   sparketteinok
    How about those that set their cell phone alarm to go off 20 minutes before it's due, so as to graciously remind you so that you have time to go pull it and get it ready?

    And then make sure and call you 5 minutes before it's due just so that you didn't forget?

    At our place, it's run by a nun, and she really loves to come hunt you down just to make sure you know what a bad nurse you are for neglecting his pain status, never mind the fact that she has no idea that you may have to code him if he gets one more dose.....
  4. by   tnrose
    I wouldn't consider you ancillary staff. I see the Aids/PCP's at our facility as valuable resources for this type of information. I always listen because for the most part they are as familiar, (or more familiar) with a patient and his needs than we are as nurses.
  5. by   tnrose
    I really don't consider CNA's/PCP's ancillary staff, is it just me?? I think of RT, PT, etc.
  6. by   tnrose
    I agree, I medicate if I have an order unless decreased resp., LOC, etc. I think it's easier for me as a nurse, the rest of the staff, and the pt. if I follow the doc's orders, it's not for me to decide if the pt. is really in pain or not, they say they are, i medicate!
  7. by   ImMrBill3, RN
    Quote from Duranie

    I know when I've had surgery, my biggest fear/concern is waking up in pain, either immediately post-op, or later on the floor. This most often happens when my pain is relieved, I fall asleep, and wake up later having missed my next dose. Invariably, the nurse will come in & say "well I just checked on you 1/2 hour ago (or 45 min ago, or whatever) and you were sound asleep. Now you are telling me your pain is at an 8," and do one of these:icon_roll. I'm like "yeah... I'm sure 1/2 hr ago when my pain was just coming back, I was able to sleep but I guess in that time it finally got bad enough to WAKE ME UP!!! Please get me my shot..."
    I:heartbeatthe nurse I had after my bladder reconstruction who (after I asked if she could) came in to give me my IV pain meds on time all night so I wouldn't have that happen. She came in quietly, and I would open my eyes to see her there and smile and whisper "Thanks," and go back to sleep. Iher - she was an.
    Its Evidence Based Practice to give pain meds on schedule for exactly the reasons you described, in addition it has been shown that it is much harder to reduce pain than to prevent it. Why should nurses feel free to judge patients about their desire for pain meds? It seems some people can be awfully judgmental about others when it is THEIR JOB to take care of the patient, especially to address pain. The evidence indicates that pain is NOT being managed well. Shouldn't nurses be trying to find ways to improve that, not taking negative or hostile positions towards patients and other staff providing information that identifies a specific incident of an ongoing problem? Regardless of one's personal feelings or our society's attitude towards drug use providing ADEQUATE pain relief is a part of nursing responsibility. Unless you are providing addiction treatment issues of "drug seeking" or drug tolerance are not a part of your professional responsibility except in that such information provides you with data that supports more pain medication.
  8. by   tnrose
    That's what I've been trying to say, the CNA's/ PCP's are part of the nursing team, it's those PT's and housekeepers that really get on my nerves!
  9. by   tnrose
    Again, I feel like some pt's, (especially those with chronic conditions), are scared they wont' get the meds in a timely manner like they do at home so they get a little stressed. Maybe it's because they have experienced a very long wait to get meds after requesting them.
  10. by   Ploppers
    As a CNA yeah it is my duty to report pain.... but if they have asked multiple times and I know the nures is good and busy with another patient, checking the chart, ect. I'm not gonna jump on them again sayin 520 is STILL hurting because I'm pretty sure they know. FireStarter I hear what your sayin about the PT, Rt ect. They do the same crap to me about urinals, food trays, ect.. They even tell me about meds being needed and I'm not even a nurse! Lol! What I do when it happens is just smile and nod. I provide a quick thanks, tell them its been handled and go about my business. I know in their heart they are just trying to help (I hope so at least). Heck I might do the same I dunno. When they have that implying "you suck" attitude I just take a breath, tell myself "Who cares what they think darnit I know I'm doing my job the best I can" and keep doing my job the best I can!!! That is one awsome thing about this site. You can smile and nod and then vent like crazy in a post later! :throcomp:
  11. by   zuzi
    Firestarer, you like a nurse, whatever one or another tell you or disturbe you, you need to go to asses and give pain meds IF are requested. If your assesment tell you that he/she is not in pain, even if is the time or not, you need to admit that patient IS in pain because he stated that and give it or obtain a new order for pain meds. The pain addicted ones know very well this and for this reason they come in hospital, they ask for pain meds and they will have pain meds. Is creepy but is PERFECT TRUE!

    The only one solution to finish with this marry go around CNA- patinet- physical therapy, bla, bla, is to make pain meds on schedule talking with physician, or to have a order to setup a PCA, or for pain patch. Only someone who don't want to deal with that, will not deal with it. Count how many doses/grams he/she received PRN per day, Hx of pain meds abuse, Hx of Dx, Hx from MAR pain meds admin and talk with physician.

    Be proactive my dear, plug an addicted, that could make to him self and to all of you the life miserable, is easy just be proactive.
  12. by   Magsulfate
    Quote from Jules A
    I agree and as a nurse I could care less if my patient is drug seeking. If they have the order I give them the medication as soon as I can and appreciate my techs keeping me in the loop. I'm not there to detox them and I suspect that drug abusers do have a lower pain threshold anyway. That really isn't my point in posting though. What is interesting to me is the people that constantly posting rants about their issues with patients, coworkers and supervisors without ever taking a look in the mirror. Is it always someone else in the wrong?
    Yes, because I am perfect :angel2:
  13. by   Jules A
    Quote from Magsulfate
    Yes, because I am perfect :angel2:
    Lol, my dear MGSO4 so now I have to watch out for threads from you complaining about how you are constantly sabatoged by everyone and the victim of numerous conspiracy theories?

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