Administering pain meds to a sleeping pt - page 2

I'm a new nurse and recently received my first "negative" comment on a patient survey. Pt was a young woman s/p lap appendectomy; she complained that I "must have forgotten" about her pain meds... Read More

  1. by   Biffbradford
    Be careful that you don't snow your patient. I'll take them waking up and mad at me for having pain over having them go unresponsive on me, any day. I always tell the post surgicals that I can reduce their discomfort, but I can't make them pain free.
  2. by   rn/writer
    I will ask each of my postpartum patients if they want me to wake them and at what time interval. If they have been going a little longer than four hours without difficulty, we will pick a time--usually five to six hours--and I will assess them at that time. I let them know that they are certainly welcome to call me sooner, and for those who are breastfeeding, we can evaluate throughout the night. But I also caution them that if they say they don't want to be awakened, I won't be waking them.

    I also will not wake someone up for pain medicine. If you can sleep you are not in agony.
    Maybe not in agony, but the sleeping patient can certainly be very uncomfortable. If it reaches a certain level, you can end up with a patient who is chasing severe pain, something no one wants.
  3. by   StrwbryblndRN
    I am big with education. My surgical patients are usually observation and would be dc'd the next day. I make sure they are aware that I will not wake them but if they want pain med to ask since they are not scheduled. Also I try hard to stick with PO overnight before they go home with the usual, "you can't go home on IV meds" When I check on pt's, usually if they are hurting they stir enough to be able to let me know they want pain meds or I ask if I notice they are not fully asleep.
    If the pt is admitted for an extensive time then my approach would be a little different and more proactive. But I still will not wake a pt and will educate them in advance so there is no confusion.
    We do not get ortho pt's.
  4. by   MunoRN
    I really don't understand where this myth comes from that patients have to ask for prn meds. It's our job to assess for the need for prn meds, even if the patient doesn't ask.

    Coming to an agreement ahead of time about pain meds through the night is always a good plan, some patients with chronic pain will have some sort of routine they stick to and can tell you ahead of time what they will need.

    Post-op patients however don't have as much experience with pain control and you need to be the one to foresee the issues that may arise with getting 'behind" with their pain control.

    In California it's actually the law that you administer or at least offer prn meds as though they were scheduled for the first 24 to 48 hours post-op unless you find contraindications for doing so.
  5. by   MrChicagoRN
    Quote from Flo.
    Yes, I have waken sleeping pts to asses their pain. I work ortho so if the pain gets out of control it is very difficult to get back under control. If the pt has been taking 4mg dilaudid po q 3 hrs for the past 2 days, you bet I'm waking them up. I also have a conversation with the pt at the start of the shift in which I ask them do they want me to wake them up. Some people would rather sleep.
    I agree completely

    Our unit was day 0-2 post op joint replacement & spine surgeries. Many times people may look comfortable but are in fact just resting quietly. Also, if a short time later they awake, either in abrupt pain, or gradually escalating pain, their perception is that they've been in pain a long time. That start of shift conversation is a great intervention.

    And to the O.P, don't take it personally. Sometimes patients have expectations, sometimes realistic, sometimes not, about their POC. Think of it as one more new tidbit to be learned.
  6. by   rn/writer
    Quote from MunoRN
    I really don't understand where this myth comes from that patients have to ask for prn meds. It's our job to assess for the need for prn meds, even if the patient doesn't ask.
    Yeah, sometimes it sounds like we get bonus points for every PRN med we don't give. With that in mind, we surely wouldn't want to bring the subject up. And if a call bell goes off and someone actually asks for one, dang! there go those points.

    It'd be funny if there weren't nurses who actually function like this. I know, because I've had some of them. And so have family members.

    We ARE supposed to bring up the subject and assess, with the patient, whether additional meds are needed or not. That's a big part of our job!
  7. by   amarilla
    Young woman with a lap appy who you had a good rapport with and then complained about you afterward...

    it's probably not what you did (or failed to do), OP. I work on a surgical floor and have experienced this with a few patients, too. At the beginning of shift (nocs), I have a routine: introduce myself, assess patient and check lines / drains / incisions, ask pain level and any concerns, and go over plan for shift. We go over each med to be given, any dressing changes in AM or planned intervention (NG tube flush, bladder scan, etc), and when and how pain PRNs work. I encourage patients to take something before bed if POD 0/1/2 or later if surg was open; many describe feeling 'uncomfortable, sore, out of sorts' but 'not exactly pain' as the evening winds down but this seems to turn into the 'woke up with awful pain at 4am' if not addressed. We do hourly rounding and I often tell patients that I will be popping in every hour or so but will not wake them unless asked, (or if something seems amiss.) Most are okay with this...

    but I've learned exactly what one poster already said: patients often have unrealistic expectations about pain / recovery. I now add the 'progression of recovery' schpeel to my routine: importance of ambulation, use of IS, incisional vs. generalized pain, POs vs IV meds, return of bowel motility, etc. I ask patients to describe the pain they have, where and when they have it, and how/when it gets better/worse. Medicating a patient Q2 with IV narcs for what may actually be gas pain isn't going to help them when they stay a week or more for an ileus. This seems to be working better for me and most of my patients seem to relax when they know what to expect and what may/may not be normal.

    Cosign that I will wake patients for scheduled pain meds, especially chronic pain pts and onc patients.
  8. by   CoffeeRTC
    Quote from OCNRN63
    I would, so they don't wake up in out of control pain. Then you have to play "catch up" trying to get them comfortable again.

    Sleep is an escape mechanism from pain. It does not equal "comfort."
    and I also ask them at the start of the shift about what they will need during the night. Depending on how recent the surgery was or what leve of pain they were in, that helps you judge on what their pain might be like during the night. They only way to really know is to ask them.
  9. by   Whispera
    I don't know that I'd wake someone up for a prn pain med, but I'd do what I could to make sure the patient was really asleep. Patients can look asleep and not be asleep.

    If the patient was needing scheduled and prn pain meds while awake, I'd be more inclined to awaken him or her whether sleeping or not, to assess and give if needed.
  10. by   netglow
    I would have the conversation. I will warn that if I don't wake up, the pain might wake them up, and I don't want that to happen, that it is not fun to suddenly be in pain. If they have been receiving meds consistently and have not yet experienced pain (dep on dx/procedure) they might not right now understand that the reason they currently do not have pain is because we've been ahead of it all day.

    Basically post op or pain producing dx, I would wake them.
  11. by   tyvin
    Quote from OCNRN63
    I would, so they don't wake up in out of control pain. Then you have to play "catch up" trying to get them comfortable again.

    Sleep is an escape mechanism from pain. It does not equal "comfort."
    This is exactly right. What nurses need to understand is the theory of pain control. The higher you let it go the more it will take to get it under control. A little bit of discomfort is OK but I recently had some major surgery and the pain control nurse was a serious joke. After 2 days of enduring horrific pain I grabbed the resident, told him exactly what I wanted and got it. When the pain control nurse found out she had a tizzy fit charging into my room screaming about how she was going to get things changed blah blah ... I basically told her to sit and twirl I also told the night nurse to wake me up for my pain meds. Everyone's pain is different and poosy footing around with pain control is ridiculous. Yes, you can be asleep and be in pain.

    The best plan is to talk with the patient before hand to have a plan of action. If they want to be woken then fine, if not even better.
  12. by   rn/writer
    "Sit and twirl." I'm going to keep that one for future use.
  13. by   vashtee
    I don't wake sleeping patients for PRN pain medications (unless terminal) if they appear to be comfortable. Am I the only one who uses the FLACC scale to assess for pain?