LTC Drug Addicts - page 2
Has anyone else ever worked with LTC residents that were on a lot of pain medications but it was not clear why they were being given them regularely? I hope I worded that right...I'll explain... ... Read More
Jun 9, '03Wow...great thread. I am a total believer in treating and assessing pain. Pain is pain... I never doubt my LTC pts complaints of pain and always try to be proactive and even encourage my res to take their prns more frequently.... A situation at work makes me think....have a 43 yo chronic pancreatiis past 7 months NPO with TPN getting 100 Oxycontin BID, Dilaudid 4mg q 3 IV push, Phenergan 12.5 q 6 and Ativan q 6 prn... comes and goes on LOA frequently. Until recently coming in to get meds and leaving.... last week came back from LOA and "seemed high or intoxicated" md ordered a drug screen.. couldnt find the oxycontin but did detect Ultram. Now... I watch her swallow her pills....Where's the Oxycontin?? I still don't know what to believe with her...MD changed orders Dilaudid 2mg q 4, Duragesic patch 50mcgs and phenergan q 6... the one day she accidently got 100mg oxycontin she slept like a baby.... now I still believe she has pain...and medicate her as much as able, but what do you think of this one?
Another question for you all......Why do you think LTC res are either over or under medicated for pain?? This is such a pet peeve of mine....people will medicate for behaviors (probably caused by pain) but not for pain...
Jun 9, '03This is a great thread for discussion.
As a chronic pain patient myself, I'm working very hard to stay off pain meds for as long as possible. In order to cope with my ever-increasing arthritis pain, I find I must very carefully monitor my rest, my activity, my diet, and frankly the weather in order to maximize my energy and tolerance for the day.
I wonder if part of the problem in LTC is that it's not always feasible to try alternate pain relief activities. Some days, I need two stretch-out flat naps instead of one, some days I need two hot baths instead of one, some days I can't get out of bed without a pill. I believe that physicians and patients and often some nurses know we live and work in a world where often there's little time for anything other than a pill to provide relief.
Just a different perspective on a troubling problem...
Jun 9, '03For those that are interested in reading more opinions on "drug seeking patients", here is the link to a discussion in the past.
As for my opinion. On one hand you have to watch for polypharmacy and tolerance and on the other you cannot let someone who is in pain suffer as it is cruel for the person in pain.
Who is the only person that can judge pain?
Not only that but nurses must learn that sometimes people have different ways of coping with pain that may not be normal. I for one try very hard to try to sleep through my pain. There may be those that say, "Oh, well she can't be having too much pain if she is sleeping". No, I don't have pain when I am sleeping, it is when I wake up that I have the pain. Call it psychosocial or whatever. I only hope that I can sleep through labor:roll
Jun 9, '03Scarlett: What dose of Duragesic did you start on? It is totally appropriate to have breakthrough while on Duragesic, but I would suggest OxyIR or MSIR; hydrocodone is more difficult to titrate to an appropriate breakthrough dose, esp. because of the tylenol component. By seeing how much breakthrough you need, your doc can adjust your Duragesic.
Jun 9, '03I went to the doc this afternoon and he took me off the Duragesic (25mcg) because I have spent the last week nauseated and with a headache. The spot where I put the patch, regardless of location, itches and leaves a square welt from the adhesive. He put me back on hydrocodone but a higher dose, and frankly, I still have pain, and nausea but now I feel drugged, which I did not feel on the patch. I don't feel like I can win!
Jun 9, '03God I hope that when I am old and in the care of someone who has the power to relieve my pain, that they believe me.
Jun 10, '03I too took no offense it is an important topic. I have sever arthritis of the spine and knees, fibro, PLMD, RLS, chronic migraines and positive lupus test though that dx is still not certain. I take hydrocodone daily, ultram, flexiril, prozac, atenolol, and temazepam at night. I worry a great deal about tolerance and dependance however the pain meds are not all that affective. The most effective has been demerol and dilaudid although the high feeling I could do with out. Dr's around here are hesitant to give these which I understand. I did here that there are dilaudid supps that take care of the pain but do not give the high effect. That would be great however I too worry about being considered a druggie. Obviously that would be a very bad thing for ones nursing career. It feels like a darned if you do and darned if you dont. Either stay and bed cause ya cant function or get relief and be called a druggie what is a pain filled gal to do.
Jun 10, '03Isnt it interesting tha we have so much 'guil;t ' associated with taking medication - that is given to us to make our life qualitative meaningful and often remian part of society both social and working
Centruires ago we aould have probably have gone to the local wise woman/ monk / doctor / etc who would tried to grind natural products to prolong our life - we would have taken these and in all reality - may have died earleir (than now)
So this is just a philosphopical question why should we feel guilty to take advantage of advances in the various feild especially science and nursing that extends our life - now that is not the real question - the question l am wandering about is - the general public will accept what they are given - and will have an improvement in their life - why as nurses do we find it so difficult to accpet medication that improves our life
BTW gizzy76 - great thread - hope you dont mind the alternative thoughts that it is provoking
Jun 10, '03About the LTC patient- who really cares if she is addicted at this point. If she is able to enjoy her life at this point that is the main thing. However, perhaps the manipulation is more of a problem than her needing the meds.
Another thought- perhaps she needs the interaction that frequent visits from a nurse will bring... that would be nurses feeling manipulated again, and I can understand why you would be frustrated.
Jun 10, '03I don't believe in giving so much as to render the patient unable to function, but think that you need to work with the patient to get what combination is necessary (sp) to ease the pain. Sometimes it is a hard thing to do.
Jun 10, '03Originally posted by gizzy76
To everyone who's replied so far...I did not intend to offend. I do believe that a person's pain is their own perception and what they say it is, is what it is. I guess my biggest part of the post was wondering why doctors just accomodate these requests and not give her a pain patch then?
Also, call me crazy, but I find it hard to believe that pain comes on regularly timed intervals. She calls to the minute almost each day for her PRN's. Also, when you try to assess her pain for your charting she can't even look you in the eye, she looks away as though she is lying. All of the nurses in our facility are concerned and feel relatively the same way.
I was not doubting her pain if it came across that way.
Jun 10, '03This is a great thread.
I have seen the issue from both sides.
I am a nurse, in chronic pain, 24/7. No doc has ever prescribed a narcotic to me for it.
Last year, I got my finger crushed in a fire-door at work and the ER doc gave me 30 Lortab. I didn't need it for the finger injury- I used it for my chronic back pain.
How wonderful it was to finally be free from the pain, and be able to sleep through the noc without being awakened by pain.
Although, now the Lortab is gone. At least I had some relief for a short while. Almost makes me want to crush my finger again.
MRI and X- ray show nothing, so no one will give me anything for my back pain. I have asked about cortisone injections and lidocaine patches. Every doc just blows me off. My chronic back pain was caused by an on-the-job injury 8 years ago. I have been accused of drug seeking r/t this injury and r/t my chronic migraines.
I have also taken care of LTC pts who are obviously not in pain and are addicted to the many meds they are on.
I've also had LTC pts who are obviously in a great deal of pain, but despite having tried many, many times, I can't get their "doctor" to prescribe anything for them.
Yes, there are drug seekers out there. Yes, there are addicted pts in LTC. There are also pts in pain, not getting treated for it.
All points are valid in this discussion.Last edit by Hellllllo Nurse on Jun 10, '03
Jun 10, '03Thanks, I'm really enjoying the discussion that this threat has generated. Myself, I could not imagine being in chronic pain. My normal, daily aches and pains are sometimes aggravating enough let alone to have a pain that would interfere with my daily living.
More info on the lady in question...she decided once upon a time that she would not be joining the rest of the residents in our unit for supper in the dining room anymore and that her supper was to be delivered to her room each night. She would have a fit as well if her medications were not delivered to her room before the "med nurse" went to distribute supper meds in the dining room, rather than waiting to get them after the others.
I looked into this situation upon starting at the facility and found no sound reason for this to be happening. Policy states that each resident is to come for all meals unless bedridden and sick, to which this lady is not.
She was raging mad at me when I discussed this with her and informed her that staff would no longer be bringing her a meal to her room if she was not going to come to the dining room at supper time. Her reasoning was that she was tired after being in her w/c all day and after participating in physio and ceramics, (Physio is 2x/week, and Ceramics is Friday afternoons) and she wanted to rest in her pajamas in her room and have supper. Let it also be known that the only times she would be in her wheelchair in a day is at breakfast and lunch in the dining room unlesss she went to physio and ceramics. She would not look at me then either and her actions toward me reminded me of my 3 year old godchild. Sad but true. It has been 2 months since this was enforced and she is talking to me again as though we are friends.
This woman gets info from staff members and uses it against other staff members. She also sleeps every night in her lounge chair in front of the television. I have learned from other staff that the only time she will get into her bed is on her birthday and she will ring for staff to bring her breakfast in bed.
Her husband is crippled and uses 2 canes to hobble around and when he visits, he has to push her around the unit in her wheelchair and you can tell he is in obvious pain but does it anyway. Meanwhile, she sits in her chair with a smug expression.
It breaks my heart to see. She is known as the Princess on our unit b/c that's how she acts and expects to be treated. She will ring at 0500hrs for her medicine, her teeth, clothes and cup of hot milk. The staff don't mind assisting her, it just gets to be too much after awhile.
I suppose it sounds as though I am venting, and come to think of it, maybe I am. Thanks for listening. I feel much better now.Last edit by gizzy76 on Jun 10, '03