No pain meds for you, mother - page 3

I've been taking care of this 80 years old women for total of 4 or 5 shifts now. Diagnosis of ARDS, intubated on the vent, FiO2 from 70 to 100%, off sedation, alert, awake and somewhat appropriate,... Read More

  1. by   Blee O'Myacin

    "The force of the air rushing into your mother's lungs and the end pressure keeping them open, hurts"

    "The chest tube hurts"

    "The central line in her neck hurts"

    "The boots that inflate every fifteen minutes to keep the blood from pooling in her legs are uncomfortable"

    "The medication that is keeping her blood pressure up to where we like it to be makes her fingers and toes cold, and it probably hurts"

    "The nitro paste gives most people really bad headaches"

    "The blood pressure cuff that I have cycling every 15 to 30 minutes, hurts"

    "The sacral wound from incontinence or "skin failure" (tm - my favorite geriatrician), hurts"

    "The bag I had to attach to her rectum to catch all the feces to keep it out of said wound, hurts too"

    "And you are asking me if your mother had a good day today because she is in sinus rhythm and her "map" is greater than 60??"

    I do tell families this - quietly, gently and with plenty of tissues - while explaining the need for sedation and analegesia. If this family is still refusing, I'd call ethics. And I'd document my tail off...

  2. by   jill48
    Quote from SharonH, RN
    Geez nurses, I'm very disappointed in all of you whose first response was to "call the doctor". As a patient advocate and the professional who is on the front lines of this patient's care you are empowered to take action other than "call the doctor". Is there a clinical nurse specialist on your area? Contact him or her about your concerns and perhaps they an set up a meeting. OR you can get with the charge nurse, call a meeting with some of the family members yourselves and get to the bottom of it. It need not be a huge formal meeting, you can start off with "It seems to us that you have some concerns about your mother receiving pain medication. Let's discuss this." You can also at that time assess what their understanding of what a DNR really means. If your discussions do not bear fruit, you may then go on up the food chain, possibly your nurse manager, ethics committee or whomever but you should be the ones to handle this. By all means, let the physician know what is going on since it is his/her patient, but you really don't have to wait for someone else to handle it. This is within your scope of practice.
    I think the only reason some people were suggesting to call the doctor was that maybe if they hear it from him (or her), they would accept it. Not that that is right, but it's just one more thing to try. :spin: