Pain assessment: do you believe your pt when...

[Morainey]

So I have a question:

A patient of mine (who was a nurse) told me that if the patient is sleeping, then they are not in pain.

Since I am a new nurse, I a little gun-shy with pain meds (I work nights on an Orthopedic unit). Do you believe a patient who says that they are in 8, 9, 10 out of 10 pain when they were sound asleep five minutes ago?

I try to incorporate the whole picture, such as, are they showing any other signs like grimacing, moaning, grabbing their incision? What was the last time they were medicated? Do they have a high tolerance for pain? Were they taking a lot of pain meds at home and thus have a high tolerance for opioids? And so on.

Let me know what you think... I am scared to death of overmedicating a patient!! I had a scary experience with someone who was taking a LOT of Dilaudid and now I am really nervous.

[Anna Flaxis, BSN, RN]

That's interesting that you thought to look at your watch under those circumstances. I honestly don't think that most people would have the wherewithal to do that.

[DixieRedHead, ASN, RN]

Honey, if they want it and it's time, they're getting it- If they don't want it, and it's time, sometimes they're getting it.. I am not the drug police. All they are required to have is respirations above 12 and I am good.

[allheart_nursing]

Pain is what a person says it is occuring when a person says it does. Doesn't matter what I think. If it's ordered & there is no medical indication NOT to administer the medication, I give it exactly how it is ordered by the physician. My job is to take care of my patient...not JUDGE whether their in pain or just want to get high.

[Horseshoe, BSN, RN]

Anyone who doesn't believe that a patient could be asleep one minute and in severe pain the next minute has no business working in a post surgical unit. After surgery patients are often still very sedated. They will sleep and wake in cycles. Those on PCA pumps will get some relief and sedation and will naturally fall asleep. As the medicine wears off, they wake up hurting. And finally, pain and stress of surgery can be very exhausting. At some point even a patient in pain will slip off for short periods. They absolutely may have severe pain upon waking.

[turnforthenurse, MSN, NP]

There have been many times when a patient says their pain is a 10/10 and they are laughing/talking on the phone. In my mind, yes, I do judge, but I don't withhold their pain medication. Pain is whatever the patient says it is, and as long as their vital signs are okay and they're due, I'll medicate them.

[*4!#6]

When I had my tonsilectomy (at 19 y.o.), I had to wake up in the night to take my pain medication. If I didn't, I would wake up in excrutiating pain in the morning. I think this is another consideration, maybe the patient isn't in pain during sleep, but if enough time lapses between doses, they may soon be in a LOT of pain.