Pain shots are us, not this nurse!

Nurses General Nursing

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Are you ever enraged by patients who really show no visual signs of pain but say that their pain scale is 10/10 and demand their pain shot every time it's due (thinking that they should know when it is due, as if it was a scheduled med not PRN).

:icon_evil: :icon_evil: :icon_evil:

The OP said it was an exaggeration, why don't you just believe what she says? She said it was an overstatement.

People will believe the 10/10 claims to pain by every scruffy, tattood from head to toe pt, but won't believe a hardworking nurse's statements? I think that's unreasonable.

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How about the patients that actually set their cell phones to wake them up every 2 hrs overnight so they can receive their 12mg Dilaudid. (off course they also need the benedryl and reglan to go with it.)

Then the patient who was caught having sex with his girlfriend in the hospital bed, discharged then readmitted the same day and medicated q 2 hrs for "severe" pain.

There are some genuine and some not so........:monkeydance:

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12 mg of Dilaudid? That's a hefty dose!

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:uhoh3:

12 mg of Dilaudid? That's a hefty dose!

Not for the sickle cell patients on my last unit - and it was not unusual for the "crisis" to last several weeks - despite no raise in retic or LDH.

Who am I to comment - the Drs don't want to hear it.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Yes, but she specifically asked if we got enraged and many of us are saying absolutely not.

I said I don't get enraged either. I then took into account the milder version of "annoyed" in the post that came after and examined my true self and decided that yes I get annoyed with certain patients. I'm not Mother Theresa.

;)

I think we need to give the OP the benefit of the doubt with her/his correction is all I'm saying. We need to move beyond the presumption that the OP get's enraged (which they later said they don't) at patients in pain and look at how these patients make us feel. Some of us feel empathy and nonjudgemental compassion. 99% of the time I do too, but every blue moon there is a challenge. Like most of us, 100% I treat their pain regardless of my inner feelings.

Let's please however stick to the topic and not each other.

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Specializes in Emergency room, med/surg, UR/CSR.
To me, and maybe I'm wrong, but if the patient would rather have an immediate IV pain shot rather than a longer lasting PO med, the then patient simply wants the buzz rather than the true pain control.

Yes, you're wrong. When I'm in severe pain, I can't handle trying to wait for the PO med to kick in - the pain is too severe and often makes me nauseated. I can't take the chance of puking up the PO med and then having to have to go through it all over again, when an IM, SC or IV would have done the same thing but more effectively.

I don't understand the reasoning that PO lasts longer. A med has a certain half life, regardless of how it is given. One just starts working faster than the other.

No, I'm not talking about someone in obvious, nauseating pain. I'm talking about someone who had had 10 mg of oxycodone an hour before, and was sitting on the bed in no visible distress. I know pain is what the patient says it is, but when a patient is whining to me about benadryl IV vs PO then I have to wonder if the patient wants the immediate high or the overall benefit of the medicine I am administering and she was getting (and did get) her morphine like she asked for so I wasn't withhold her IV PAIN med. I'm no one's servant, that's not why I went to nursing school and it seems like society has turned expectations people have of nurses, into we're happy to bend over backward to please you, stepford nurses. It sickens me sometimes and the biggest reason that I don't miss ER at all. And no, I usually don't show it in front of the patient, but yes, I and my coworkers do plenty of griping about it in the nurse's station and my coworkers agree wholeheartedly with the way I feel. Are we an uncaring lot? No, just sick and tired of being jacked around by patients that think we have nothing better to do than run up and down the halls chasing their prn narcotics when we have 6-7 other patients that we are supposed to be taking care of. And yes, I did admit that I was ashamed of the way I acted; there was no excuse for that, and it won't happen again.

Interestingly enough, I have been taking care of another patient who requests his dilaudid every 3 hours. Rather than wait for him to ask for it and not have time to get it and have him get mad, I just try to watch the clock myself and get it to him. It makes him happy, and it makes my life easier because he knows that he will get the dilaudid in a timely manner and if I'm a little late with it, he's ok with that. I'm probably the only nurse in the building that will do that for him, but as I tell them when I give report, he won't ask for anything if you just keep his dilaudid on time. Inconsistant, I know, but even though I get along great with him, he is in the group of patients that none of us can take care of for more than two days in a row because of all the wants and needs. They just suck the life from us and make all of us feel like we are drowning all day. I had had this group for several days prior to my run in with the first patient, so I probably was a little on edge about doling out narcotics.

Oh well. Again, sorry for the vent. Hope everyone is starting the new prosperous.

Pam

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Never enraged. If they ask, they get it. I believe the most dilaudid I ever gave was 10 mg q 2h.

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i had a pt as a nursing student, who according to staff and my instructor, was extremely med-seeking.

when it was time for his meds, my instructor gave him a vicodin instead of his usual 2 lortabs.

he immediately became inquisitive, and i didn't know what to say-since i was against this act of deception.

my instructor told him this vicodin was stronger than the 2 lortabs.

he stated "i think not" but took it anyway.

an hr later, I was scolded by the doctor, who told me to never deceive a patient like that ever again and furthermore, WHO AUTHORIZED YOU TO GIVE HIM THE VICODIN?

it was a horrible experience.

i didn't say a word but waited for my instructor to speak up.

and she did.

i was vindicated but ever since then, i don't care if someone is med seeking or not.

if i can anticipate their needs, i'll give them their prns.

and i don't care how many addicts there are.

i need to ensure that everyone is getting their due, esp those that do suffer and are afraid to speak up, because of this ubiquitous stigma we have against pain sufferers.

if someone is truly an addict or med-seeking, my withholding a prn isn't going to do diddly in the grand scheme of things; but it will agitate and invoke much undue anxiety....and for what?

because we play God and judge those before us?

not my style.

not good for my bp.

leslie

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....ever since then, i don't care if someone is med seeking or not.

if i can anticipate their needs, i'll give them their prns.

and i don't care how many addicts there are.

i need to ensure that everyone is getting their due, esp those that do suffer and are afraid to speak up, because of this ubiquitous stigma we have against pain sufferers.

if someone is truly an addict or med-seeking, my withholding a prn isn't going to do diddly in the grand scheme of things; but it will agitate and invoke much undue anxiety....and for what?

because we play God and judge those before us?

not my style.

not good for my bp.

leslie

Right on, earle!

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
i had a pt as a nursing student, who according to staff and my instructor, was extremely med-seeking.

when it was time for his meds, my instructor gave him a vicodin instead of his usual 2 lortabs.

he immediately became inquisitive, and i didn't know what to say-since i was against this act of deception.

my instructor told him this vicodin was stronger than the 2 lortabs.

he stated "i think not" but took it anyway.

an hr later, I was scolded by the doctor, who told me to never deceive a patient like that ever again and furthermore, WHO AUTHORIZED YOU TO GIVE HIM THE VICODIN?

it was a horrible experience.

i didn't say a word but waited for my instructor to speak up.

and she did.

i was vindicated but ever since then, i don't care if someone is med seeking or not.

if i can anticipate their needs, i'll give them their prns.

and i don't care how many addicts there are.

i need to ensure that everyone is getting their due, esp those that do suffer and are afraid to speak up, because of this ubiquitous stigma we have against pain sufferers.

if someone is truly an addict or med-seeking, my withholding a prn isn't going to do diddly in the grand scheme of things; but it will agitate and invoke much undue anxiety....and for what?

because we play God and judge those before us?

not my style.

not good for my bp.

leslie

Good post. :)

You're instructor was definately wrong. I work with a nurse that gives placebos sometimes without an order, she admitted it, but I haven't caught her in the act, but if I did, I would report her.

I also don't believe labels put on a patient given by coworkers, at least three times a patent has been labeled, but was actually in serious trouble internally.

I don't play with people's pain medicines, either and always believe them. It's safer and more ethical, and more peaceful to how my days goes. I still allow myself to get irritated at the patient that says with a smile "you're going too slow, push it faster.......". Sorry, I'm still not Mother Theresa.

If someone wants to call me judgemental, so be it.

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I think you have to be really careful being too judgemental, esp in report. I've gotten some really negative reports on pts that seemed more of a personality conflict between the previous nurse and the pt, nothing more. Better to stick with the facts and not make too many assumptions. I can't imagine messing with someones meds. I may have my opinions, but if they complain of pain, I report it and let the doc deal with it.

Regarding Mother Teresa, I've heard that she was a saavy, tough woman who told it like it was. She was no pushover...

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As a student, I don't have enough experience to say really say what I would and wouldn't do. However pain is a vital sign and I would want to treat it as such. If I have a patient with no outward signs of pain at all, and is getting high doses of narcotics at a regular interval and they constantly say their pain is at a "10", I would have to be concerned that the patient is getting high doses of a drug that is not actually helping them. If a B/P was constantly at 170/110 and didn't go down significantly after medicating the patient with "XYZ" drug, then you would switch to another type of antihypertensive most likely, or at least add another type to their med load. Same for a person with tachycardia or a low o2 sat level. If pain is a vital sign, then I would want to treat it as such. I probably would voice my concerns over the patient continuing to be in so much pain, with no improvement, and let them no that I would be talking to the doctor about alternatives to their current analgesia.

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