I have been a CNA for 5 years. i am also a nursing student (BSN/RN) on my last quarter. i work as a registry CNA right now, so i see a lot of different nurses and units etc.
I was on an ICU unit with a elderly female pt who was there for encephalopathy after trauma to the head. she fell outside a liquor store. she has history of alcohol abuse but she denies recent consumption. the liquor store owner states she regularly buys alcohol. she takes anxiolytics at home for anxiety. shes also on SSRI antidepressants. she has a history of chronic lower back pain, neck pain, and states she has pain all over.
I was called in to sit with the patient. when i came she was really agitated and anxious and kept trying to get out of bed. she is A/O X4. shes been there for 5 days now. she continuously asked for her pain and anxiety meds. she had, tylenol q4hr prn (mild to moderate pain 1-6) norco q4hr prn (sever pian 7-10), lorazepam q2hr agitation (on a scale CIWA scale 0.5-2g).
she knows her meds but doesnt know what times theyre suppposed to be given. she asked the nurse but the nurse refused to give her the times because she thought the patient was addicted and drug seeking. the nurse would say "thats all you care about is your painkillers to get off. you dont ask about anything else".
i was sitting with her the whole time and she was shaking and visible anxious the whole time. the nurse would refuse to give her lorazepam or pain meds until she was literally ready to get out of bed.
based on her CIWA she was suppsoed to get at least 0.5 to 1g q2hr however she only gave it twice the whole shift. at the beginning and at the end.
the mobile xray came. from her xrays i saw she had plates pins and other surgical metals in her neck. so that explains the neck pain.
the nurses excuse for withholding the pt meds was that her blood pressure was too low and her respirations were too low. her blood pressure and respiration would naturally lower when she fell asleep but shot up to normal when she was awake. so the pt is anxious so is constantly looking at the clock, so i advised her to relax and try to sleep so that the time passes faster. now, the nurse comes in to assess the patient but every time she would come, the patient was napping. the nurse would write down pt's v/s and leave. then the pt would wake up and ask for her meds and anxiolytics. the nurse would come in and say that her v/s are too low even though they arent when shes awake. so this goes on for the whole shift. i told the nurse that shes axious and in pain but the nurse just shrugs it off and says shes an alcoholic, all she wants to do is get high.
this RN was floating from another unit to the ICU. shes from a medsurg floor.
in my head this is not ethical practice. is it? pain and anxiety are subjective. sometimes objective data can help us assess a patient's pain or anxiety but the patient's word should be taken as truth when it comes to pain or other subjective data. or at least thats what our nursing school teaches us. im always learning so please do provide constructive criticism thanks!
