to give pain meds or not to give meds?

emmalou* · Sep 23, 2006

I worked in a facility once where the Alzheimer Program director tried to tell everyone that people with dementia don't feel pain like the rest of us! One old lady scrunched up her face with every step and the PD tried to tell us it was a facial tick. SO....I said give her some tylenol...hmmmm....amazing how that "tic" went away when the woman was medicated. And as for the person who said she won't medicate because someone else will think she's pocketing the meds...shame on you! Have someone give an inservice on pain and document document document. No one should have to suffer unnecessarily.

Oh my god, that is absolutely terrible - dementia patients (or otherwise confused or neurologically impaired patients) are the most vulnerable when it comes to pain or discomfort because they can't tell us they're in pain!

Observing and assessing someone's non-verbal communication in terms of pain is a necessary part of the role of nursing, this is something I have always done instinctively.

Sometimes the lack of education in some of my managers and/or peers has both appalled and concerned me. Some definite education is needed for those nurses who won't administer PRN meds to people who cannot communicate verbally.

CapeCodMermaid, RN · Sep 24, 2006

On the doses of Tylenol-our pharmacy recommends no more than 4000mg/24 hours....that's fine for US, but if you read the studies, elderly people should get no more than 3000mg/day...and some nurses are always surprised at how many meds have Tylenol in them.

PS. Darvocette and Darvon are on the Beer's list and should never be used in the elderly population.

dano3 · Sep 27, 2006

:wink2: remember we are the eyes & ears for our patients. just treat your patients like you would your family, you spend more time with them than your own.if their in pain medicate.most are 80-100 years old i doubt they will get addicted. make them comfortable

jschut, BSN, RN · Sep 27, 2006

I also give my pain meds. Especially in the AM. When I get there at 5:30a, and I see my patients walking bent over, obviously in pain, or another, who tends to get more agitated when her leg hurts...yea, they get their PRN's when I am there.

It's unfortunate that I only work two days a week because of school, and the other nurse that takesover for me, says... "State's gonna look at this real close cause of all the PRN's you give."

I just know when they are in pain, and yes, I do ask, or am able ot tell by their action! When my elderly folks wake up in the morning, athritits or any other thing hurts, they are getting what they need. Keep up your good work!

mrsalby · Sep 27, 2006

I am glad to see that you are being attentive to your patients and really using "all" your assessment skills and not just your ears.

A quick story....my Grandma is in a LTC in another state. I go to visit as often as I can (keep in mind I am in NM and she is in FL). She had fallen and broken her hip. COme to find out, when we got there, her toenails were literally curled around and under her toe. the podiatrist had not attended to her although when we would call and check on her the nurse would say "oh in the chart, it is noted that Dr. so and so was here last week blah blah blah." Well, we really feel that part of her fall was due to the condition of her feet.

My grandma was what they call a "walkie talkie." A&O x 3, helped other patients find their rooms etc. After her fall, she would not come out of it and would just sit in her WC all day real still. PT stopped attending to her and she began to diminish in numerous areas. Imagine my shock when we went home to visit in June and here is my walkie talkie Grandma who raised me almost an invalid. Now this may be bad, but of course thinking I am the super nursing student I am:wink2: (jk), I asked to see her chart and MAR etc. come to find out she had fractured her hip in May and since 4 days after she returned from the hospital (no sx required) she had recieved NO pain meds. Even with notes from physical therapy saying she noted pain, grimacing, pt states etc etc. One of the first things I remember learning was how elderly can react to pain and G'ma had shut down! I was furious.

We were in Fl for 30 days and by the time I got off my soap box with the nursing director and seeing grandman everyday and PT starting again, she was walkie talkie again although not as strong as she was before. Very disappointing.

sorry so long, But kudos to you and know families appreciate your diligence! I wish your were taking care of my Gma.

Mrsalby

banditrn · Sep 28, 2006

I am glad to see that you are being attentive to your patients and really using "all" your assessment skills and not just your ears.
A quick story....my Grandma is in a LTC in another state. I go to visit as often as I can (keep in mind I am in NM and she is in FL). She had fallen and broken her hip. COme to find out, when we got there, her toenails were literally curled around and under her toe. the podiatrist had not attended to her although when we would call and check on her the nurse would say "oh in the chart, it is noted that Dr. so and so was here last week blah blah blah." Well, we really feel that part of her fall was due to the condition of her feet.
My grandma was what they call a "walkie talkie." A&O x 3, helped other patients find their rooms etc. After her fall, she would not come out of it and would just sit in her WC all day real still. PT stopped attending to her and she began to diminish in numerous areas. Imagine my shock when we went home to visit in June and here is my walkie talkie Grandma who raised me almost an invalid. Now this may be bad, but of course thinking I am the super nursing student I am:wink2: (jk), I asked to see her chart and MAR etc. come to find out she had fractured her hip in May and since 4 days after she returned from the hospital (no sx required) she had recieved NO pain meds. Even with notes from physical therapy saying she noted pain, grimacing, pt states etc etc. One of the first things I remember learning was how elderly can react to pain and G'ma had shut down! I was furious.
We were in Fl for 30 days and by the time I got off my soap box with the nursing director and seeing grandman everyday and PT starting again, she was walkie talkie again although not as strong as she was before. Very disappointing.
sorry so long, But kudos to you and know families appreciate your diligence! I wish your were taking care of my Gma.
Mrsalby

:yelclap: :yelclap: Kudos to you!! I'd be more than a little furious at the bunch of them. Unfortunately, I see this sort of thing a lot - because the resident is quiet and doesn't complain, they tend to ignore them.

And sometimes other things will help besides medicine - cold packs, massage, etc.

hospitalstaph · Sep 28, 2006

I have the same sort of reputation...only my coworkers feel that I am too generous with narcotics. We have a resident with a long history of drug and alcohol addiction. He also has a history of several MVAs, arthritis, falls, and a work related back strain. He has taken percocet on a routine basis for years. Now, he complains of pain on a regular basis...he says no matter what we give him, he is never pain free. So, I routinely give him the dilaudid and percodan he has ordered...he can have them each every 6 hours, so unless he is asleep, I give him something every 3 hours. Usually, he asks for his meds, so it's not like I am just giving them without assessing or anything. I honestly think he is in pain...I also think he is an addict. I worked with a physiatrist for a while and I agree with his belief that addiction is a choice...I shouldn't encourage his addiction, but if he says he needs the meds, then he needs the meds. A lot of the other nurses will tell him he still has an hour before his next dose even if it is time or who will give him an ativan instead of dilaudid. We also have nurses who will make him go for long periods without narcotics. He has a habit of staying awake for the greater part of three or four days and then crashing for 24 hours straight...it is something he has always done. When he is on his 24 hour crash, I will wake him up at least once to take either the dilaudid or percodan...otherwise, he has been known to go up to 36 hours without anything...then we have a hard time playing catch-up with his pain (and his addiction).
I have no problem giving pain meds to other residents on a routine basis as well. A lot of times, even the residents who are not cognitively impaired either don't ask for pain meds, don't want to become addicted, don't want to make extra work for nurses, or whatever. It is our job to look for the cues that they are in pain and assess and medicate appropriately. I don't think it is my place to decide that they are taking too much of something or that they don't need something (unless there are definite signs that they are). Simply because I don't think they are in pain does not mean that they aren't.

EXACTLY! I am so tired of seeing nurses avoid patients that are asking for pain meds b/c the nurse thinks that the pt is an addict. So what if they are an addict? Addicts have pain too and if the medication is ordered then it is not the nurses job to detox someone. You sound like an awsome nurse:)

T

vloho · Sep 28, 2006

I like the key words HE HAS ORDERED. If the Dr. didn't think the PT needed them he wouldn't have ordered them .

nurseJLoo · Sep 28, 2006

If grandmas axox3 and a walkie talkie why dont you take her home?

carolbear · Sep 29, 2006

The docs I work with are almost always happy to write for pain meds to be given routinely. That way you can be assured the resident is getting something for pain, especially if they are demented. Just be careful about being the only one who passes PRN narcs. If you are the only nurse who cares enough, and I'm one of those too, to be concerned about pain in demented patients, speak with someone in management about what you are observing and what other nurses say to you. To be the only person who passes narcs prn on a unit, you could be placing yourself under the microscope for possible diversion. As a manager, if we have med problems with a nurse, or people are saying "Nurse So-and-So" is the only one who gives narcs, etc, management does look at the MAR's. Please protect yourself and the patients. Good job for what you are doing for these poor people, just get everyone on the same page.

Nurset1981 · Sep 29, 2006

I am the same way and had the same doubts you all have shared, until I was doing a med pass in front of a DPH nurse(we were in survey and I alays got stuck doing it lol) and I had this patient that I knew very well, ETOH, DM, HTN, Neuropathy and a recent partial foot amp. I poured his 5PM meds and signed out two Percocets for him because I knew his schedule and when he would start to hurt. I went down gave him his meds and left the room. The DPH nurse took me aside and actually commended me for anticipating my patients needs. Pain mngt. has been a huge part of thier focus during recent surveys. I was shocked she said that to me. Usually they rip you a new one. I always assess my pts for pain regardless of thier mental status. All of our pts come in with a standing APAP order as well as MOM, colace and usually trazadone. Side note..I can't believe they make you sign out tylenol. What a joke. You work your butt of the least they can do is give you a couple tylenol. Its not like its costs an arm and a leg.

mrsalby · Sep 30, 2006

[quote=nurseJLoo}If grandmas axox3 and a walkie talkie why dont you take her home?

Simple question to ask, I suppose, when you are not involved.

My father her POA and won't allow it. Also, for "me" to take her home would include a 1500 mile trip and isolate her from the friends and extended family that are local to visit her. Also, she is a heart patient and has dementia. Before you ask about these friends and family taking her home...no one is able to, or cannot afford it or simply doesn't want to. Family dynamics are different everywhere. Besides, importantly, she likes where she is and doesn't want to come to come to NM. I believe her wishes are important. She is able to leave and visit and spend the night which she enjoys from time to time.