I had a Resident that threatened to sue/ call the state on the facility because she did not get her PRN dose of Oxy IR/ Vicodin RIGHT on schedule.
1. Resident says she is in 8/10 pain, and has been 'falling asleep but had to stay awake to get the next dose of pain meds' I re-educated about the pain scale and how w/ 8/10 pain you cant possibly be asleep and if you are asleep that's a good thingetc...
2. Resident pulls call bell right on schedule for PRN meds (all of them) and says she needs then NOW. When i am even 3 minutes late, she starts cursing and rolling around the bed.
3. Resident writes down all the doses and sets an alarm clock to wake her up during the night to get her PRN meds and then complains that she has had no sleep.
- How do you handle such a pt. One who has admitted to popping oxy before going to work. i'm documenting EVERYTHING that i do.
i understand that i am biased about this... its really frustrating and i need some advice on how to deal with this.
Specializes in Oncology; medical specialty website.
I'm probably going to need a flameproof suit for this, but I can't help it. I just can't let this go without saying something in defense of addicts.
SO WHAT if they are addicted? Addiction is a physical dependence on a substance, right?
Doesn't that mean that they physically NEED whatever it is they are addicted to?
So, really, I think a lot of nurses are being unintentionally cruel when they withhold pain meds because they think the patient may be addicted. They are basically causing physical and psychological harm to a patient.
If she is breathing well, isn't snowed, and it helps her feel better, GIVE HER THE MEDICINE!!!
I get emotional over these discussions, I admit it. My father has severe pain from back, neck, and spinal cord injuries. He's a walkie-talkie, though, so no one believes him. He is often treated like a junkie. He rarely slept more than 4 or 5 hours at a time for the past couple of decades, because the pain gets so bad it wakes him up.
This year, he finally got to a pain specialist that believed him. He called me one morning at 0530, crying, because he slept through the night for the first time in almost 20 years and he woke up on his own, without having to reach for a pill bottle.
Please believe your patients when they say they hurt. If they aren't getting relief, try to work with them until they do. If they are using the pain medications to get high, then get them help, instead of judging them. It takes a lot of psychological pain to put up with all the rudeness, judging, and general crappy attitudes toward addicts.
This post broke my heart. I'm so thankful your Dad finally got the treatment he deserved.
I agree with the previous posters. I would tell her that it is not late until whatever the facilty's policy is,say an hour after it is due on the MAR, that she is not the only patient on your team, that you will bring the medication as near as you can to when it is ordered but that you must administer life saving or life preserviing treatments and meds first and then you will, of course, happily bring her whatever is on her MAR.
Encourage her to believe that you are "just a nurse" but she can always happily complain to her MD about whatever is or isn't on the MAR. Also, you can always tell her that you are calling security if she continues to be loud/issue threats, etc. because she is disturbing other patients but I am hoping that you don't have to get there.
In terms of addict versus not addict, it is kind of irrelevant at this point. She is admitted and getting her pills/pushes so just go with it and don't let it eat you alive.
I'm probably going to need a flameproof suit for this, but I can't help it. I just can't let this go without saying something in defense of addicts.
SO WHAT if they are addicted? Addiction is a physical dependence on a substance, right?
Doesn't that mean that they physically NEED whatever it is they are addicted to?
So, really, I think a lot of nurses are being unintentionally cruel when they withhold pain meds because they think the patient may be addicted. They are basically causing physical and psychological harm to a patient.
If she is breathing well, isn't snowed, and it helps her feel better, GIVE HER THE MEDICINE!!!
I get emotional over these discussions, I admit it. My father has severe pain from back, neck, and spinal cord injuries. He's a walkie-talkie, though, so no one believes him. He is often treated like a junkie. He rarely slept more than 4 or 5 hours at a time for the past couple of decades, because the pain gets so bad it wakes him up.
This year, he finally got to a pain specialist that believed him. He called me one morning at 0530, crying, because he slept through the night for the first time in almost 20 years and he woke up on his own, without having to reach for a pill bottle.
Please believe your patients when they say they hurt. If they aren't getting relief, try to work with them until they do. If they are using the pain medications to get high, then get them help, instead of judging them. It takes a lot of psychological pain to put up with all the rudeness, judging, and general crappy attitudes toward addicts.
I'm so glad your dad finally got a good pain doc! There are so many docs (way too many) who undermedicate their pts. I truly believe docs and nurses should get more education on pain relief. Undermedicating is one of my "grrrrr moments".
We've had CA pts referred to hospice and the only thing they are getting for pain is Lortab 7.5/500 Q 6 hrs. When asked if their pain is under control, they say "no". After a few days (or weeks) of messing around w/ the meds, our doc is able to get the pain controlled. Crazy!
I consulted with the doc. Phenergan potienates dilaudid or morphine. I've had him for a few days now (long story)....but as a nurse you get your niche to things as you are probably well aware of....When pt ask for something or why they ask for something etc... When you see the pattern of falling asleep with a coke spilling over in their hands or when your drawing blood and they don't even realize you are there....No offense! These are the patient's that I am talking about....about the ambulation I will always highly encourage it when the patient's pain level is a 1/5 and wanting pain meds....Thanx for your input tho I understand that I left much out
Specializes in Oncology; medical specialty website.
OCNRN63
I consulted with the doc. Phenergan potienates dilaudid or morphine. I've had him for a few days now (long story)....but as a nurse you get your niche to things as you are probably well aware of....When pt ask for something or why they ask for something etc... When you see the pattern of falling asleep with a coke spilling over in their hands or when your drawing blood and they don't even realize you are there....No offense! These are the patient's that I am talking about....about the ambulation I will always highly encourage it when the patient's pain level is a 1/5 and wanting pain meds....Thanx for your input tho I understand that I left much out
I'm aware that it increases sedation, but it does not "potentiate" narcotics (i.e. make them stronger). That's an old wive's tale. I suggested a different anti-emetic to reduce the sedating effect. Just as sleep does not indicate pain relief, neither does sedation.
I have encountered patients who want phenergan and an opioid given together because they like the "buzz" it creates. That's why a non-sedating anti-emetic would be preferable.
Patients definitely need to ambulate, so it is in their best interest to do so when they have the least amount of pain.
I'm probably going to need a flameproof suit for this, but I can't help it. I just can't let this go without saying something in defense of addicts.
SO WHAT if they are addicted? Addiction is a physical dependence on a substance, right?
Doesn't that mean that they physically NEED whatever it is they are addicted to?
So, really, I think a lot of nurses are being unintentionally cruel when they withhold pain meds because they think the patient may be addicted. They are basically causing physical and psychological harm to a patient.
If she is breathing well, isn't snowed, and it helps her feel better, GIVE HER THE MEDICINE!!!
I get emotional over these discussions, I admit it. My father has severe pain from back, neck, and spinal cord injuries. He's a walkie-talkie, though, so no one believes him. He is often treated like a junkie. He rarely slept more than 4 or 5 hours at a time for the past couple of decades, because the pain gets so bad it wakes him up.
This year, he finally got to a pain specialist that believed him. He called me one morning at 0530, crying, because he slept through the night for the first time in almost 20 years and he woke up on his own, without having to reach for a pill bottle.
Please believe your patients when they say they hurt. If they aren't getting relief, try to work with them until they do. If they are using the pain medications to get high, then get them help, instead of judging them. It takes a lot of psychological pain to put up with all the rudeness, judging, and general crappy attitudes toward addicts.
You won't get flamed from me. I agree. I was just saying yesterday in a different thread that chronic pain patients belong in the care of a pain specialist. One of the responses was "why?" Duh, this is why. Thanks for sharing.
Specializes in Oncology; medical specialty website.
You won't get flamed from me. I agree. I was just saying yesterday in a different thread that chronic pain patients belong in the care of a pain specialist. One of the responses was "why?" Duh, this is why. Thanks for sharing.
I think you're right if the primary dx. is a chronic pain issue. I do believe there are circumstances where having the FP manage the meds is also acceptable, even preferential, if getting to a specialist creates an undue hardship on the patient (e.g. patients with a serious/terminal illness).
You won't get flamed from me. I agree. I was just saying yesterday in a different thread that chronic pain patients belong in the care of a pain specialist. One of the responses was "why?" Duh, this is why. Thanks for sharing.
I'm so glad your dad finally got a good pain doc! There are so many docs (way too many) who undermedicate their pts. I truly believe docs and nurses should get more education on pain relief. Undermedicating is one of my "grrrrr moments".
We've had CA pts referred to hospice and the only thing they are getting for pain is Lortab 7.5/500 Q 6 hrs. When asked if their pain is under control, they say "no". After a few days (or weeks) of messing around w/ the meds, our doc is able to get the pain controlled. Crazy!
Thanks, guys. It was getting so bad before the pain specialist that he was flirting with suicidal ideation. I'm so grateful that he found her!
The way he described it to me is that it feels like there are spikes being driven into his body in his heels, hips, shoulders, and neck, all the time. Some days it is a weenie driving in the spikes, some days it is Hercules.
And he is terrified of becoming addicted to his meds, too. He intentionally withdraws from them every so often to make sure he can. It breaks my heart.
Anyway, sorry to hijack the thread. OP, try to make sure your patient isn't in poorly controlled chronic pain. If she is just being manipulative, maybe you could advocate for some kind of care contract that sets boundaries.
I'm probably going to need a flameproof suit for this, but I can't help it. I just can't let this go without saying something in defense of addicts.
SO WHAT if they are addicted? Addiction is a physical dependence on a substance, right?
Doesn't that mean that they physically NEED whatever it is they are addicted to? ]
Addiction is a psychological phenomenon. The patient believes he must have the medication to survive. A patient who is physically dependent is one who suffers withdrawal symptoms when he does not receive the medication. Can the two occur together? Yes. Do they always go hand in hand? No.
The OP needs to examine his/her attitudes toward patients and why he/she thinks it is appropriate to judge them. If he/she truly wants to help the patient, he/she should be in touch with the patient's primary care provider to discuss appropriate assessment and treatment -- not simply lecture the patient. It is also not appropriate to give a med without questioning it if the OP truly believes it is to the patient's detriment. If someone is truly addicted or dependent, that patient needs treatment, not speculation and judgment. I also find it curious that the OP thinks it's inappropriate to "pop" an oxy before work. That med may be what's enabling the patient to stay on the job.
It's often said that many of us are just one paycheck away from disaster these days. We could all just be one debilitating injury away from chronic pain as well. If my nurse were lecturing me on his/her perception of my need for a medication that my doctor had ordered, I'd pick up the phone and complain.
Sometimes I give them an option or ultimatium. Because if you continue to give her all those narcs she can get an ileus. I usually tell my seekers or patients who are tolerant to take a couple laps around the unit before they ask for their pain meds so keep their stomach active. And when I see them taking their lap I know to get their meds ready.
You can not deny people pain medication if they are "in pain", but you can set limits. Like can I have my dilaudid with my phenergan. I usually ask why and when they say because it makes me nauseous ...I usally say well you can have crackers or call me when you feel nauseous! They can not argue with that and nor are you denying them anything.
You have a difficult situation, but finding wayz to safely and appropriately deny their request for something becomes easier.
Good luck to you!
It's evident from your efforts to better understand your opioid-tolerant patient's actions and concerns about the potentially dangerous side effects narcotic drugs can have on bowel function that you're a very caring nurse.
However, I'm troubled by some of your methodology. Requiring a patient to do laps in order to get the pain meds that they've been prescribed and withholding phenergan until a patient is suffering from nausea crosses the line from caring into, and I don't use these words lightly, controlling and abusive. No matter how noble or well-intended your reasons, 'finding ways to deny requests' for pain relief is not your responsibility, it's the doctor's.
And when I see them taking their lap I know to get their meds ready.
OCNRN63, RN
5,979 Posts
This post broke my heart. I'm so thankful your Dad finally got the treatment he deserved.