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.
Well said, xtxrn! My DH's pain was not being controlled by his oncologist until I began to advocate for him LOUDLY. He always told me, I always hurt, but I don't want them to think I'm an addict. When he started on fentanyl, he said he was not in quite so much pain, but he still rated it 6 or 7.
When his fentanyl was upped (over a period of time) to 200mcg he FINALLY had relief. He was also taking Lortab 10/500 4 or 5 times/day. He wasn't gorked....just not hurting. He was still able to function.
If it is ordered, and not gonna make you code, and it's time, I give it.
It isn't my place to try to tell someone else they aren't in pain.
Personally, I am prescribed a benzo for SLEEP, but if the doc writes the order as a PRN and doesn't write an indication, our system defaults to anxiety.
"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. "
When a patient has dilaudid q 3 and phenergan q6....and the patient does not get nauseous when given the dilaudid alone due to it not being time for phenergan is what I was basing what I said on....And there always are alternatives to things as previous posters have stated...crackers for nausea, meditation for some pain control, etc....if you have read my following post I had stated that I never withheld pain medication I simply made them walk around the unit when they request pain meds for pain 1/5.....thnx for your thoughts tho I can see where you are coming from with your statement..
Great thread by the way...Good to see opinions from both sides of the fence!
To those who suffer from chronic pain/know someone who does, i apologize for coming across in a way that offended you. Its been an eye opening experience to read the responses from those that have experienced it.
As a nurse you are expected to have NO judgments, biases or opinions. As a human being that is impossible. I am willing to acknowledge my biases and try to learn from them.
I no way did my original post imply that i was withholding PRN medication. I was concerned that the ammount of narcotics we were giving her were a lot... an example is 2 oxy IR, 1 Oxy SR and Vicodin all in a space of 1.5 hrs... as she had BOTH scheduled and PRN narcotics....
I have never had chronic pain thus i DON'T know how it feels and how you learn to cope with it. The posters that shared their personal experiences put this into perspective.
I have not experienced chronic pain either Ohio Student' RN and for the most part I don't hold meds from paitents.....Just when they are acting out of the norm like I stated before....Acute changes in VS, very lethargic (i.e. falling asleep while talking to me, falling asleep with things in their hands, etc...)...
Me and you are still kinda new to this, but as time goes on we will get better at it... Like scared to overdose our patients....tolerant patients vs our drug seekers, etc...
To those who suffer from chronic pain/know someone who does, i apologize for coming across in a way that offended you. Its been an eye opening experience to read the responses from those that have experienced it.
As a nurse you are expected to have NO judgments, biases or opinions. As a human being that is impossible. I am willing to acknowledge my biases and try to learn from them.
I no way did my original post imply that i was withholding PRN medication. I was concerned that the ammount of narcotics we were giving her were a lot... an example is 2 oxy IR, 1 Oxy SR and Vicodin all in a space of 1.5 hrs... as she had BOTH scheduled and PRN narcotics....
I have never had chronic pain thus i DON'T know how it feels and how you learn to cope with it. The posters that shared their personal experiences put this into perspective.
Just keep learning, and hang in there- it gets easier to give the meds....when I worked drug rehab, in order to get the daily dose we needed to start with for tapering benzos, we'd give 10 mg of po valium every HOUR until they got nystagmus...then divide the total by 4 to start the QID doses. Some guys got to 100 mg before their eyes twitched...
:) No offense taken from me- just like to be able to offer a different POV:up:
Well said, xtxrn! My DH's pain was not being controlled by his oncologist until I began to advocate for him LOUDLY. He always told me, I always hurt, but I don't want them to think I'm an addict. When he started on fentanyl, he said he was not in quite so much pain, but he still rated it 6 or 7.
When his fentanyl was upped (over a period of time) to 200mcg he FINALLY had relief. He was also taking Lortab 10/500 4 or 5 times/day. He wasn't gorked....just not hurting. He was still able to function.
Everyone is different in how they handle pain.
I would love to see some studies done on why different persons gave different reactions and feelings to pain. Whether it's genetic, personal, emotional, or whatever. That would be really fascinating to me. Especially if they could find that it's genetically related.
To those who suffer from chronic pain/know someone who does, i apologize for coming across in a way that offended you. Its been an eye opening experience to read the responses from those that have experienced it.
As a nurse you are expected to have NO judgments, biases or opinions. As a human being that is impossible. I am willing to acknowledge my biases and try to learn from them.
I no way did my original post imply that i was withholding PRN medication. I was concerned that the ammount of narcotics we were giving her were a lot... an example is 2 oxy IR, 1 Oxy SR and Vicodin all in a space of 1.5 hrs... as she had BOTH scheduled and PRN narcotics....
I have never had chronic pain thus i DON'T know how it feels and how you learn to cope with it. The posters that shared their personal experiences put this into perspective.
You definitely didn't say that, and I don't think anyone inferred that you do this (other posts eluded to withholding meds, which I think is why that came up.....also, some of us know from personal experience that HCP's can and do withhold meds, so it was discussed in general, not about you in particular). I am also very glad that you have taken the time to read the responses here, and to take them into consideration.
xtxrn, your post on the last page....I'd kudos it 100x if I could. You've expressed a lot of what I think, better than I could.
One example of the prejudice/stereotype: one of my dx's is endometriosis. Before I got into pain management, my GYN would write me a small script for Percocet monthly (and this was after YEARS of trying various meds....we didn't get to Percocet on the first try, it was a lot of trial and error, and seeing what worked and what didn't). I've had 3 surgeries now for the endo; it regrows within weeks or months, so it does not help. Anyway, he was ALWAYS good about treating my pain when I would call (and I was so grateful to him, for his understanding). However, his partners would not prescribe it for me if he was not there. When I would call, I'd get the lecture via the nurse from the on-call, etc....I mean, LOOK AT MY CHART, you can see that this is what we do, and that it works! If they aren't comfortable, that's fine, it's their choice.....but don't lecture me. If you have a problem, take it up with my doctor!!!
One night I went to the ER, because my pain was SEVERE and I didn't know what else to do. I couldn't even breathe, I could hardly walk. Gave the ER doc my history, and SHE asked ME: "What do you usually take for this pain?" I said Percocet. She left the room; a few minutes later, the RN comes back in with a dose of Percocet. Okay, fine. Took it, waited, pain did lessen some. No big deal, right?
A few days later, I requested and received a copy of my ER records....in the dictation, the doctor said, "Patient asking for Percocet." Um, what? Doesn't sound like a big deal, but really, it is....I didn't ASK for ANYTHING, I didn't know what to do (didn't know if the pain was due to the endo or something new, since it was worse than I was used to). That ONE statement, and the tone of the rest of the dictation, made it look like I went in specifically to get a dose/rx for Percocet. It made me very angry, and made me realize what she was REALLY thinking that day....drug seeker!
Here's the trouble with endo, too: it does not show up on scans, like xrays or ultrasounds. Not MRI's. The only way to diagnose it is by direct visualization; a pelvic laparoscopy. Now, I have had these done, so my diagnosis is not a guess, but when you go in and complain of pelvic pain, they do an U/S....and come back and tell you it's fine (which it certainly would appear to be). I would have a cyst here and there, maybe, but otherwise, you couldn't see anything different. Had a doc tell me once (on another ER visit), "I can't do anything for you, there is nothing to treat." Granted, yes, I absolutely KNOW that the ER is not the place for chronic pain, etc, but when I could not get a hold of my doctor and his partners would not write a Rx for me on his behalf, what else could I do when it was so bad?
Luckily, I haven't been to the ER now in quite some time; pain management has given me my life back, truly. I don't know where I would be without them....suicidal ideation in the face of unrelenting pain is common. Dealing with daily pain is still depressing and frustrating, but it's so much more manageable now.
I think this thread has turned out to be very informative, so thanks to the OP for asking the question, and thanks to those who took the time to post. We all can always learn something new, every day. Thanks for letting me tell some of my own story!
Yep, cherrybreeze.....if pain meds are discussed with any sort of specific med, it becomes an issue that it's really not. It's no-win for the patient.
To the OP- you will work out your own way to deal with pain medications and those who are behaving in a way that is annoying. Sometimes, knowing that the nurse will assess their pain, and just believe them- that what they say is how THEY experience what is going on is enough to relieve enough stress to help with the anxiety aspect of pain. People who are normally not anxiety prone become very anxious if they know that the pain they deal with at home is subject to changes in orders by unfamiliar docs, etc.
I have not experienced chronic pain either Ohio Student' RN and for the most part I don't hold meds from paitents.....Just when they are acting out of the norm like I stated before....Acute changes in VS, very lethargic (i.e. falling asleep while talking to me, falling asleep with things in their hands, etc...)...
Me and you are still kinda new to this, but as time goes on we will get better at it... Like scared to overdose our patients....tolerant patients vs our drug seekers, etc...
:bdyhdclp:One learning experience at a time!
Oh yes, you will definitely see how much narcotics a body can handle without skipping a beat. One 20 something yr old pt the other day has chronic pain and takes 80mg of oxycodone Q 3 round the clock plus long acting opiate QID, lyrica, cymbalta. This kid is certainly going to be in a pickle when they're older. What can be used for pain control?
People can develop tolerances FAST but doesn't mean psychological addiction like many others before have said.
I know the other side since I've been dealing with chronic back pain from numerous on the job injuries the past 20years. It's a big hassle to finally get an Rx for 10mg of oxycodone BID. When I report that this definitely is not managing the pain I've been reminded about how fast tolerances happen. That's all common knowledge in healthcare dear Dr. Now what can you do to help me?
Finally after 5 yrs I've been able to get an MRI and now can prove it's more than a 'deep tissue injury'.
Please help your pts and don't judge. They could have been just like you in the recent past. The behaviors I'm sure have developed as a means to an end. I can't imagine having no control and being in chronic pain. Believe me when I say it is truly demeaning to be treated like a second class citizen because of chronic pain. Whenever I have a difficult pt whatever the issue and I start having judgmental thoughts I try and imagine walking a day in their shoes or if it was my family member, how would I want them to be treated?
Thank you to all the newer nurses for trying to learn and understand what you do not know!
Oh yes, you will definitely see how much narcotics a body can handle without skipping a beat. One 20 something yr old pt the other day has chronic pain and takes 80mg of oxycodone Q 3 round the clock plus long acting opiate QID, lyrica, cymbalta.
Thank you to all the newer nurses for trying to learn and understand what you do not know!
From the meds alone, it sounds like the 20-something is living with central pain, a specific type of chronic pain that occurs as a result of damage to the central nervous system.
I've been living with central pain for 33 years, and have had way too many experiences with HCP who don't believe I'm in pain or pass judgment on me and withhold pain medications because of lack of knowledge and personal bias:
I've had quite a few doctors and nurses tell me that I couldn't possibly be in pain because I'm an incomplete tetraplegic and use a wheelchair. "You can't feel me touch you, so you can't possibly have unbearable burning, shooting and stabbing pains. Therefore, you're a drug-seeker."
Certain areas of my body are affected by severe hyperpathia [increased response to painful stimuli] and allodynia [things that wouldn't usually hurt, like wearing shoes, trigger significant pain]. When I broke into tears after a nurse put a non-slip sock on me despite my repeated explanations about why I couldn't have that foot covered, she told me to 'quit being such a baby.'
An ER doctor on duty when I came in for a tib/fib fracture in leg affected by hyperpathia and allodynia refused to give me any pain medication. The doctor told me to my face that I was a drug seeker and had likely deliberately injured myself to get a 'fix' because I told the triage nurse that I had central pain and take 80mg of Oxycontin BID plus oxycodone for breakthrough pain.
I've recently had to switch from Oxycontin to a more affordable pain medication because the cost, even with insurance, was bankrupting me. The more affordable pain medication I'm on now is Dolophine, which is the brand name for methadone. Even though the script from my pain management doctor specifically states 'for pain', the pharmacist who's filled my prescriptions for opioid pain meds from this same doctor for the last seven years told me that it was 'illegal for him to dispense methadone to manage addiction, so I needed to go to the clinic'.
Seeing so many nurses who are already well-educated about chronic pain, pseudoaddiction, etc. and even more who are eager to learn to better help their patients is a beautiful thing.
Seeing so many nurses who are already well-educated about chronic pain, pseudoaddiction, etc. and even more who are eager to learn to better help their patients is a beautiful thing.
Hospice Nurse LPN, BSN, RN
1,472 Posts
Well said, xtxrn! My DH's pain was not being controlled by his oncologist until I began to advocate for him LOUDLY. He always told me, I always hurt, but I don't want them to think I'm an addict. When he started on fentanyl, he said he was not in quite so much pain, but he still rated it 6 or 7.
When his fentanyl was upped (over a period of time) to 200mcg he FINALLY had relief. He was also taking Lortab 10/500 4 or 5 times/day. He wasn't gorked....just not hurting. He was still able to function.
Everyone is different in how they handle pain.