I must be an idiot

[sharann, BSN, RN]

Thats how I feel. I had a patient fool me and good!

Appy, uncomplicated, young adult, and screaming in what I thought was

an abnormal amount of pain. I am no beginner recovery rn here. She gave an academy award level performance. 30mg of MS in 2 hours and some sedation later I learned this. So despite getting reamed by the surgeon for making him come back in to check the patient, I still think I did the right thing. I didn't know she was just acting out until I really got her talking.

Have you ever been fooled by a patient. I should get a Darwin Award for last night.

Ugh:(:angryfire

[sharann, BSN, RN]

Apparently everyone agrees with my assessment.

LAter

[morte, LPN, LVN]

i was going to answer, and realized i was in a specialty forum.....oh well......think we all have been.....and perhaps she wasnt opiate niave (sp)?

[Marie_LPN, RN, LPN, RN]

We were fooled not that long ago, but we didn't find out until later.

A pt. who was "visiting" relitives popped his hip out of place. It couldn't be reduced in the ER, he kept screaming in pain. Ok, so he was brought to the OR, after IV therapy placed a very small gauge access in his TOE, because he has such poor veins.

In PACU he kept asking for more pain meds. No one suspected drug seeker, because he didn't really display any symptoms for it. Until the MDA said "he's had enough 'killer to power a tank, he can't get anymore until (insert time length here)". And magically that hip came out of place about 10 minutes later. AGAIN.

By then, the surgeon put in a couple of calls at this guy's hometown hospital. Since it was a weekend, he wasn't able to get ahold of a particular person, but by tuesday of the next week, he had the whole story. Apparently this guy had dislocated his hip once after getting hit by a car, and he was in the hospital for about 3 days on heavy duty drugs. And after that he became a FF in their ER with you-name-it-he-had-it his problems. And after awhile he wasn't getting the drugs he'd asked for, because the staff knew what he was up to.

Hence the visit to us.

And he visited our ER several times after that, but then stopped when he wasn't getting what he asked for.

One of the reasons why we didn't suspect a thing at first: He's a priest.

Some people are slicker than we give them credit for.

[prmenrs, RN]

Anyone who hasn't been buffaloed by some pt @ some time in their working life just isn't having much fun. It's happened to most of us @ one time or another, whether we work in PACU or whereever!

Don't feel bad, I think you did the right thing, for what it's worth.

[sharann, BSN, RN]

Thanks guys.

Buffalowed is a great way to put it!

I guess I'll just chalk it up to another experience. Remember what we are taught about pain everyone....ALL together now, "pain is what the doctor says it should be despite what the patient says it is".

Well, something like that right?

[Siss]

We have pain control drummed into our heads by JCAHO and as PACU nurses, it is our job to relieve post op pain as much as possible. You did the right thing, no matter what the surgeon says

[Scififan]

I think you did the right thing, many a time I have felt the pain being complained about seemed excessive for the procedure that was done, but I'm not lying in the bed and all sorts of things can contribute to pain. I make sure that all vital obs are within safe parameters and administer the analgesia as charted, and keep the anaesthetist updated. Drug seekers are clever people and their tolerance is usually high so they are usually never happy with the amount we are able to give.

[rn/writer, RN]

Look at it this way--until you're perfect, you're going to make mistakes now and then. If you give meds to an addict, you get to feel p.o.'d that you were bamboozled. But if you deny meds to someone truly in pain, they get to feel miserable and scared. By erring on the side of caution, you are in effect saying, "I'd rather my psyche take the hit than keep someone in agony suffering." Sounds kind of noble to me.

[Sabby_NC]

In my view, until I get taught something different, Pain to the pt is what they say it is.. How can we decide that?

You gave the pt pain medication and that is exactly what you needed to do. :)

[sharann, BSN, RN]

Thanks guys.

I still get teased about this by the nursing sup. I just tell him that until he is the one in my shoes and hears the screams of pain(or great theatre), then he better quit it!

He is just kidding with me though so it's ok.

I agree that until they tell me that pain is what the doctor thinks it is or the nurse judges, then I will medicate as much as I have to.

[DanceRN]

I'm sure all of us have been "fooled" at one time or another. Don't even ask me what the most pain med I have given a pt is. We use the sedation scale along with aldrete and pain level. If a patient states pain level is an 8 but sedation is a 4 and aldrete is an 8 then they are ready for discharge from PACU.

One of our MD's has the pt cough (abd. or chest surg). If the pt can't cough or is splinting then they are a 7-10 if the pt coughs but winces 4-7 and if th pt coughs without problem 0-4. He uses this to "verify" what the patients states pain level is.