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.
Wow, sounds like an interesting new pain scale there by Dr. McCough. So, he "Verifies" this cough scale. Gee, I should use my "Nurse I'm thisty" scale. Pain is 10/10, no wait, 100/10, and the patient can thrash around, scream prfanity, demand food, want their cell phone and visitors, and have to pee as well. I ask them which they want most. PAin meds or peeing? Pain meds or water? PAin meds or your ipod?
Guess which one always wins?
I love narcotics(for the pain control!), they are proof that there is a god.
One question though. IF the patient had ankle or knee surgery, does he make them hop on one foot for major pain and 2 feet for mild?
Specializes in OB, Telephone Triage, Chart Review/Code.
I know there are some out there that would pull this on nurses, but I had something happen in my recovery over 5 years ago.
I woke up from surgery with horrendous pain...the nurse tried everything...I was on a PCA pump, she called Dr...dose increased...still not helping.
When I got to ICU, my new nurse pointed out to me that my IV tubing had disconnected and I had not had any pain medication for probably the past 4 hrs I was in recovery!
I have done that to a patient once but I figured it out in 15 minutes. I kept giving a loading dose and the patient kept having pain. Then I traced the tubing down and lo and behold, it was feeding the floor a nice 15mg of Morphine. So once I hooked her up...amazingly felt better!
So, yes I AM an idiot, but I am getting better. I learn from my stupidity:)
Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.
I've probably been fooled more than I know. Recently I had a patient who was a drug addictions counsellor. Unfortunately,he didn't tell me until the patient in bed #4 (that had put up a fuss to get the "right" analgesic prescription, "only such and such works for me"),had been discharged to Post Recovery Lounge -that "John" was one of his clients -a loooong time drug addict. He was setting himself up to make a tidy sum on the street as soon as he got out,likely as not.
As long as you didn't give more pain meds than what was ordered and the patient remained stable I don't see where you have done anything wrong. The patient is the one in the wrong IMHO.
My wife has 18 years hospice experience so I asked her how she tells if a pt has pain or is just drug seeking. She said it's easy, if they have pain, they get relief. If they're drug seeking, they get stoned. I believe every one of my patients and dose them until their sats start dropping.
A user will feel surgical pain just as others do, maybe even worse since they haven't had their usual dose and therefore are not even up to baseline. I don't work rehab so it's not my job to wean them off narcs, especially when they're fresh out of surgery. Last week I gave my largest dose. 6mg Dilaudid in one push. I checked the MAR and that was what the pt had been getting, q6h. Still seemed a little strange but her pain improved dramatically after the med and she didn't get stoned.
I choose to err on the side of beliving my patients whether I KNOW they are messing with me or not. My job is to treat the pain, and since we are asked to have them rate theri own, we must treat accordingly.
I have never given 6mg of Dilaudid push or any other route, but since opiods have no ceiling, it sounds completely plausible.
I just felt lame at the time. I stand by my descision to medicate her as much as legally allowed by orders.
Don't feel bad. I had a cute lil Down's pt. completely convince me that I was seeing grande mal seizures. The neuo doc made me sneak a peek at just the right moment and boy, was I embarrassed.Pt. was totally faking it.
It makes me crazy when staff questions giving sedation for a cardiac cath if the patient has a current/past drug problem or chronic pain. These patients usually need the medication adjusted up to their needs not down. It's my job to make sure their anxiety and pain is under control not to treat their issues or judge their long term pain. Thank goodness for the MD's that understand this and treat accordingly.
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sharann, BSN, RN
1,758 Posts
Thanks DanceRN.
Wow, sounds like an interesting new pain scale there by Dr. McCough. So, he "Verifies" this cough scale. Gee, I should use my "Nurse I'm thisty" scale. Pain is 10/10, no wait, 100/10, and the patient can thrash around, scream prfanity, demand food, want their cell phone and visitors, and have to pee as well. I ask them which they want most. PAin meds or peeing? Pain meds or water? PAin meds or your ipod?
Guess which one always wins?
I love narcotics(for the pain control!), they are proof that there is a god.
One question though. IF the patient had ankle or knee surgery, does he make them hop on one foot for major pain and 2 feet for mild?