IV Dilaudid problem patients!!!!!!!!!!!

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Recently i have been noticing a great amount of IV dilaudid addict patients. Nurses what in your opinion we should do? Giving the pain medication for post-op and other acute pain issues, i understand very well that we have to manage pt's pain. But the frequent flyer to our hospitals just bacause they are addicts in my opinion is encouraging these pt's and making a dilaudid/morphine society out there. Yesterday, i refused to participate in this with one of our MD's and demanded that this particular pt be sent to rehab for narcotic problem. Most of these pt's have pyschological issues to begin with. I refuse to be manipulated with this pt group and support there addiction in name of pain and medicine!!!!!!!!!!!!!!!!!!!

I agree with whoever said just give them their pain meds...say little, don't buy into the drama...that way they don't create big scenes and monopolize even more of your time. Every drug addict I've encountered couldn't care less about anyone but himself...he will absolutely play/monopolize you if you allow it.

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Specializes in ICU/Critical Care.

I've had those patients before, as we all have. You can't feed into their manipulation. I just tell them, such and such pain med is due every four hours as needed. If they want me to bring it every four hours, fine. If they ask me to call the doc and see if they can get an extra dose of whatever, ok, but I'm not making guarantees that the doc will give them what they want and I say that to the patient. I say, the doc says no more pain meds and If you'd like to discuss it you can do so when they come to see you otherwise you are getting what you have ordered and thats it.

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Specializes in Hospice.
I've had those patients before, as we all have. You can't feed into their manipulation. I just tell them, such and such pain med is due every four hours as needed. If they want me to bring it every four hours, fine. If they ask me to call the doc and see if they can get an extra dose of whatever, ok, but I'm not making guarantees that the doc will give them what they want and I say that to the patient. I say, the doc says no more pain meds and If you'd like to discuss it you can do so when they come to see you otherwise you are getting what you have ordered and thats it.

And that's the key ... clear, enforceable limits, no emotion ... helps to have a cooperative doc, too!

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Specializes in ICU/Critical Care.

Good point. I am very expressionless and emotionless with these types of patients because they play off of it. I learned the hard way.

Had a patient complaining about right-sided chest pain and SOB. Ok, the docs are thinking "hmmm, Pulmonary emboli"...Patient has long list of allergies which include, morphine, toradol, vicodin, IVP dye etc. Anyhow, patient was making random comments to me when I pushed his dilaudid like "Can you push it in faster?"...THEN he'd want benadry IVP. Benadryl enhances the effects of the Dilaudid. However, I didn't catch on because I was a newer nurse and into wanting to please and advocate for my patients.

Well, Chest CT time comes around. I have to prep this guy with prednisone and benadryl PO so he doesn't have a reaction to the IVP dye they give in CT scan. Well, he refused to take it and starts a tirade "Those docs don't believe there's anything wrong with me, they're withholding pain meds, my wife is a lawyer, I can sue them." So I said "The docs do want to find out whats wrong with you, they think you have a clot in your lung and we need to do the CT scan"...he just refused flat out to go through with it. So I tell the doc this. CT is cancelled.

Anyhow, was looking at his medical records after a visit to another area hospital about a week before this admission, where he COMPLAINED about the same thing: right sided chest pain with SOB. They also did a CT scan of his chest and low and behold, it was negative and clear as day. All his other tests were negative also.

But I didn't realize he was playing me until one of the older nurses I worked with pointed it out. I learned my lesson that day. Anyhow, all his other tests were fine. He ended up getting discharged.

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Specializes in Telemetry & Obs.
I'd like to ask a few questions. I'm just interested in the responses. Please - no judgment, no 'implications' of anything. Just some questions and hopefully, I'll have some thoughtful answers :)

Q: How many nurses here have seen/believe it possible to have 10/10 pain (for example) - with no change, alteration, abnormality (and/or any combination thereoff) in the pts. vital signs? I'm obviously talking about AOx3 patient here.

Q: "Pain out of proportion to exam" is a valid, medical concern. How does this relate to "pain is whatever the patient feels/reports?"

Q: How many nurses here use qualifiers when describing the pain scale to patients (E.g.: "Mr. John Doe, how bad is your back pain? If I were to ask you to describe it on a scale of 0-10 with 0 being no pain and 10 being the pain you might feel if someone shot you in the chest or set your arm on fire, what number would you rate your back pain right now?")

Q: Follow up to the question above - is the use of such 'qualifiers' valid (or how about ethical?)

cheers,

A: I believe it. My husband is a perfect example. The man has a pain threshold that the normal person would need a lift to climb over. He just has a high tolerance for pain I guess. When he was in the hospital I had to tell them if he complains of pain please know that he's already experienced a much greater amount of pain than the average person before he complained.

A: So exams are perfect?? I've been in pain before when the docs had absolutely no idea "why" yet I HURT. Even now I have a LOT of pain related to my reconstruction surgeries that I'm not "supposed" to have. Ok, then.

A: I ask my patients to rate their pain from 0-10 with 0 being no pain and 10 being the worst they've ever felt. I had a painful childbirth, I've had bilat mastectomy with reconstruction, a TAH...and none of it has hurt like my danged root canal that the endodontist claims doesn't require prescription pain meds! Hmph....good thing my dentist doesn't agree and prescribed them even before I went to the endodontist!!

A: n/a

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Specializes in Cardiac Telemetry, ED.

Had a guy come in on three occasions a month apart, using different names each time. C/O chest pain, allowed himself to be cathed three times (all negative) before he was recognized by staff and called out by the doctor. He always wanted his IVP MS and lorazepam on the dot, and asked me once why I was pushing to so slowly.

Had a female patient in for gyn surgery, on a PCA pump, went through a syringe and a half of Dilaudid in one eight hour shift, and was still crying and carrying on, calling the doctor's office from her hospital room, demanding only one thing; an IM injection of Phenergan and Demerol, inbetween trips down three stories to go outside and smoke. Did not stop carrying on until she finally got it (BTW, her surgeon had already had a frank discussion with her warning her that her postop pain would be hard to control given her high tolerance to opioids). I looked up her medical history and she had years and years of visits to the ED for migraines, always getting her shot. Then there was one ED report where it stated that she was angry that someone else with chest pain was taken back before her. Very next visit, she presented with chest pain, and got the usual Toradol, nitroglycerin, chest xray, EKG, all negative. Next visit after that, she states she is allergic to Toradol.

Another guy who had a history of traveling up and down the West Coast, presenting to the ED with chest pain, getting admitted for observation, treated with MS IVP, only to be discharged with nothing wrong.

These people are out there, and can be extremely frustrating to deal with and can suck up all of your time so that other patients are not getting the attention they deserve. I agree with the previous posters who say that the best approach has been to just be detached, not allowing them to suck you into the drama, and give them what's ordered when it's ordered (unless of course it seems unsafe from a nursing judgment point of view). As irritating as it is to know you're being manipulated, it's not personal at all, so don't let it be personal.

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Specializes in M/S, Travel Nursing, Pulmonary.

"Yes ... if an addict is hitting his bottom and you happen to be on hand to offer intervention, you can indeed support a healing process ... but that doesn't happen just because you decided it was time."

Exactly the point I was trying to make. They will decide to quit when they decide to quit, no amt. of confronting them will bring this on any sooner.

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Specializes in Psych.

I just want to clarify that I would not give a person I thought was overly sedated a narcotic. I was just saying that I don't care about anything other than the patient having an order for the med. Not my business to judge and they aren't my drugs -- who cares?

I think the real issue here is we all have been manipulated by patients, the hospital admin and physicians to compromise ourselves and other patients by having to manage pain in an ineffective, old-fashioned and time wasting manner. It demeans be as a nurse to do things I know are expensive, ineffective and not evidence based. It demeans me as a professional to know my prescious time and skills are being wasted. It demeans me as a consumer to know that I am wasting resources.

If a person is getting IVP drugs q 1-2 hours to control pain of a duration of more than a few hours, then somebody is playing games or is just plain stupid. That, IMO, is what is really the issue.

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Specializes in Cardiac, Maternal-child, LDRP, NICU.
I get patients like this from time to time (I work M/S). I just give it to them. I honestly don't really care. You're not going to hurt them. 99% they are more than able to tolerate the dosage. If not then you should be monitoring their VS anyways and a dose of narcan can correct any problems very quickly. I've seen (young) people get 7mg of dilaudid in short periods of time and it doesn't even touch their pain. I've also seen people get 1mg and start getting toxic. You use your good judgement.

If they're conscious enough to hit their call light and ask for more, I'd assume they're probably able to handle another dose.

Again, if they ask, I give it. If they say their pain is coming up, I give it. I give it if they say their pain is a 5 out of 10. I give it if its a 10 out of 10. Doesn't matter to me...Pushing drugs is what I do. Kind of comes with the territory when you're a professional nurse.

However, when I have patient that comes in for DKA and then starts c/o leg pain and wants dilaudid that's about right when I start rolling my eyes.

Or what about a quad who does not feel any pain or anything as a matter of fact below there neck needs dialudid for pain in there back or spine :rolleyes:!

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Or what about a quad who does not feel any pain or anything as a matter of fact below there neck needs dialudid for pain in there back or spine :rolleyes:!

if you were a quad and had to live their life how would it feel? even if it isnt real pain and he wants to feel good for a few hours then i dont see a problem. Life is hard enough for them.

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Or what about a quad who does not feel any pain or anything as a matter of fact below there neck needs dialudid for pain in there back or spine :rolleyes:!

perhaps you need to educate yourself on spinal cord injury.

you don't think they experience neuropathic or neuromuscular pain?

spasms?

*shakes head*

http://www.spinalcord.uab.edu/show.asp?durki=41119

leslie

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Specializes in ICU/Critical Care.
Or what about a quad who does not feel any pain or anything as a matter of fact below there neck needs dialudid for pain in there back or spine :rolleyes:!

Nice. :rolleyes:

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