Knocking a Patient Out, a bad thing?

[CaLLaCoDe, BSN, RN]

The other day I was hopping. Manic as ever, from room to room making sure everyone who was post up was in a chair using their IS making certain their diet had arrived on the cart and giving pain meds, really no big deal. However, a patient who was not mine (post op) adjacent to one of my patient's bed was in bed in the morning, in bed in the afternoon and very sleepy indeed, in fact I suspect that the nurse that had her purposely knocked her out with as much Percocet, Vicodin, or Dilauded as was ordered just so she could be sitting at the nurses station chillen with her coworkers.

Understand, this is my personal objective observation, please don't infer that I believe everything I see as being the "truth." Don't get me wrong, this nurse knows her stuff. Has her certificate from the ONS to treat any cancer patient under the sun (well educated).

However I do note, that more than enough times I'll observe her just kicken it, chatting about all her new technical toys, her favorite cologne, her favorite musical group with others. It really shouldn't bother me. Everyone loves her.

She is a popular personality on the floor. In fact, since she is per diem: a shift leader hoped she could sign on to be a permanent staffer.

And heaven forbid you're given her assignment midshift; you might find yourself catching up with things ordered or things that should have been documented not documented such as blood sugars.

Anyone else seen this and questioned in their heart that if it was right? What would you do? Anyone else bothered by the popular personality who seems to get away with not doing the work of nursing?

[Equinox_93]

... are you certain that the patient hadn't *requested* the medication?

[CaLLaCoDe, BSN, RN]

Yes, indeed, the patient had probably requested the medications for pain. I did have the patient the following day and tapered the pain meds so I could have her up in a chair, alert to my suggestions.

[Equinox_93]

Yes, indeed, the patient had probably requested the medications for pain. I did have the patient the following day and tapered the pain meds so I could have her up in a chair, alert to my suggestions.

... So... you are criticizing/questioning the nurse for giving a patient an ordered medication at the patients request to control their pain? I'm not understanding you here I think...

[Flightline, BSN, RN]

I think it's difficult to comment on the use of pain medication without personally assessing the patient, but I certainly know the type of nurse you are referring to. In the ICU, you may see them in their patient's rooms twice, unless they're coding, and then they are in there a third time for the code. They print out all the vitals at the end of the shift to "catch up" the paperwork, and they are social butterflies. Nursing to them seems to be like just another job they are doing at the current time. They replace "professional" with "cool." They fit very well in the organization, because they are friendly and carefree.

What disturbs me is that nursing, in truth, is very difficult, depressing, and serious--when it's done right.

[CaLLaCoDe, BSN, RN]

I think it's difficult to comment on the use of pain medication without personally assessing the patient. But I certainly know the type of nurse you are referring to. In the ICU, you may see them in their patient's rooms twice, unless their coding, and then their in there a third time for the code. They print out all the vitals at the end of the shift to "catch up" the paperwork, and they are social butterflies. Nursing to them seems to be like just another job they are doing at the current time. They replace "cool" with "professional." They fit very well in the organization because they are friendly and carefree.

What disturbs me about these nurses is that nursing really is very difficult, depressing, and serious--when it's done right.

Yes that's is exactly it! Spot on!

An MD told me once that he was in ICU post operative open heart, he'd been receiving 2mg of Morphine q 4 hours when along comes the night shift nurse who decides on giving him 4 mg of Morphine. OMG, he told me he couldn't move a muscle and was putting all of his concentration on the next breath. :eek: what the foxtrot?

[Flare, ASN, BSN]

I think that as long as the patient asks for the meds and understands what the effect will be then no issue. I understand what you are saying about pushing for the higher amount though to make the patient more drowsy, but being the neurotic that i can be i always watch those people a little closer anyhow. I have only needed to use the narcan a few times, but it was a few times too many.

[Virgo_RN, BSN, RN]

It is hard to say without having been there, but yes, I do believe that this can and does happen. Regardless of whether the patient requested something for pain, which being a post-op undoubtedly they did, they still need to get out of bed and use their IS.

If the patient is extra sensitive to the soporific effects of pain medications, then the nurse ought to at least be in there making the patient turn, cough, and deep breathe if they are too sedated to get OOB or use the IS. Leaving the post-op patient immobile for long periods of time isn't really best practice.

Since it can be tough to balance adequate pain control with keeping the patient alert enough to participate in self care, I could see this happening every once in a while. But if it seems to be a pattern with this one nurse, I'd be beginning to wonder.

[Virgo_RN, BSN, RN]

... So... you are criticizing/questioning the nurse for giving a patient an ordered medication at the patients request to control their pain? I'm not understanding you here I think...

Post op patients need to get out of bed and move. They need to breathe deeply, use their incentive spirometer, and ambulate. They should be OOB for meals, and they need to be alert enough to eat safely. Knocking a patient out so you don't have to be bothered is not good nursing practice, and every surgical nurse knows this. It sets the patient up for postoperative complications necessitating a longer hospitalization at best and causing debilitation or death at worst.

The fact is, getting out of bed post op is gonna hurt. Turning, coughing, and deep breathing is gonna hurt. Even with appropriate use of pain meds. The nurse needs to educate the patient on realistic pain control goals. The idea is to take the edge off enough that the patient can still function; they can still get OOB and TCDB. But the idea that they will have absolutely no pain is not realistic, and trying to medicate to that goal will only result in snowing the patient so they can't function.

This is what the OP was wondering about. There is nothing wrong with giving the patient pain meds if they ask for them, but completely snowing them so they sleep all day instead of move and breathe is not okay. Of course, you will learn this when you go to nursing school.

[netglow, ASN, RN]

... but I certainly know the type of nurse you are referring to. In the ICU, you may see them in their patient's rooms twice, unless they're coding, and then they are in there a third time for the code. They print out all the vitals at the end of the shift to "catch up" the paperwork, and they are social butterflies...

Have seen this too, even more frightening if it's ICU. Hope it's not the case, but I am sure your intuition is right, I know that mine usually is.

OP, luuuuuuve your name.. "CaLLaCoDe"

[Equinox_93]

Yes- I am aware of these things. One doesn't have to be a nurse to understand these concepts :) Essentially what I am asking is- did the OP check to make sure that these things *weren't* already done? Just because they did not SEE the patient OOB, doesn't mean the patient hasn't *been* OOB. Ya know? If they know that the nurse IS in fact neglecting these things- OK. But to assume because they hadn't seen it? Well... Maybe. The OP seems to have looked in a few times... OK- peachy. But- what else is there for a patient to do in the hospital? Not much. So a few check ins doesn't paint a comprehensive picture of the care that patient is receiving. If that makes sense?

I know when I've been in the hospital- I sleep when I'm bored. Nothing to do in the hospital- so catching up on sleep seems a good idea. Doesn't mean I never get OOB- it just means there's little else to *do* (as a patient).

Post op patients need to get out of bed and move. They need to breathe deeply, use their incentive spirometer, and ambulate. They should be OOB for meals, and they need to be alert enough to eat safely. Knocking a patient out so you don't have to be bothered is not good nursing practice, and every surgical nurse knows this. It sets the patient up for postoperative complications necessitating a longer hospitalization at best and causing debilitation or death at worst.

The fact is, getting out of bed post op is gonna hurt. Turning, coughing, and deep breathing is gonna hurt. Even with appropriate use of pain meds. The nurse needs to educate the patient on realistic pain control goals. The idea is to take the edge off enough that the patient can still function; they can still get OOB and TCDB. But the idea that they will have absolutely no pain is not realistic, and trying to medicate to that goal will only result in snowing the patient so they can't function.

This is what the OP was wondering about. There is nothing wrong with giving the patient pain meds if they ask for them, but completely snowing them so they sleep all day instead of move and breathe is not okay. Of course, you will learn this when you go to nursing school.

[CaLLaCoDe, BSN, RN]

Yes- I am aware of these things. One doesn't have to be a nurse to understand these concepts :) Essentially what I am asking is- did the OP check to make sure that these things *weren't* already done? Just because they did not SEE the patient OOB, doesn't mean the patient hasn't *been* OOB. Ya know? If they know that the nurse IS in fact neglecting these things- OK. But to assume because they hadn't seen it? Well... Maybe. The OP seems to have looked in a few times... OK- peachy. But- what else is there for a patient to do in the hospital? Not much. So a few check ins doesn't paint a comprehensive picture of the care that patient is receiving. If that makes sense?

I know when I've been in the hospital- I sleep when I'm bored. Nothing to do in the hospital- so catching up on sleep seems a good idea. Doesn't mean I never get OOB- it just means there's little else to *do* (as a patient).

Actually, I was in the room dealing with the neighbor patient nearly every hour. So, you can come to your own conclusions.