Published Sep 13, 2004
How do you handle these patients?
Or, better question : Do you even "allow" yourself to think that the patient is a drug seeker and not actually in pain? We were drilled to be non-judgmental, openminded (and as a person, I truly am) yet still feel guilt when I believe a patient is a drug seeker.
It is hard to believe otherwise when you hear the patient laughing on the telephone, eating a McDonald's cheeseburger...and then suddenly, when you enter the room, they start to moan and say, "Ohhhh, what time is my Dilaudid due?"
I am well aware that people respond differently to pain - and I respect that. I know that pain is not categorized by behavior but rather by subjection.
Still - admit it - it's hard to not judge.
So, how do you personally handle drug seekers / manipulators / patients who like to play nurses "against" each other?
Gosh it is so hard! When I'm charging on 300 hall at my nursing home I have at least 3 drug seekers. I know that these people may be in pain but I also realize that they are addicts. We have rules set in place that we must check these 3 people's mouths after taking their meds because they spit them out and save them for later and then take a whole bunch at a time just to get baked. Also we have some that sell them or give them to friends. Lovely isn't it? I have had to call the doctor on one of them to get an order to crush his meds because he took his dose, threw the cup at the nurse and refused to open his mouth! If it wasn't for those three people constantly asking for drugs I would love my job. I have one patient that got pissed off at ME because her doctor switched her from Histenex to Robitussin!!!! Her excuse was because Robitussin tastes gross.... yeah right!!!! Every 4 hours she was on that call button going "honey, I need my pain medicine and my cough syrup please". I would come back and she was sleeping. GRRR! I haven't seen that woman cough one time. Needless to say she has quite asking for her cough med!!!
Something that bothers me more than "drug seekers" are those nurses who have sedated post-op surgical patients or patients who are noncommunicative and don't give pain meds for hours or even entire shifts and then complain that they've had to give prn antihypertensives or can't figure out why their patient has been restless or agitated, or been unable to control a patient's blood pressure, respiratory or heart rates . :angryfire
Pain is what the patient says it is, period. While they're under my care, if they say they have pain, I treat it with what I have available. I sometimes adivse the paitent to take their pain prns around the clock and I dole out the meds as such. If that's not enough, I advocate for the patient by contacting the doc to get things changed.
I am not there to police a person's drug use.
edit to add: It's up to nurses to not allow a patient to play nurses against each other. Simply don't buy into it.
We have a woman on our hall at the nursing home who knows she has PRN Lortab Q4-6 hrs. She will start ringing her call light about 20 minutes before the 4 hrs. is up. If you turn off the light and tell her she has 20 minutes to wait as soon as you step out the door the light is back on. And if you aren't there to answer the call light within about 1 minute she starts screaming "HEEEEELLLPPP!!!!!" at the top of her lungs and you can hear it on the other side of the nursing home.
The doctor is aware of this, but what can anyone do?
We have another who absolutely cannot sleep without her 'cough syrup' every night. I made the mistake of giving her Robitussen one night. I though she was going to go into orbit. She wanted the 'good stuff.'
We are also seeing a new generation come into the nursing homes. Many younger people who are old pro's when it comes to knowing what will get you wasted. I guess they are drug addicts but at least they are legalized drug addicts
I know soooo many will probably disagree with me on this but....That's another thing...nursing homes. I guess it depends on why one is in a nursing home, but dang, if there's an elderly person living in a nursing home, maybe nearing the end of their life...why on earth worry about whether or not the are or will become addicted to pain meds?!?
"We are also seeing a new generation come into the nursing homes. Many younger people who are old pro's when it comes to knowing what will get you wasted. I guess they are drug addicts but at least they are legalized drug addicts :rolleyes:"
I totally agree with the above. The 3 med seekers that I described above are all in their 40's!
Something that bothers me more than "drug seekers" are those nurses who have sedated post-op surgical patients or patients who are noncommunicative and don't give pain meds for hours or even entire shifts and then complain that they've had to give prn antihypertensives or can't figure out why their patient has been restless or agitated, or been unable to control a patient's blood pressure, respiratory or heart rates . :angryfire Pain is what the patient says it is, period. While they're under my care, if they say they have pain, I treat it with what I have available. I sometimes adivse the paitent to take their pain prns around the clock and I dole out the meds as such. If that's not enough, I advocate for the patient by contacting the doc to get things changed.I am not there to police a person's drug use.edit to add: It's up to nurses to not allow a patient to play nurses against each other. Simply don't buy into it.
Well, consider myself spanked! :rotfl:
I am not there to "police" anyone's drug use either - and I certainly give all of the PRNs I have available and will call the doctor if the patient complains about pain despite treatment. (Within reason - I am not going to keep the calling doctor continusously when it is obvious to both of us that the patient is just trying to get as high as possible - heart rate of 45, B/P of 90/50, slurring "I need stronger pain medicine...") Have you really never encountered that kind of patient?
Have you really never encountered that kind of patient?
I think I can say that I've seen a couple of people like this. I think my situation may be differnt though. I work in an ICU were we will give pressors so that we can treat pain.
"heart rate of 45, B/P of 90/50, slurring "I need stronger pain medicine...") Have you really never encountered that kind of patient?"
OOOOHHH Yes! My guy, I go into his room, his head in his breakfast tray, I get him to stir for me and he goes, I need my ativan and my darvocet, then puts his head right back into his bacon & eggs to go back to sleep!!!!!!!!!!!!!!!!!!! Oh yeah, you look really anxious to me buddy and oh the pain!
I have a personal example of undertreated pain.
Someone close to me has been hospitalized for about 10 weeks. He's a surgical case. This is his 5th major abdominal surgery since October of last year. We're not talking laprascopic stuff here, were talking full open sternum to pelvic area and from rib cage to rib cage incisions.
With all of these surgeries except the last two he came out of the OR with epidural pain control (bupivicaine and dilaudid and PCEA). After several days following the first two surgeries, the epidural was d/c'd and oral pain meds were started. He went home with the same oral pain meds and after the first surgery in October used them for only a couple of weeks prn but pretty much around the clock.
After the second surgery in December, he went home with the same pain meds but found that he had to take them more frequently to get the relief he needed to be functional enough to exercise and heal. He never really was pain free following this surgery but quit taking pain meds about a month or so post-op.
After the third surgery in July he came out again with an epidural with PCEA. They stopped the bupivicaine and dilaudid a few days post op and left just the PCEA which was not adequate because when he slept he didn't hit the button so he was always "catching up" with the pain.
For reasons that are just beyond me, they decided to switch his pain control over to the PO route. This was already a belly patient with absorption issues. It DID NOT work. They restarted the PCEA with a basal rate and a patient controlled bolus dose. He got .2 of dilaudid hourly and a .2 blous if he needed it q 8 minutes. This went on for about three weeks. The amounts of pain med that he was receiving would probably put you or me into respiratory arrest, but not him as he's grown a tolerance and has required higher and more frequent doses.
So now, after two short take-backs to the OR, they are once again treating him prn. This is a person who's been sliced up and down and from side to side. He's alert, he's oriented and he has pain. The miniscule doses of prns that they were giving were a joke. His respiratory staus became compromised because it hurt to breathe and he didn't want to move at all, not because of the pain medications.
When I visit, I ask for pain meds for him frequently. I ask why they aren't given around the clock. The RN says it's because his systolic pressure is not adequate enough to support a dose or that they just gave some tiny little dumb dose. And instead of contacting the doc about the problem of pain control, they just let the patient suffer until parameters that the nurse is happy with are met, and then they give the dose they feel is appropriate.
Now, anyone can see that a tolerance to the pain med has been built up in this patient. He's not that old, he's been living with pain for almost a year and may seem pretty darned normal and pain free at times. But that's how people who live with chronic pain are....they sadly, learn to be functional and live with it.
But tell me that this patient is addicted to pain meds or med-seeking when he calls for his meds 15 minutes before they're due around the clock and I'll pull a Trump on you and say...
Believe me, I have put up a big stink about this. It's just wrong. Nurses should not be afraid to treat pain.
I just wonder if those who complain about "med-seekers" really really know their patient's entire history?
To the OP: If you do a "search" on this, you'll see that there are probably thousands of threads on this topic. They might be helpful to you.
Some of what I am reading here are the old myths regarding pain mgmt. Many of them have been disproven by good research. It's our obligation as professionals to keep current on treatments such as pain mgmt.
For example, it is possible to be sedated (drowsy/sleeping, slurred speech) and still be in pain. "Clock-watching" is often an indication of inadequate pain relief, not addiction. And it is also very feasible for a pt to appear normal while family is visiting, then request pain meds/rate pain level high as soon as the visitors leave.
My suggestion would be to get a really good pain mgmt manual for nurses, such as the one by McCaffery and Pasero.
Some of these posts remind me of the time I spent working in a nursing home. I recall a couple of male patients who were probably in their 40s who would stroll up to the medication cart and want their oxycodone. They would sign themselves out from the facility (which is permissable) and go out at their leisure. One time I went into their room and they were watching a porno movie. I think all the staff knew that they were doing something illegal (I can't even remember what it was, probably had something to do with drugs). I had one glorious moment when I pulled into the parking lot at work one day, and there were those two men, handcuffed in the backseat of a police car. Much to our relief, they never returned.
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