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?
My peeve is not the request for meds. If 10 is the worst pain you've ever had in your life, and you've experienced labor, amputation, major surgeries, car accidents, etc-- DO NOT tell me your pain is a "9" when you just took a shower, cooked breakfast, got dressed and are calmly sitting errect in your chair while you tell me how excrsheatin' the pain is. I have to explain that if the pain is still a "9" with q4 hr use of narcs, I need to call the doc to get the meds changed because they aren't working. I'm not going to withhold meds if you tell me your pain is kept at a 3 when you take them as ordered! We created the problem back when we'd only give meds when they yelled, hollered and were going to die without a dose.
Has anyone seen the drug Cymbalta has FDA approval for diabetic neuropathy? Better yet, has anyone seen it work? Hot dang! I could get my pts pain and depression treated in one pill!! Whoohooo!
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.
Well, she's obviously not overmedicated. :chuckle
The doctor is aware of this, but what can anyone do?
I'd probably ask the primary for a pain specialist consult, especially if I suspected that the patient was having neurologic pain, and request that all the nurses diligently document the patient's c/o pain as it happened. It might be time for that patient to have a long-acting patch ordered.
Remember, docs and nurses can be held liable for undertreating pain.
I feel exactly the same way. I dish out evrything they can have as often as they can have it!
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?!?
It has nothing to do with "being judgmental" or "policing" anyone.
It doesn't take a rocket scientist to figure out when someone is a drug-seeker.
Come on.
You won't see that in ICU. I worked Med/Surg and about half the patients there were "very familiar" to us, shall we say. It was all about the IV pain meds.
I gave them to the patients when I was ordered to and when they asked (if they had an order.) But I wasn't dumb enough to think that these people were in "excrsheatin'" pain..........
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?!?
Isn't this the TRUTH?
Why is it drug-seekers get all the narcs they want, yet these poor old people lay suffering?
Alot of geriatric patients won't even ask for pain meds because they have been indoctrinated with this sort of thing. So they suffer.
I'm sorry, but anyone nearing the end of their life deserves all the pain med they want! Why should people have to suffer needlessly??? :angryfire :angryfire
There's a myriad of answers to this age old nursing question of treating pain. I believe in treating a patient for pain when they ask for it. Period. I am not the pain police. If what I give doesn't work, then it's time to reassess and talk to the doctor about it. Of course, common sense plays into this too. If somebody wants pain meds, I go to assess them and if they are having snoring respirations or if their speech is slurred and their vital signs are on the low side, I'm not gonna start shelling out pain meds just because it's ordered.
As long as addictions exist, there will be drug-seekers. And on this note,
my biggest pet peeve: A terminally ill cancer patient gets ordered a Darvocet prn pain and a non-compliant patient with drug-seeking behavior gets MS Contin bid for whatever their illness of the month happens to be--along with Xanax, Soma, sleeping pills, phenergan, Vicodin prn breakthrough pain and COUGH SYRUP prn to boot. And they look more alert than I do after taking everything they can have!!!!! What's up with that?
I think it is terribly naieve to think that everyone in a nursing home who wants their pain medication nonstop around the clock and throws a hissy fit if they don't get it is suffering and in pain. People get hooked on pain meds. for reasons other than pain, there is no doubt about it. I can care less if they want to get wasted or why they want their pain meds... if they can have it, I'll give it. It's true, the nursing home is usually the 'last address' and there is no benefit in trying to keep things from the resident that will make them more comfortable. But when it gets to the point that this resdient's addiction is disruptive to the lives of their neighbors and takes nursing staff's time away from the other residents it is a problem. But what we have learned is that it is just a problem we have to tolerate. yes, we nurses at this nursing home have all had the 'if I was in here I would want to be in the twilight zone too' discussions, but there has to be some sanity to it, too. We have residents who would be thrilled if someone would just walk down there and hand them the pack of Lortabs or Vicodins and tell them to go at it. They may be on their way out and in a nursing home but I think if they actually heard someone say 'oh well you're on your way out anyway, lets hit the old narc box and keep you happy for awhile' they would not only be shocked but offended.
This hollering woman, she has been in the nursing home for YEARS. She is bedridden, so of course she will have aches and pains. But forget repositioning and comfort measures, she cuts right to the chase (I WANT MY LORTAAAAB!!!!) This woman is nortorious for being a nasty woman. She called a CNA who recently had a miscarriage a ''baby killer." So that doesn't mean she isn't in pain? Of course not. She can have her pain meds. when they are due. But you can't convince me or anyone else who works at that nursing home she is miserable and suffering and at death's door.And she does get other things for pain (such as neurontin). And someone hurting sooooo bad usually won't have such a hearty appetite (she eats everything but the plate.)
The people who are really suffering are the ones we have to ask if they will accept a 'pain pill.'
I have soooo many experiences with this. We had a woman who complained to the doctor we weren't giving her enough of her 'nerve pills' and 'pain pills.' To CHA he prescribed Ativan TID and Lortab BID. Within a week this woman couldn't even talk, she couldn't sit, you would have to try to coax her to eat after you propped her up on her pillows. Her mouth hung open all the time and when you would put food in her mouth it would fall out the side. So the doctor DC'ed the Ativan and Lortab but she has not been the same since.
Another woman we have is so hooked it is almost funny. She came to me an hour after I had given her a prn ativan and said 'Hon I'm so nervous I need a nerve pill I'm so nervous I can't stand it!' I told her "I just gave you a nerve pill an hour ago, Elizabeth" She says matter-of-factly (the drama just disappeared) "oh, ok....can I have a pain pill then?" This is a sweet woman and we I wouldn't try to deny her anything she was prescribed to have but you can't tell me she wasn't looking for a buzz.
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?!?
thank you begalli.
i've always viewed ltc and our elderly as a hospice program that expands its' life expectancy beyond the 6 month requirement.
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 Mediao 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.
and i'll bet my bottom dollar that prison is preferable to these men, than staying in a nh with the 90 yo immobilized, demented population. at 40 yo, i can't think of anything more depressing.
i cared for an aids pt one time that came to stay where i worked.
although i worked in the hospice unit, and she was end stage (around 30 yo), the family refused hospice.
so she was placed in the ltc unit.
this poor woman decompensated so badly, (in spirit) saying that she just as well die now if she had to stay in this environment.
i stepped on many many toes, but did manage to get her transferred to a facility (much to the discontent of my superiors) with people of her ethnicity as well as her terminality.
i just cannot fathom being young and living in a nursing home.
I've never worked LTC, so I can't really speak for that population. I am a float nurse and work everything from mother/baby to ICU. But I wholeheartedly agree with the poster who said that it's hard to swallow a cancer patient getting Darvocet prn, and the frequent flyer with no medical problem ever found getting Dilaudid, Ambien, Ativan, Phenergan, Flexeril...I find the situation most often on a general med/surg unit. ICU doesn't have these patients, because you have to really be physically ill to be a patient in the ICU (at least where I work.)
Of course post-operative patients should have adequate pain relief, and I believe ATC rather than PRN narcotics. We are discussing two totally different topics, I believe. Post-operative patients have legitimate pain and are not "clock watchers" because they call for the med before it's due.
I recently had a young man who brought an alarm clock and set it to go off every four hours during the night so that it would awaken him and he could ask for his pain med! :rotfl: He was sleepy he couldn't even stay awake long enough for me to take the Dilaudid back to him!
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?!?
I don't understand this either. That poor person is probably suffering physically and emotionally. I say give them what makes them happy. If they're terminal, give them as much as they can safely have. It's not hurting anyone and may improve the quality of whatever life they have left.
Remember, docs and nurses can be held liable for undertreating pain
Really? Then there are several I need to sue for the years that I spent in pain before I was finally treated properly and had my pain managed. You know, I can almost forgive the doctors who failed to diagnose me, but I cannot forgive the ones that ignored my pain after I was diagnosed with herniated disks, 2 other disks bulging, bone spurs, arthritis...
Well, I got lucky and found a great doctor who is working with me to find the appropriate pain medication. I have trouble with many meds so it's slow going, but at least my pain is somewhat under control, and he is doing everything he can.
After I found him, I intended to cancel an appointment I had with another MD that I had been trying to get in to see for weeks. But I was curious as to whether or not the other doc would be as concerned about my pain and what he would suggest I do, so I kept the appointment.
When I went to see him, bringing copies of all test results, I was shocked that he didn't even read them. He briefly glanced at the top page and asked me why I was there. My response was "I've been in pain for 4 years, after a MVA, no one knew why until recently when all of these back and neck problems were diagnosed and I'd like my pain to be treated". He immediately said "I don't like to prescribe narcotics so why don't you try something OTC first and see how it works"
Hello? I've been in pain for 4 years, don't you think that I've probably tried all of those by now? And, I hadn't asked for any specific drug, and he hadn't looked at my chart, the papers I brought, or even asked me about my pain location, level or anything.
So I said, " I see, so you wouldn't prescribe something like MS Contin?(which is what the other doctor had put me on)" and he said " Oh No no, you're much to young to be taking that." Huh? There's an age requirement for pain management? Who knew?
I didn't bother to tell him what I thought of him, at least not in so many words, I simply said, " Well, thank you for your advice, I never thought to buy a bottle of Tylenol, I'll get right on that."
I guess my sarcasm was missed because on my way out he told me to make a follow-up appointment for 6 weeks. I gotta hand it to him, that was the best laugh I'd had in a long time.
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nancynurz
23 Posts
My peeve is not the request for meds. If 10 is the worst pain you've ever had in your life, and you've experienced labor, amputation, major surgeries, car accidents, etc-- DO NOT tell me your pain is a "9" when you just took a shower, cooked breakfast, got dressed and are calmly sitting errect in your chair while you tell me how excrsheatin' the pain is. I have to explain that if the pain is still a "9" with q4 hr use of narcs, I need to call the doc to get the meds changed because they aren't working. I'm not going to withhold meds if you tell me your pain is kept at a 3 when you take them as ordered! We created the problem back when we'd only give meds when they yelled, hollered and were going to die without a dose.
Has anyone seen the drug Cymbalta has FDA approval for diabetic neuropathy? Better yet, has anyone seen it work? Hot dang! I could get my pts pain and depression treated in one pill!! Whoohooo!