Postpartum pain management

  1. Just wondering if I am too liberal with pain medication as a new nurse or if I am pretty normal. I sometimes feel as if more experienced nurses are questioning why I was giving the medication so often, etc. Or I see them only giving one type when I use a combo.

    Our docs' standing orders are for Motrin 800 mg q 6-8 hours for mild-moderate pain and Percocet 1-2 q 3-4 for moderate to severe pain. They also write for Tylenol 3, but I rarely have patient's want want that.

    I typically suggest taking the Motrin on a schedule sort of. I think it really helps with the cramping and my patients that were only getting Percocets always tell me how it is working better now that they are taking both. I always try to remind them to stay on top of the pain and sometimes that means taking it on a bit of a schedule.

    I had a Vag delivery with that had a 1st degree lac that was repaired. She was allergic to NSAIDS and was just getting Percocets. When I gave report in the morning to the day nurse, she was just 12 hours post delivery. She and her hubby had both said that she had a low pain tolerance even with her first child. She was having quite a bit of cramping. I was giving her the Percocet, 2 q 3 hours or so. When I gave report, the day nurse told me that that wasn't happening on her shift and why was she having so much pain, she was "only a vag". It really upset me because she was obviously in pain and the Percocets q 3 were just keeping it under control.

    I thought that our job was to believe what they tell you their pain was and go from there. When I came back that night, she was on 1 q 4 hours and it was kind of helping. I told her to call me when she needed one and if it was only 3 hours, I would still give it to her. Her doctor even told her that she would like to see her on 1 q 6-8 hours before she went home. I don't get that. She couldn't even have Motrin!

    Anyway, just venting. I really try to keep my patient's pain under control and hate to come back to see that they haven't been medicated except once in 12 hours. I know they can ask, but still. I always ask how their pain is everytime I am in the room.

    I also do other measures to help them like ice packs for the first 24 hours and then sitz baths after that. I offer warm blankets when cramping, peppermint or chamomile tea for gas, etc. I am not just about medication.

    Any suggestions? Am I completely off base here?

    Thanks guys!
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    24 Comments

  3. by   Spidey's mom
    You are not off base. You are a great nurse. You did the right thing.

    steph
  4. by   VivaLasViejas
    I'm with you both.......I'm very much a proponent of good PP pain relief. A new mother's got enough on her plate without having to deal with unrelieved pain in the bargain. Your instincts are right on the money, breastfeeding RN.......kudos to you!!
  5. by   Fiona59
    Pain is subjective and its not up to some RN to tell a patient when she's in pain. I speak from experience on this one. First delivery was 28 hours, high forceps, cervical tears, too many stitches to remember, and huge 'roids. One nurse actually had the nerve to tell I couldn't still be in pain six hours after I delivered...

    Never heard of anybody becoming an addict on the post partum unit. Do what is best for your new Mums, and remind them it's their right to requet medication!!!
  6. by   SmilingBluEyes
    You are doing beautifully. I could only add this: I teach all my patients to use their pain meds ON ROUTINE, not only when they HURT, necessarily. This would mean, taking their Motrin 600mg every 6 hours and their Percoset every 4, (unless they have negative reactions to medication) without skipping---- for a few days after birth. Vitally important is keeping blood levels of pain meds even, and this will go a LONG way in pain control. And no you are NOT too liberal. Vaginal deliveries can hurt mightily, too. No one should have her recovery hampered by lack of pain control, and yes, pain IS subjective. Pain control is a HUGE issue for me; I want my patients to have theirs as much under control as possible.

    Also, don't discount adjunct therapies, such as positioning and heat packs or ice, as ways to relieve pain! And remember, well rested moms cope better with pain, so remind them to sleep when the baby does!

    You have done the right things; keep up the GREAT work! Pain is what the PATIENT says it is, that is the cardinal rule!
  7. by   breastfeedingRN
    Thanks guys! I just needed some reassurance. In my heart I feel I am doing the right thing. I always teach my patients to take them routinely as well. Thanks so much for helping me to realize I do know what is right for them!

    I am totally for adjunct therapies as well! I am always suggesting ice, heat, etc and am often seen making some hot peppermint/chamomile tea for my c-sections that can't pass gas and aren't ready for a suppository yet.
  8. by   Spidey's mom
    Anti-gas meds helped me tremendously after my cesarean ...

    steph
  9. by   SmilingBluEyes
    yes simethicone and heat and laying knee-chest work VERY well for trapped gas.
  10. by   palesarah
    you're doing your patients a great service by taking their pain seriously and treating it! You sound like a great nurse to me.

    We give our vaginal delivery patients a self-meds pack with motrin, tylenol and pericolace with instructions on how much to take and how often. Most of the nurses are good about telling the patients that they have percoset available if needed but since I have taken over a few patients who did not know that I always remind them when I am assessing their pain at the start of my shift (the self meds pack does NOT replace the nurse assessing the patient's pain!). Our patients absolutely love the self-med program, especially our "repeat customers" who did not have it available with their previous babies.
  11. by   USA987
    Quote from palesarah
    you're doing your patients a great service by taking their pain seriously and treating it! You sound like a great nurse to me.

    We give our vaginal delivery patients a self-meds pack with motrin, tylenol and pericolace with instructions on how much to take and how often. Most of the nurses are good about telling the patients that they have percoset available if needed but since I have taken over a few patients who did not know that I always remind them when I am assessing their pain at the start of my shift (the self meds pack does NOT replace the nurse assessing the patient's pain!). Our patients absolutely love the self-med program, especially our "repeat customers" who did not have it available with their previous babies.
    Palesarah,
    We had something very similar until just before JCAHO this year. The current administration decided that this was unsafe to allow the patient meds at the bedside. Where are your self-meds stored?? And have the inspectors ever given your facility a problem with it??

    BreastfeedingRN,
    Pain relief is one of my huge issues. I get my NSVD's into a routing with alternating Motrin 600mg/Vicodin (1 tab) q3h. I sometimes throw in 2 Vicodin for sections. It seems to work well. I stress the importance of staying on top of the pain. Simethicone is great for gas along with a combination of hot tea and ginger ale. I always remind my multips that the cramping after delivery seems to get worse with each child. One word of caution, if any patient seems to be complaining a lot of greater than "usual" pain, assess that patient carefully. They may have a hematoma, etc.

    Best wishes!
  12. by   Spidey's mom
    Speaking of pain - does anyone have a good reference for pain competencies? This is an issue near and dear to my heart as a nurse and I'm doing some competencies for our nursing staff and need more input.

    I've told this story before but I one of our nurses asked a post-op total knee who was a bit developmentally slow what her pain level was and when she said "2" he told he she needed to wait a bit for pain meds as she needed to be 4 before getting medicated. :angryfire

    Thanks,

    steph
  13. by   KaroSnowQueen
    "When I gave report, the day nurse told me that that wasn't happening on her shift and why was she having so much pain, she was "only a vag". '

    THAT burns me up!!!! I had vaginal deliveries with 4th degree lacerations and hematomas. With one I also had hemorraghing with aggressive uterine massage and packing. I HURT!!!! FOR TWO WEEKS!!!!!!! WHO do these nurses think they are to DECIDE who has pain and who does not?
    My doc did send me home on Percocets and I needed them. I did get off of them after a few days and onto Tylenol/Advil but I would have been absolutely miserable without them.
    I commend the OP for her interest and empathy for the patients under her care. For all your patients who need pain control, I heartily thank you!!!
  14. by   BETSRN
    We do the Motrin thing, also, doing a lot of the 600 mg variety probably more than the 800mg, but we do that, too. Sounds as if you did fine.

    My experience tells me to go easy on the 2 Percs, however. 2 can put people over the edge really easily as far as nightmares go and I have to agree that I think it is the rare patient after a NVD that degree that probably needs 2 as opposed to 1 Perc.

    Don't forget, too, that narcotics are very constipating and I tell patients this also. The last thing a new mom with a sore bottom needs is constipation on top of things!

    We also ahve used Tordol very successfully in patients who have difficulties with Motrin.

    IV Tordol works like a charm after a C/S, too!

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