Two Big Questions For Pain Experts

Specialties Pain

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Specializes in PACU.

If it's assumed that the patient's pain is ALWAYS what they say it there are two major questions that arise. The questions arise because they are real-life situations.

1. A patient has had surgery that isn't expected to be painful. The patient has had 4mg of Dilaudid for pain that is reported as 10. The patient has a goofy grin and says: "I'm going to say that my pain is a 10 because I like pain medicine." (This actually happened)

Do you continue to administer Dilaudid in this situation? Do you take his report of pain at face value? I was advised by my co-workers to send the fellow home and I did so.....He left smiling......Did we do the wrong thing?

2. A patient is close to being in a Dilaudid coma after receiving 10mg of Dilaudid. The patient appears very comfortable and, when awakened, rates his pain at 10. (This actually happened)

Do we have a pain emergency here? (I've seen many situations that are clearly pain emergencies but this one doesn't seem to be a pain emergency.) Can you in good conscience send the patient to the floor with a pain of 10 under these circumstances?

O.k.....I asked more than two questions but the other questions are tied to the main ones.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

It is impossible to say for certain how any nurse would/should respond in these situations based on subjective information from someone on an anonymous social media site......without assessing the patient in person. Each nurse is held to a set of standards and what is usual/customary for another reasonable and prudent nurse.

I would have to assess the patient myself and make a determination from there.

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Specializes in PACU.

The assessments are extremely simple....1. A smiling patient saying that he's going to say that his pain is a 10 because he likes pain medicine. He's had 4 mg of Dilauded. What do you think?

2. A patient who has had 10 of Dilauded, looks comfortable, and is obviously in an Dilauded stupor. He says his pain is a 10 when you wake him up but he's only awake when you arouse him.......It's not a complicated assessment......What would you do? It's not as if his Dilauded stupor is subtle.......It's the first, second, and third thing that you notice.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I am completely aware of pain assessment as an ICU/CCU/CTPACU/ED nurse but I don't base my interventions on assessments from other nurses. I will assess them myself and decide what is appropriate.

Do I blindly give pain Rx based on patient statement alone? The answer is no. However I would consult pain management for a possible nerve block (depending on the patients pain) for it is possible to be sedated by the med and still have pain.

You seem to paint patients with a single personal bias, brush and stroke. Each patient is unique and therefore their interventions treatments are unique. You just can't say...the patient seems over sedated therefore they are a seeking drugs and therefore are in no further need of intervention and their pain isn't real.

For that just isn't the case.

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Specializes in PACU.
You seem to paint patients with a single brush and stroke.

I don't do that. I gave two examples that actually happened.

Do I blindly give pain Rx based on patient statement alone?

So you're saying that the patient's pain ISN'T always what they say it is?

I would consult pain management for a possible nerve block

That wasn't an option.

You just can't say...the patient seems over sedated therefore they are a seeking drugs and therefore are in no further need of intervention and their pain isn't real.

O.K......Would you give more Dilauded in either case? If so why?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

It is helpful when you quote a member it is helpful if you include the members name to clarify to whom you are speaking....other wise it can be confusing.

Two examples out of how many patients we see. I would make a decision about pain treatment based on patient assessment. Assessment that includes patient vitals, treatment, diagnosis, history, and situation.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The assessments are extremely simple....1. A smiling patient saying that he's going to say that his pain is a 10 because he likes pain medicine. He's had 4 mg of Dilauded. What do you think?

2. A patient who has had 10 of Dilauded, looks comfortable, and is obviously in an Dilauded stupor. He says his pain is a 10 when you wake him up but he's only awake when you arouse him.......It's not a complicated assessment......What would you do? It's not as if his Dilauded stupor is subtle.......It's the first, second, and third thing that you notice.

First..... it is Dilaudid not Dilauded.

Second, you seem to have 2 scenarios consistent in all your posts...what is your personal experience that has personally affected you to be concerned about these two scenarios?

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Specializes in PACU.
what is your personal experience that has personally affected you to be concerned about these two scenarios?

I was taking care of the patients in question. My concerns pertain to what the proper care was for those patients. My personal opinions aren't what's being discussed. Whether I think they should be nominated for President or whether I think they should be jailed for fraud doesn't have anything to do with this discussion.

What's being discussed here has to do with what should be done for the patients I mentioned in my two scenarios.

I've been a PACU Nurse for a long time. There are all sorts of situations I could be discussing but that's not what I'm doing here.

My questions have to do with the care of the two patients I described.....What would you do for them?

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Specializes in PACU.
First..... it is Dilaudid not Dilauded.

Sorry....Let's call it "Hydromorphone".

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I was taking care of the patients in question. My concerns pertain to what the proper care was for those patients. My personal opinions aren't what's being discussed. Whether I think they should be nominated for President or whether I think they should be jailed for fraud doesn't have anything to do with this discussion.

What's being discussed here has to do with what should be done for the patients I mentioned in my two scenarios.

I've been a PACU Nurse for a long time. There are all sorts of situations I could be discussing but that's not what I'm doing here.

My questions have to do with the care of the two patients I described.....What would you do for them?

Sure it is....it is your personal opinion that these patients were mishandled in some way. Were these patients in your care of someone elses?

If I felt a fellow nurses patient was mishandled I would not discuss it on social media for various reasons.

If I had these patients I would assess the situation and decide the best course of action based on that assessment. Have I not given narcotics when I have assessed that the patient was too sedated based on vitals, level of consciousness and diagnosis/procedure...yes...and always discussed it with the attending for the best solution for optimal outcome for the patient.

Have I not medicated a patient because they are smiling and state they like pain meds...NO, not usually...... it is not my subjective judgement to make whether or not they are actually having pain because of a personal subjective observation.

I would look at their history...I would see what would make them make that kind of statement I would look at all the data and make a collaborative assessment of the patient including the attending....and make the best clinical intervention/management plan.

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Specializes in Pediatrics, Emergency, Trauma.

^ Esme makes a very valid point; even with the scenario and additional information you have presented; I still would have to make a comprehensive assessment in order to get the big picture.

Do you have a comprehensive assessment to determine if the patients had a sensitivity to the opioids? Were they still having the effects of the anesthetics??? Possibly post OP delirium??

Most people don't know they have sensitivities to opioids or anesthetics.

I'm posting this article as a means in hoping that there is info that can help guide an answer: http://www.learnicu.org/SiteCollectionDocuments/Pain,%20Agitation,%20Delirium.pdf

Edit: I also found this article as well:

http://www.nursingconsult.com/nursing/journals/1089-9472/full-text/PDF/s1089947207003255.pdf?issn=1089-9472&full_text=pdf&pdfName=s1089947207003255.pdf&spid=20380803&article_id=627051

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Specializes in Hospice.

There's something hauntingly familiar about this thread :sarcastic:

As in the last thread, OP, you are oversimplifying.

I get that you believe that the inappropriate prescribing of opioids contributes to addiction.

The problem is that you keep trying to blame what you refer to as "experts" for creating the problem. Our point - at least my point - is that the real experts have nothing to do with the kind of knee-jerk throw-a-drug-at-it response you describe.

Addicts are the population we love to hate ... with very good reason. No one likes the manipulation, lies and thievery that they use to get their drug of choice. You seem to have been badly burned by this dynamic.

Blaming the attempt to manage their pain for their addiction is not a useful approach.

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