Wake up...Are you in pain? - page 4
Ok, so what is the consensus here? I was taught that one can be in pain and be asleep. So do I wake up my PACU patient every 15 minutes to question them, or do I chart "pt sleeping"? We must chart... Read More
Feb 29, '04Occupation: RN Specialty: 15 year(s) of experience ; Joined: Oct '02; Posts: 4,763; Likes: 844I can't speak for PACU pts, never worked with them. But, I can speak about pain mgmt in hospice pts. And many hospice pts are not actively dying. some are walking, talking, living and have a lot of life left before their time comes.
We got a lot of pts in pain and sx crisis admitted to our inpt unit when I worked hospice. I love sub-cu ports, because you can give the pt their prn ordered meds in atc fashion, if you see fit, without waking the pt.
Often pain meds were ordered "q 4-6 hrs, prn". Based on my assessment, I often gave them q 4 hr (more like q 3.5 hrs) atc.
Feb 29, '04Occupation: RN Specialty: 15 year(s) of experience ; Joined: Oct '02; Posts: 4,763; Likes: 844Fab4,
My migraines almost always come on when I'm asleep. I, too, dream of something painful happening to me, then wake up with the migraine. They hardly ever come on when I'm awake, only when sleeping.
Feb 29, '04Occupation: RN-i (RETIRED) Specialty: ORTHOPAEDICS-CERTIFIED SINCE 89 ; From: US ; Joined: May '00; Posts: 14,479; Likes: 2,298I can vouch for the BSO-Hx post op pain being HORRIBLE! Of course mine took 3 separate surgeries so I had 3x as much fun .
I also have pretty fair amount of pain with peripheral neuropathy and RSD as a result of an injury. I don't sleep well and my "dream" is I am paralyzed and can't tell anyone that I am in pain. My head doc tells me that this is one of the main sleep interrupters...pain. He Rx Lorazepam and/or Ambien and for the past 2-3 weeks I have slept well. But of course my insurance only allows 45 sleepers in a 90 day period. Of course they are right and the doc is wrong
Anyway I can say that most times I did wake my patients. And if I knew then what I know now I would have done it every time.
Feb 29, '04Occupation: RN Joined: Feb '01; Posts: 1,840; Likes: 218P_RN, I take care of many post Hyst/BSO pts and boy do they suffer!
Well, you all have me convinced that it is a good practice to wake pts up! So my next question is, how often is enough. Now as for PACU, I only keep them for 1-2 hours, and they are rarely asleep for that long. So do you wake them every hour or two? Or longer?Shorter?
Believe it or not, I learned from this posting (the hard way
Feb 29, '04Joined: Apr '03; Posts: 235; Likes: 5Interesting about others' migraines coming on during sleep...I have the opposite issue, mine come on when I don't get enough rest or become extremely stressed. I use pain meds only when nothing else works or I can't leave my stress and I've found that for me, using relaxation techniques and simply going to bed resolves the issue. I'm sorry for those who are waking up w/ pain.
Feb 29, '04Joined: Jul '03; Posts: 153; Likes: 1I was taught in nursing school, that it IS appropriate to wake a patient up to assess their pain, and to medicate for pain. I have no experience in a PACU......but thats what I learned, and practice in Med/Surg. Also, when waking a patient up to take thier vitals q4h, its convienent to ask them at that time. (I do know things are different in PACU)
Mar 5, '04Occupation: ICU Specialty: 18 year(s) of experience in Ortho, Neuro, Urology, Cardiac, CC ; Joined: Mar '04; Posts: 21; Likes: 3I work in neuro Icu and will wake up my patients before the med duration is up and remedicate. I also try to allow for a sleep cycle of 90 minutes before waking them up. If you wake them up just after the med onset and check response and then let them sleep for that at least the 90 minutes or the med duration, it seems to work very well. This is fudging on the every 1 hour neuro checks, but I seem to get better neuro assessments and my patients seem less confused with this extra 1/2 hour of sleep.I also can observe vs changes in my comatose patients, before and after pain meds. These include overbreathing the vent and increased bp and icp. Hr seems to more be affected by n/v and temp. With my conscious patients, I tell them that I will need to wake them up for pain meds. They seem very happy with me despite these interuptions.Last edit by nurse lucky on Mar 5, '04
Mar 5, '04Occupation: ICU Specialty: 18 year(s) of experience in Ortho, Neuro, Urology, Cardiac, CC ; Joined: Mar '04; Posts: 21; Likes: 3Quote from kytiWe used to use Toradol as it helped with the cramping. I am into brains now, so its been a while. It seems to me if you gave some PPI for the gut that it would be safe. I remember lots of patients said it felt like labor pain combined with a csection pain. Can they still use Toradol? What about preop motrin?Ok Dave I need your help on this one. I work in the pacu. Wakeing pts up and assessing pain is my job. I want to give my pts the best pain control possible. My problem is with our TAH pts. This is a very painful surgery. We generaly use fentanyl and or dilaudid. Now if I have given someone anywhere from 250-500mcg of fentanly and/or 1-4 mg of dilaudid and they are sedated from the pain med (and anestheisa still on board), takes tactile stimuli to wake them, resp rate 10 and o2 sat 92% on 3-4l nc o2, and when I wake them they still rate their pain a 10 what can I safely do? (they generaly get 30-60 of toradol intra-op if not contraindicated) What should I do for these pts. I don't want to see anyone in pain, this could be me someday.Last edit by nurse lucky on Mar 5, '04
Mar 5, '04Occupation: CCU (coronary care); clinical research coordinator-neurology Joined: Jul '02; Posts: 1,088; Likes: 82I care for a lot of patients post heart surgery. Once extubated, we use IV meds until the patient can tolerate PO meds. Once, the patient tolerates PO meds...I will usually keep them up about every four hours since we are doing alot of coughing, deep breathing, sitting up, moving to a chair. I will usually give the patient the first PO meds...evaluate how well it works, etc. I let the patient know that I will be waking them up for another pain pill in three-four hours etc. I find that it works pretty well, but, as with the rest of you, I evaluate what is working the best for my patients. I try hard not to let my patients pain get out of control from the beginning. Sometimes it is a challenge
Mar 5, '04Occupation: LPN in ICU/SDU Joined: Oct '03; Posts: 101; Likes: 6I am occassionally awakened from sleep by miagraines. These tend to be the worst, as compared to the ones I get while awake, I am now thinking, it is because I take something sooner while awake. Tends to take more powerful pain meds when I am awakened w/ full blown miagraine.
On another note, we had a patient awhile back w/ gangrene of the left foot. All the Dr, gave pt was Tylenol 650mg q 4-6 prn. We begged the doc for stronger meds, to no avail. Finally had to go to the Cheif of Staff to get the pt something stronger. In the end both of the pt's feet were amputated and he was later sent to nursing home were he died shortly after getting there. Was in our unit approx 1 month total.
Mar 5, '04Occupation: Staff Nurse; Now Rstricted Duty Specialty: Psych, Med/Surg, Home Health, Oncology ; Joined: Oct '03; Posts: 3,014; Likes: 346I absolutely wake pt's up for there pain meds!! 100% of the time; I learned a long time ago that you give that pain med when it is due otherwise people wake up in horrendous pain that is so much harder to control;
That really was a nasty way to reply to Dave who knows what he is talking about!! I always look forward to his responses because he does. I agree with you that people need sleep, but people who sleep can still experience pain--I know that for fact because I do!!
Mar 5, '04Occupation: RN - oncology and palliative care Joined: Jun '00; Posts: 134; Likes: 4Quote from MD TerminatorPain medication for palliative patients in chronic pain is usually long acting opioid bid with prn for break through. Waking someone consistently through the night to check for pain in these patients is entirely unacceptable. If it becomes necessary, as it sometimes may, then the plan and medications need to be adjusted to make it unnecessary. I have been in palliative care for several years and managed many people with chronic pain and pain crises and the object is to get the pain controlled so the person may lead as normal a life as possible and that does not include being awakened. When patients are no longer able to take po meds, then very often it is continuous IV or SC meds with prn boluses. Again the object is to get to a level where boluses and prns are at a minimum and a consistent level of relief is maintained.You're close, but not quite there yet.
Chronic and pallative patients still need to be checked for pain according to the schedule the medication is ordered. Some patients, particularly the elderly, need to stay away from long acting medication. Some patients do fine not taking a long acting, but still need breakthrough coverage. You'll not know they need it if you don't ask.
Patients getting a PRN for breakthrough, in addition to their long acting medication, also need to be awoken. Breakthough meds are given in the event of b/t pain, and are best given in the early stages. Pain may be onsetting during sleep, and if given early, less medication will be needed. They could be sleeping to avoid the pain, thus they'll need their medication. More and more and more reason, but you get my general idea.
Very good logic, though. I totally see where you're comming from~!
Mar 5, '04Occupation: RN in PACU/House Supervisor Specialty: 17 year(s) of experience ; Joined: Sep '03; Posts: 164; Likes: 1Where is Dave. Haven't heard from him lately. I would really like his advice.