Wake up...Are you in pain?

Specialties Pain

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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 every 15 minute vitals on all PACU pts, which includes the pain "vital sign"(which I still maintain is an assessment not a VS). What to do? I don't want to ignore pain, but I will not medicate a sleeping pt!

Yes, but that's not the intent of my post. I posted to indicate that pain control should be a team effort and that I hope service providers are directly communicating with their staff, instead of asking patients if their nurse has been doing her job.

It's not a matter of going behind anyones back. That's soo not it.

I trust the nurses 100% to wake the patients up and give them the meds as I have ordered them. The only time things come into question is when a patient has a c/o pain, which wasn't covered by medication. THEN, since I am already in the room, I do ask the patient.

Afterwards, I contact the nurse, who in every instance but once, tells me that the meds were given as ordered, and can point to the screen to show it was. The one instance was actually a whole other story that's best not gotten into. We'll just say the nurse had some problems documenting (kinda hard to when you inject the dilaudid into yourself).

-Dave

Thank you for clarifying your statements. Medication diversion...well, that's a whole different issue for discussion :o

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. :crying2:

I 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.

Fab4,

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.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

I 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 :crying2:

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.

P_RN, I take care of many post Hyst/BSO pts and boy do they suffer! :crying2:

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 :)

Interesting 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.

I 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)

Specializes in Ortho, Neuro, Urology, Cardiac, CC.

I 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.

Specializes in Ortho, Neuro, Urology, Cardiac, CC.
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. :crying2:
We 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?
Specializes in CCU (Coronary Care); Clinical Research.

I 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 :)

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