Pain Management: The 5th Vital Sign

SmilingBluEyes · Dec 27, 2006

I give PRNs as asked for/ordered. I often will offer to just bring them when due rather than make the patient ask for it----I tell them staying on top of pain is much better than trying to manage it once it's out of control. I think pain management is a big priority---and it's been more so in my mind since being a patient myself a few times in the last 3 years.

Zizka · Dec 27, 2006

I give PRNs as asked for/ordered. I often will offer to just bring them when due rather than make the patient ask for it----I tell them staying on top of pain is much better than trying to manage it once it's out of control. I think pain management is a big priority---and it's been more so in my mind since being a patient myself a few times in the last 3 years.

I'm the same. I encourage our patients to treat their pain.

Marylou1102 · Dec 27, 2006

I always offer pain meds when I am doing the med pass, especially at HS. It saves a lot of running later.

clemmm78, RN · Dec 27, 2006

Sounds to me like you're preaching to the choir. I give prns whenever needed, as dictated by the patient.

Antikigirl, ASN, RN · Dec 27, 2006

Big pain management advocate here! Pain chain reacts in a way that hurts anything positive we are trying to achieve and therefore is contraindicated by the rules of having a person achieve their potential. Not only do I medicate well and in a knowledgable way, I educate my patients on how to do this effectively, the clear scoop vs the rumors, and that pain hurts all body systems and must be dealt with effectively and within REASON (not like snowing someone).

I am also a true believer in pain being like a snowball...once you get that snowball running down a hill (as in pain level), it picks up speed and soon you have a huge snow ball that can't be easily controlled. Hit it when it is starting down the hill...and looking into someones history of pain is the best way to guage that.

I ask my patients a few questions that help:

1. What was your worse pain ever? (we will rate that 10)

2. What level of pain do you think to yourself "OKAY NEED MEDS!"? (this will be tolerable pain level that signals the start of the snowball slope).

3. What do you use typically for this pain (hx of medicational use gives a guage).

4. Is what you take at home effective to you? (again hx)

5. What is your pain level now? (where on the slope are we).

Then it is up to you and the patient to choose what is in the MAR for pain and come up with a plan. Keep in mind the times and amounts so when they ask for more you can go over what has transpired and discuss changes.

Also, do NOT assume because someone is taking lots of pain meds at home that they need more! I have seen this cycle too many times, and what happens is you load them up...liver doesn't process well on the first pass, but second pass BOOM...but meanwhile you have medicated again for effect...now you have a potential probelm...especially in elderly! Look carefully at history and effect and think about what is in your MAR to use, and try what you think will be best routinely (even if it is PRN, best to keep on it) and trial and error will get you there as long as you are working with the patient (nonverbals/confused are harder...I use painad scale on them).

It is amazing to me how well pain management works if you actually involve the patient as much as possible...even the ones that seem like they are abusing pain meds...typically it is a cycle of anxiety along with pain that just keeps feeding eachother! Take out part of the anxiety...and part of pain follows! People have thought I was nuts before treating pain agressively for a 'drug seeker' (so they thought), and had to eat crow when the patient was no longer crying out for pain meds, responsible with them, understood the ones they are taking, and much easier to deal with! :)

nursesaideBen · Dec 27, 2006

This is kinda off the wall, but I always wondered why O2 sats weren't the fifth vital sign? I mean at the facility I work at, with every set of VS you get an O2 sat on, we document the O2 sats with the VS so why isn't it considered a VS? If anyone knows the answer to this I'd be very happy to hear it because I'm tired of wondering about it lol as far as pain goes, yes I think it's very important to help the pt manage their pain simply because we all know pain is subjective and we have no way of knowing whether or not they are "truly in pain" just my 2 cents.

Antikigirl, ASN, RN · Dec 27, 2006

Unless you have a arterial blood gas taken all the darn time, there is NO way to guage oxygenation effectively and individually!

Don't ever give me that "but the pulse ox says"...that means nothing to me since pulse ox has so many variables in order to get an accurate reading! A pulse ox says the color via a spectrum of hemoglobin..not what is in it, doesn't work well if the patients extremities are below normal temp (and whose fingers are always normal temp? Hemoglobin binds at a certain temp, unbinds at a certain temp...since you are in a capillary bed where the oxygen should unbind to feed the extremity cells...duh...you will get a lower number in most people!), does't account for people of dark skin well, and the numbers we set our facility criteria on (like ours is above 96 or call in respiratory help) don't account for individual oxygenation cycles or norms!

That is a tool, like a vs machine, and how many times have we all taken a manual to find the machine was wrong?

So therefore the only accurate way is arterial blood gas, and if it was to be considered a vital sign...then we need to do that q shift! OUCH! I only get one if the pulse ox is really being consistant and the PATIENT shows signs and symptoms of respiratory distress or probelms! I treat my patients not the machines.

Anyway...off soap box...I am very strongly against setting a number on that piece of machinery and making everyone fit in automatically without getting an arterial blood gas or actually ASSESSING the patient well! And that is exactly what it does...

SO not the 5th vs...but you can lump it in very well with respirations and know if your patient has a probelm or not!

nursesaideBen · Dec 27, 2006

Unless you have a arterial blood gas taken all the darn time, there is NO way to guage oxygenation effectively and individually!
Don't ever give me that "but the pulse ox says"...that means nothing to me since pulse ox has so many variables in order to get an accurate reading! A pulse ox says the color via a spectrum of hemoglobin..not what is in it, doesn't work well if the patients extremities are below normal temp (and whose fingers are always normal temp? Hemoglobin binds at a certain temp, unbinds at a certain temp...since you are in a capillary bed where the oxygen should unbind to feed the extremity cells...duh...you will get a lower number in most people!), does't account for people of dark skin well, and the numbers we set our facility criteria on (like ours is above 96 or call in respiratory help) don't account for individual oxygenation cycles or norms!
That is a tool, like a vs machine, and how many times have we all taken a manual to find the machine was wrong?
So therefore the only accurate way is arterial blood gas, and if it was to be considered a vital sign...then we need to do that q shift! OUCH! I only get one if the pulse ox is really being consistant and the PATIENT shows signs and symptoms of respiratory distress or probelms! I treat my patients not the machines.
Anyway...off soap box...I am very strongly against setting a number on that piece of machinery and making everyone fit in automatically without getting an arterial blood gas or actually ASSESSING the patient well! And that is exactly what it does...
SO not the 5th vs...but you can lump it in very well with respirations and know if your patient has a probelm or not!

Sorry Triage didn't mean to get you riled up lol I was just wondering :chair:

leslie :-D · Dec 27, 2006

it's true what triage speaks of.

pulse ox's are very misleading and do not portray an accurate picture.

it's also time to walk the walk, and actually treat pain as the 5th vital sign.

i just love it when a nurse writes "no c/o pain" or "pt denies" w/o doing a full assessment.

esp with the elderly, who have so many misconceptions about narcotics, that many are petrified to take them.

time to start taking all of this seriously.

i've always been huge of pain mgmt.

leslie

pickledpepperRN · Dec 28, 2006

I agree that it is necessary and good that pain is focused on and treated now.

BUT don't like the terminology "vital sign".

Pain assessment is not a vital sign. It is not simply asking for a number on a scale or having the patient point to a drawing os a face.

I've been at hospitals where the aide, often not certifies, will document the level of pain. Sorry, this is an assessment for the nurse to perform.

Of course I want to know if the patient c/o pain.

pannie · Dec 28, 2006

Off topic but I'd really like some opinions. I had a lap chole last week. However, I'd had an adrenal tumor removed a few years ago and had considerable scar tissue that made it difficult for the surgeon. I awoke with severe nausa and apparently had vomited. The wonderful nurse in recovery worked her tail off getting different orders for IV Zofran, changing from Demerol to morphine, etc. When I got to my room, the nurse on the floor got a bit testy when I didn't want oral pain meds. I KNEW there was an order for IV morphine or oral meds. She got kind of snotty saying "You'll get just as nauseated whether you take it PO or IV." I was just too darn tired to argue and took took the PO. What a mistake. Then she came and gave the IV Zofran that was the only order she had for nausea. What would you have done? I'm so mad at myself for giving in to her pressure and starting the misery all over again. I'm one of those that phenegran gives the kicking, jerking reaction.