Pain medications & pt preference

[compassion#1]

I had clinical today. I'm in my second semester of an associate nursing program. My patient today was in with a main diagnosis of hypercalcemia. He came in 9 days ago through the ER with c/o of pain in lower back. They found metastatic cancer that they believe began in the lungs and has spread to the bone and liver. He was c/o of pain @9am, 10/10. I informed his assigned nurse. She immediately doubted his pain level, recognizing that it was not right to do that. He was grimacing and holding his abdomen. He has a history of drug abuse. She came in and spoke to him asked him to rate his pain, c/o 7/10, then she asked if he wanted anything for the pain. He said no. Still continued to complain of pain and refused pain meds. His nonverbal signs of pain decreased some through out the day. I believe our interaction lifted his mood some, it was pretty poor to begin with (he signaled a putting a gun to his head and pulling the trigger X2), he later rated his pain 3-4/10, and was not grimacing. We have to do an indepth pain assessment for our paperwork for school...this was near the last thing I completed. Next time it will be the first, especially with a pt who is in active pain. "lortab is really the only thing that has helped," I did not tell the nurse this before I left. He did not have a prescription for the lortab, his friend gave it to him. Now I am concerned that I've compromised his care. He has PRN orders for dilaudid and acetaminophen. I did not look in the past nursing notes to see if this had been given before or if it had relieved c/o pain.

Should I speak with my instructor and call the hospital to let someone know? I will not be back for another week. I'm also concerned about calling the hospital because I don't want to violate HIPAA by speaking about it over the phone.

[eatmysoxRN, ASN, RN]

He needed education that using pain medicine is okay. I encourage patients who can tolerate it to take their medications and not suffer with pain. Next time make sure you teach and if he told you that lortab helps, let his primary nurse know so she can relay it to the doc. The patient probably has told the doc or will.

[missnurse01, MSN, RN]

no you don't need to call, they have probably figured it out by now.