Pain medicine and bone mets

wooh, BSN, RN · Feb 7, 2014

If you think someone is seeking medical advice or otherwise violating TOS, there's a little yellow triangle with an exclamation point in the bottom left hand corner of each post. Click it.

Whether OP has talked with the physician or not can't be judged by whether it was included in the short explanation of his/her initial post. OP didn't mention using the restroom in that post either, but I don't doubt that at some point during the day OP did in fact void.

Sam J. · Feb 8, 2014

So HAS the OP talked to a doctor?

I asked the very same question. But even more than once.

NC29mom, ASN, LPN, RN · Feb 8, 2014

What in the world??? People get a grip!!! What's the difference in this posters question and a poster on wound forum asking what dressing would work best for xyz wound?!?

We are not doctors and cannot prescribe medication. However, we can make suggestions. ...which in hospice is extremely important since our doctors don't generally see our pts...and our doctors DEPEND on us to make suggestions (not all drs, but most...there's always an exception to the rule). We work as a TEAM in hospice & lean on each other regularly. ..there's never one nurse who knows everything, has seen everything, and knows how to manage everything.

Unfortunately, we do have pts at times who have pain/symptoms which are difficult to manage. SO GOOD FOR THE OP IN SEEKING FURTHER INFORMATION TO ENSURE HER PTS COMFORT.

SoldierNurse22, BSN, RN · Feb 8, 2014

I asked the very same question. But even more than once.

The point is, to what purpose?

The OP didn't come in here asking for general guidance on pain medication. They asked for specific therapies that target a very difficult pain problem. They didn't give us a full synopsis of the scenario, as many people prefer to avoid giving away too much information on a public forum.

I'm sure the point is taken: if the OP somehow didn't know to do the obvious and contact the physician to get prescriptions for different pain meds for uncontrolled pain, they sure do now.

I really just don't understand the point of trolling the OP here. Your post history speaks to protecting one's identity online, and yet you're using a first name/initial combo as a screen name and asking for more details in a pretty straightforward question because you're not satisfied with the OP's identity.

You further insinuate that you're somehow a "real nurse" because you picked out one tiny detail missing from the OP and harp on it endlessly throughout the thread.

Whatever you feel you have to prove, please do so elsewhere. While you might like to "keep it real" (whatever that means), the point here is keeping it anonymous.

(And if you are a soldier? Kudos! I'm a veteran warrior, myself, and a REAL nurse- but as far as you know I could be a circus monkey, or a tattoo artist, or even your boss?)
-Keeping it Real

SoldierNurse22, BSN, RN · Feb 8, 2014

But to suggest OP's stated history of 22 years, or even that OP IS a nurse, when none of that has been verified, is naïve.

Also, if you're really that concerned about spilling nursing-specific information to the unproven populus--you think this thread is bad, asking about a specific drug regimen for a very particular problem?

You might ask that your own thread...

https://allnurses.com/pain-management-nursing/uncontrolled-pain-how-904447.html#post7740639

...be closed.

I'm sure some the information regarding "how to get the doc to control pain" would translate into "how the nurses get the docs to write for more pain meds and how I might be able to do the same" for many, many drug seekers.

As AN is visible to the masses, that thread has the potential to spill secrets like Edward Snowden drinking vodka in a Russian hot tub.

Sam J. · Feb 9, 2014

The point is, to what purpose?

Because it appears a patient is still in pain.

My post doesn't mention drugs, drug regimens, or doses, at all. It's a broad question about how nurses can prompt a physician to assess a patient that may be in pain, when (I clarified my post) that physician is difficult to get through to. In that order, my question can be applied to any condition that any patient may be having: How to get through to any difficult physician, about any patient's needs, or wants, without overstepping bounds, or 'breaking rank', which only serves to further alienate some physicians from the nurses that relay information to them.

And again, I'll add that I have yet to come upon a physician that would allow a patient to suffer. Not once. But it's mentioned in here, often. I have, however, naturally, dealt with more than a few physicians with a holier-than-thou attitude, and that's why I posted my own question about dealing with those types.

I'm flattered that you have researched my posts, actually. The more detail that people give, and the more insight that can be offered through this forum, in fact- the more valuable a site like AN becomes.

fireball78 · Feb 9, 2014

For our metastatic cancer patients with bone pain, we typically use a combination of NSAIDS and Decadron. It seems to work wonders and works better than any narcotic. I say this after only a few months of hospice experience though.

Sam J. · Feb 10, 2014

However, we can make suggestions. ...which in hospice is extremely important since our doctors don't generally see our pts.

If you believe that nurses (other than APNs) can make suggestions about drugs, you haven't read the NPA from your BON.

And if you work in a hospice in which the doctors 'don't generally see your patients', that scares me.

wooh, BSN, RN · Feb 10, 2014

If you believe that nurses (other than APNs) can make suggestions about drugs, you haven't read the NPA from your BON.

You realize there's a difference between a suggestion to the prescriber and prescribing, right?

NC29mom, ASN, LPN, RN · Feb 10, 2014

If you believe that nurses (other than APNs) can make suggestions about drugs, you haven't read the NPA from your BON.
And if you work in a hospice in which the doctors 'don't generally see your patients', that scares me.

Evidently you aren't familiar with hospice. No, our doctors, or the pts attending doctors, see the pt. Yep. That's right. And, its the patients decision and right. These are terminally ill pts, who CHOOSE to stay at home instead of being dragged to doctor appts. If they are entering their 3rd benefit period a NP will visit, but only to assess for continued appropriateness. We are END OF LIFE CARE....when all aggressive/curative trmt has ceased.

And as far as "suggesting", that's exactly what I do. And, my medical directors frequently ask me....before I ever offer my opinion. I am the eyes & ears of the physician. I am the one seeing the pt, talking with the pt, ASSESSING the pt.

This forum is becoming quite the bore......seriously? Are we here to HELP one another? Or nick pick and bully other posters. I am responsible for my own nursing license. ..not you. Worry about yourself. And, if you have nothing to contribute but ridiculous nonsense, spare us.

Sam J. · Feb 10, 2014

If the physician doesn't see the patient, who signs the hospice directive/certification paperwork- the nurse?

And what difference does it make if a hospice patient is at home, or in an institution- the fact remains that physicians (not nurses) make medical (which include prescribing) decisions, yes- largely based on what nurses 'report' to them.

If this forum is such a bore, why are you posting in here- that's a very valid question.

allnurses Guide · Feb 10, 2014

the fact remains that physicians (not nurses) make medical (which include prescribing) decisions.

I make those decisions all the time.

When I get a phone call from a nurse, especially a nurse seeing a patient in their home, I very much appreciate their assessment and their recommendations. I don't always agree but it is helpful to have that information presented.