Pain medicine to drug addict?

Nurses Medications

Updated:   Published

Hey guys I have a scenario I want to run by. So I work on a cardiovascular surgical floor. One of the things we do is heart valves. Every so often we get the endocarditis from drug use. Sometimes we get repeat offenders which is sad.

So anyways, thats the background. So I get my patient, 20 something year old female drug addict who had recent heart surgery. I got report in the morning and of course pain was a major issue. The night nurse was like I gave her vicodin and that seemed to help. So I come on and shes crying and visibly in pain. The vicodin is due, so I give that. Hour later she is still crying so I look on the mar and she has a small dose of morphine. So I give that. '

Next day nurse confronts me and says why would you give an IV drug user morphine? She goes on to say she was only giving the patient Tylenol. I tell her that the night shift nurse told me she was taking vicodin. She says he should not have even given her that.

Did I do wrong? The patient was clearly in pain and the medication was ordered by the surgeon. If the patient is in pain shouldn't we treat it?

Specializes in ER.

This attitude bugs me. We are not there as moral crusaders. We are there to care for patients and give meds as ordered. This poor girl has deep-seated problems that some high and mighty, self righteous nurse is not going to solve by withholding legitimately ordered pain medicine.

Grrrrr....

1
Up Vote Up Vote ×
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
Emergent said:
This attitude bugs me. We are not there as moral crusaders. We are there to care for patients and give meds as ordered. This poor girl has deep-seated problems that some high and mighty, self righteous nurse is not going to solve by withholding legitimately ordered pain medicine.

Grrrrr....

All this and more. The attitude of the nurse giving only Tylenol is unconscionable. We are there to give nursing care, which means we don't make the patient justify their need for that. Properly assessing the patient and medicating appropriately is part of that.

Good grief.

1
Up Vote Up Vote ×

That's ridiculous. I say all the time - I'm not here to cure addiction (as a bedside nurse, I am barely qualified to even address it!) I am here to help my patient heal. Pain medication, often opioids, are required to do that after an invasive thoracic (or abdominal, or orthopedic, etc.) procedure. This is not detox. This is ICU/stepdown/medicine. If detox or rehab is necessary and wanted, that can be addressed after the acute healing phase. The nurse who is WITHHOLDING prescribed pain medication is WRONG. And maybe evil. Please, please, don't let her control my post op pain.

1
Up Vote Up Vote ×
Specializes in Psych ICU, addictions.

Her pain should have been addressed, no matter what her history may be. If the medication is ordered, then the surgeon felt it was both necessary and appropriate at this time. It is NOT up to the nurse to override that judgment because of his/her own personal biases.

That being said, if a nurse feels a patient may be taking advantage of an ordered medication, let the doctor know so he/she can determine if that's the case...and if so, the doctor can discontinue it. The nurse should not be withholding ordered medication--including PRNs--unless there's a bonafide reason to do so (e.g. if the patient's RR is 7, giving morphine isn't really a good idea).

1
Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I am sorry, but under what circumstances, and under what belief system, should an addict not be deserving of adequate and timely pain relief?

Again, I have said this before: The nursing profession is sorely lacking in education about addiction, what it is, its prevalence and how to deal with it. I have medicated many addicts in my career. At no time did I hesitate; if it was ordered and it was safe, it was given without recrimination or question. I have often been on the phone with doctors, asking for "Breakthrough" pain medication orders. In the case of addicts, I tend to be very proactive, and ask for such orders if I know pain relief is going to be a challenge in a given situation.

As said before me, addicts have a much higher tolerance to opiates than others. They often require more frequent and larger doses of medication to get their pain under control. But once under control, they are often easier to deal with, understandably.

I consider myself a patient advocate, not a "drug dealer" or judge and jury of their situations.

Yes, treating addicts' pain can be beyond frustrating and they always seem to be "seeking". And you would be right to say, they ARE seeking ------relief -----and it's up to us and their prescribers, to do what we can within safe limits, to get them the relief they need.

Addiction is a separate issue. Yes, it's a huge problem. But for acute pain, it's criminal to treat them as "less" due to their status as addicts. We have to remember, we are in no way going to be able to treat or address their addiction issue in an acute situation like major surgery. That is for a later date and time and another venue.

1
Up Vote Up Vote ×
Specializes in Hospital medicine; NP precepting; staff education.
SororAKS said:
All this and more. The attitude of the nurse giving only Tylenol is unconscionable. We are there to give nursing care, which means we don't make the patient justify their need for that. Properly assessing the patient and medicating appropriately is part of that.

Good grief.

I agree, it's almost as if the nurse is a Jehovah's witness and refusing a transfusion for a patient or if she is vegan and refuses to take care of a skin graft.

I could keep going.

1
Up Vote Up Vote ×
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
SmilingBluEyes said:
I am sorry, but under what circumstances, and under what belief system, should an addict not be deserving of adequate and timely pain relief?

Again, I have said this before: The nursing profession is sorely lacking in education about addiction, what it is, its prevalence and how to deal with it. I have medicated many addicts in my career. At no time did I hesitate, if it was ordered and it was safe, it was given without recrimination or question. Yes, treating their pain can be beyond frustrating and they always seem to be "seeking". And you would be right to say, they ARE seeking ------relief -----and it's up to us and their prescribers, to do what we can within safe limits, to get them the relief they need.

Addiction is a separate issue. Yes, it's a huge problem. But for acute pain, it's criminal to treat them as "less" due to their status as addicts.

This ^^^^^^

I would add also that a fair amount of healthcare practitioners don't have a decent or balanced understanding of the principles of either addiction medicine or pain management. Thusly, people don't get the help that they need at either end of the spectrum.

1
Up Vote Up Vote ×

Just smile sweetly and tell the nurse this is not a drug rehab, NA, unit, it is a post op surgical care unit. You will give the patient what ever pain medication the doctor ordered.

Please keep that in mind when this situation comes up again.

1
Up Vote Up Vote ×
Specializes in ICU.

That was so unethical. It angers me when people don't treat pain adequately. I see a lot of drug abusers. Because of their use of drugs and alcohol, they do dumb things and end up on my unit. Car accidents, falls, shootings, all kinds of crazy stuff. They are in pain just like anybody else. Especially when they break their necks and other internal injuries.

Plus, they end up detoxing which can make everything worse, especially when you are just trying to maintain an airway on them. I will often try to keep them from going in detox or DTs if they are an alcoholic.

I will immediately make sure CIWA is put in if I find out they are a drinker. They may not see themselves as an alcoholic, but going from drinking a 12 pack of beer a day to nothing can affect the body. I had somebody who's blood pressure would spike everyday at shift change. It would take 2hpurz to get him under control. I finally found out his alcohol history, had CIWA put in for a mg of Ativan, and that did wonders for this man. He had many other symptoms I won't go into, but he was starting to detox.

It is our responsibility to protect our patients. Not judge and force our values on them. I had a young person who ended up paralyzed from her outside behaviors. They were with us for two months. I hoped in my heart by the end of the stay, maybe they woke up and realized they wanted to change their life, but I can't judge and I don't comment, I can educate, but not judge.

Don't get me wrong, I won't be manipulated as many do, but I also will always treat their pain. It's our job.

1
Up Vote Up Vote ×
MrBlueSky said:

Did I do wrong? The patient was clearly in pain and the medication was ordered by the surgeon. If the patient is in pain shouldn't we treat it?

OP, you know the answer to your question. Of course we should, vital signs permitting. We're not in the business of torturing people. You absolutely did do the right thing. Your coworker on the other hand failed her patient.

If the small dose of morphine that was prescribed hadn't been enough to adequately treat the postoperative pain (which wouldn't have been strange considering her background) then the correct thing to do would have been to contact the provider for a new/ additional order.

Should the young patient with a drug addiction problem ever find the motivation to try to get clean, chances are that your sadistic, high and mighty ignoramous of a coworker will have made it so much harder for her to be successful by introducing a new element of stress to the patient's life = chronic pain. Chronic pain after sternotomies (which I assume the patient had) is relatively common. It is imperative to adequately manage acute postoperative care as poorly managed postsurgical acute pain is a risk factor for developing chronic pain.

If it were me I would have confronted my coworker who only adminstered Tylenol and told her that it's in my opinion unacceptable and highly unprofessional to use your power as a nurse to withhold pain treatment from a patient who suffers from pain and that I expect her to perform her duties according to ethical and medical standards in the future. Her own personal feelings regarding addicts or whatever it was that influenced her actions do not belong at work. I'm not very diplomatic when I encounter what I consider cruel behavior.

1
Up Vote Up Vote ×

You did the absolute right thing!!

You also need to help your co-worker (and her future patients) by letting your manager and/or educator know what happened so that she can be taught how to take care of a patient with a need like this.

1
Up Vote Up Vote ×

Tylenol: the new cure for opiate addiction.

1
Up Vote Up Vote ×
+ Add a Comment