Pain meds for the addicted

[bellehill]

Hey Everyone!

I have a real problem with giving narcotics to pts with known addiction. I understand the pain concept and I am usually very aware of my pts pain level, but when is enough. I had a pt who slept very hard all night, even through a blood draw, woke up and in a slurred voice asked me for his "rise and shine medicine". Demerol 75mg would not get me going in the morning. I held the med until he had woke up more. Was this wrong?

Another pt I had wanted something for nausea. The MD ordere Phenergan 50mg IV. I started with 12.5 mg. She asked for it every 2 hours, when I went it to give it she was fast asleep. She was also on a morphine PCA.

I guess my question is how do you determine when to keep giving narcotics or "rise and shine" meds.

Thanks!

[fab4fan]

Sleep is absolutely an escape mechanism for some people who are in severe pain. Sedation does not equal effective pain relief, either.

I was a bit dismayed at some of the comments about people who request pain medication for migraines. Unless you get them (and I'm not just talking about a bad headache...I mean the real deal migraine) you cannot know how devastating they are. To have people then judge you and label you does aboslutely nothing except demean the patient.

Pain is whatever the pt says it is, and occurs whenever the pt says it does (to paraphrase Margo McCaffrey, nurse pain specialist).

[nrw350]

What is a DT? I never knew that there was this much involved in treating a patient's pain!!!

Nick

[zapperbapper]

DT's- short for Delirium Tremens. This happens to some pts going through ETOH withdrawal. Can be life threatening.

[teeituptom, BSN, RN]

Howdy yall

from deep in the heart of texas

If they say they are in pain, then you need to medicate them as ordered. If they are abusing the system, then its up to the MD to deal with it. Pain is the reality of an individuals perception.

keep it in the short grass yall

teeituptom

[nrw350]

Ok, what is ETOH withdrawal lol? I really feel stupid always asking these questions.

On a side note, I also fail to see how people can get addicted to a drug such as lortab which in my experience is not particularly fun to be on. Since it tends to make my stomach a little upset (not bad though), makes me loopy (I hate being loopy, because I cannot concentrate and my motor coordination is way off), and finally it just knocks me out (I dont mind this so much, because If I am on lortab then I need rest anyway). Please enlighten me on how these morons get hooked on this mess.

One more thing, do you think I should ask for a different pain med next time I go to my oral surgeon (will be going back later this month to get the last 3 teeth removed for my denture), so that I may get a better pain med that does not bother my stomach period. I can put up with the loopy and sleep parts because they are good excuses for not doing anything lol!!!

Thanks all lol.

Nick

[fergus51]

ETOH= Alcohol

[nrw350]

hmm, that is odd. Why dont you all just call it alcohol?

Nick

[l.rae]

I never wake someone up to give pain med. I work in the ER. If a person says they are in pain and then they are offered toradol, or motrin or naprosyn etc. and they refuse and demand the "GOOD STUFF" that's a good clue to me that they are seeking. I guess it is different in the ER with the frequent flyers After a while it does become obvious believe it or not..."Did you follow up with your MD?" "No...blah blahblah" always the same $hi+..I've been called vulgar names, threatened, intimidated....you name it.....by these drug seeking morons. A few weeks ago, we had a women drive herself to the ER, she walked thru the front doors and plopped down at the registration, head on the desk and requested an emisis basin. ER clerk gave her one, clerk comes to get me says this woman is puking, can I get her out of registration? The lady is heaving, nothing in the pan but spit, I tell clerk she will have to wait a couple of minutes. I speak briefly with the woman, ABC's intact, but continues with the hystrionics. Triage is full, the ER is full. one open bed. The woman continues "my stomach hurts" retch retch "oh my god" I feel like I'm dying"retch retch....still no emisis. About this time a chest pain walks in, text book..gray...clutching....I rush Mr chest pain back to the only open bed come back to triage and the puker is laying in the floor under my desk rolling around "oh god I hurt, My stomach"....... I say you can't lay there, she says I can't move I say you have to......stoic to the end she pulls herself up, we do vitals and I sit her in a w/c in the waiting area. About 30 minutes later she goes back...it's not her turn but she has grossed everyone in the lobby out now....always a good tactic. About an hour and 1 toradol and 25mg of phenergan later I walk back and hear her screaming behind the curtain "I'm dying" retch retch.......well I jerked the curtain back about mid-retch and guess what........YEP....fingers down the throat......do I believe she was in that much pain? NOPE...where I work, if we catered to everyone who demanded narcotics,, we would never have time for the sick and injured.....guess I'm a little jaded...LR

[nrw350]

After dealing with someone like that, I would think that most people would become a little jaded. I hate it when people take advantage of others. It in and of itself is outright sick and cruel. Maybe that lady needs to spend a day or week at the ER helping to treat people who are truly ill.

Nick