Pain scale (Rated R)!!!

[nurseyperson]

Found in another post here on allnurses...

I have a great story about this. The pain team was rounding in the ICU and stopped to see an early-20's-something guy who had had pleurodesis and still had his chest tube in. Now, I'll grant you CT's hurt like hell. But this guy was whining like you wouldn't believe, despite the PCA epidural. So the anesthesiologist asked him to rate his pain 0 - 10, with 10 being the worst. "Ten," the pt whined. The doc paused, and said, "No, I don't think you clearly understand the pain scale. Let me give you an example. If I took 2 bricks, and SMASHED!! your balls between them, that would be a 10. Now, given that, how would you rate your pain right now?" "Oh", the startled pt replied.

"Three."

[housoj]

Have we forgotten that pain is what the patient says it is? Granted, the ER deals with a totally unique clientel, but in the ICU I find the scale helpful in dealing with post CABG and Chest painers, etc. Yes ....there is the occasional BIG baby who makes me nuts with his whinning, but medication makes them sleep....lol !!!

[radnurse2001]

I sedate a lot of adults but under this subject one particular patient comes to mind----

a 46 year old man who stated that he has pain (10 out of 10) while lying down (on disability) and is clautophobic to boot (needed a MRI for lumbar spine). I medicated him with a total of 5 mg of versed IV and 125 mg of demerol IV with "no effect" per patient. This after the gentleman denied a history of drug use. During the scan, he had presence of mind to crawl out of the scanner and demand to be taken to the ER. My question---if the pain was sooo bad, how could he crawl out of the scanner? The kicker is the "gentleman" asked me who pays for the medicines in the little vials (Versed). I told him I think we do (the state) and he replied "in that case, can I have the rest to take home?" At first I thought he was kidding---but he wasn't. he had his wallet out ready to give me $20. I told him absoultely not and he preceded to start yelling at me and demended to be taken to the ER. I did take him to the ER and informed them of all that went on. They checked their files and sure enough he was under "drug seeker." MRI scan under anesthesia 2 days later was negative. What the he$$ gets into these people.

[housoj]

Too funny! Desperation at its best! I particularly like when they start asking to go to their car..."for just a little while". That is usually the very first clue on my floor that the pt. hasn't been forthcoming in their drug and etoh abuse history

I had a patients fmily memeber tell me last month, " The doctor said that you could give my mom a shot to calm her down."

first off..the mom was the wife of the patient..and second off..that doctor would never have told them that!

Do theu really think they can trick us into giving out narcotics. I can just hear the conversation between them prior to this.."....she is just a nurse....she won't know the difference...tell her the doctor said.."

WHATEVER!!!!!!!!!!!

[micareli]

I agree that docs and hosp admin., and nurses are not doing enough to manage pain.... in some cases the nurses ARE NOT BEING TRUE PATIENT ADVOCATES..... not long ago... we had 3 AKA on the same day , a big feat for the 48 bed hosp. that I was at , at the time. One had 2 mg stadol, one had 10mg MSO4, one had 25 mg demerol, q4-6h.....

not one nurse was willing to call the dr, to up the meds, finally on our night shift, me and one other nurse set about getting pain relief,.... I left that hospital, the culture of they like their pain med, they don't need that much pain meds, etc,etc.... made me leave..... When the new JCAHO rules came out, we had an inservice on the new regs...... it lasted less than 5 mins, the nursing administrator, stated we only doing this because JCAHO requires it.

mike

Originally posted by mustangsheba

The annoying rule is in response to public demand and even legislation that addresses the fact that real pain in the majority of the American population was not being addressed. Much of the untreated pain was in the terminally ill and the elderly and resulted in suicidal ideation. I love the bricking idea and I'm not especially fond of JCAHO, but I support the attempt to manage pain more humanely. I think we get a bit jaded working ER cuz we see a preponderance of whiners there.

[Charles S. Smith, RN, MS]

I am curious as to how a healthcare professional can argue with a patient about how that person EXPERIENCES pain? The pain a person feels is her/his pain and is not based on how we think pain is reflected for that person. The numbers are NOT absolute, but a mechanism to determine shifts in the treatment of pain. Unless you are in that person's skin, you have no clue and really no right to judge that person differently from the information you receive from them. Let them have their experiences. Those experiences are theirs, not yours.

best to all

chas

[StirLady]

I have mixed feelings about this topic. While I giggled and rolled on the floor with everyone else over the first writing, I ponder over my own experiences.

I believe that with all of us in different scopes of practice (ER, ICU, RECOVERY, LTC, HOPSICE) we need to keep in mind that not all flowers are a rose.

In hospice the patients need the medications, with LTC most times it is a nurseing judgement/assessment that the patient must be in pain. I see difference of opinions in this area often where I work. It begins to make one wonder. I had an ADON recently remark, after I brought up the subject of using a SUBQ port instead of turning our pt's into pinchusions because of an increase in MS inj med Rx's lately, the comment was "I know we have a nurse who is med happy for her pt's". I was so shocked that probably for the first time in my life I WAS WITHOUT WORDS!!!!!!! THINK SHE MISSED THE POINT? I do.

Moving on though, I wonder how long it will be before we begin seeing charges against the medical community for OVER MEDICATION again. Isn't that one of the reasons most of the mental institutions had such a bad rep and were de-institutionalized?

COMMENTS PLEASE.

[micareli]

i tend to agree with charles... if the patient states pain, i have an order, the patient gets the med......

of course i dealt with my share of seekers, the amazing thing here is that even though they were known seekers, i still had the order for dem. 25-50, or even 50-100, q4.

on the clock, q4 they asked they got,....

however i tried this on one of my seekers, she had just left after a 17 day stay, came back a few days later with the same vague s/s of abd pain..... the order read to give toradol 30-60 if dem ineffective...... upon consulting with the doc on an unrelated matter, i asked if we could use the toradol as a first line of defense as the dem. was not working..... he stated that would be a good idea..... 18 hours later the patient checked herself out, and while i was a tthat hosp, she never returned

i alos try to stay in tune woith the elderly pop., their s/s pain are sometimes misconstrued as confusion, obd, etc.... when ifn effect they are in pain, if the docs will give an order, it has been a great help.......

mike

[canoehead, BSN, RN]

I agree that different patients rate the same pain at a different level, and we should respect that. But- sometimes a 20yo rating 10/10 and grinning will respond very well to a Tylenol, but a 50yo tearing up in pain will need to have the big guns right away. So what I do is do the subjective/objective thing.

So 20yo c/o HA x3h, alert, oriented, drove self to hospital. No photophobia, nausea, states was here last night and would like Rx to take home. Appears in mild distress. Pain rating 10/10 by pt, 3/10 by RN exam.

If I'm really ambitious I can list lack of objective signs of pain, but I think we also have a responsibility to protect naive patients from being knocked off their feet for a day, when they just wanted a (relatively) mild pill. We can always give more, but can't suck out drugs when a patient has been snowed.

[Charles S. Smith, RN, MS]

Originally posted by canoehead

I agree that different patients rate the same pain at a different level, and we should respect that. But- sometimes a 20yo rating 10/10 and grinning will respond very well to a Tylenol, but a 50yo tearing up in pain will need to have the big guns right away. So what I do is do the subjective/objective thing.

So 20yo c/o HA x3h, alert, oriented, drove self to hospital. No photophobia, nausea, states was here last night and would like Rx to take home. Appears in mild distress. Pain rating 10/10 by pt, 3/10 by RN exam.

If I'm really ambitious I can list lack of objective signs of pain, but I think we also have a responsibility to protect naive patients from being knocked off their feet for a day, when they just wanted a (relatively) mild pill. We can always give more, but can't suck out drugs when a patient has been snowed.

I certainly have been in the same boat. My solution to solving the dilemma for me is to ask the next question and the next question and then offer alternatives to the patient. Asking questions will help the patient begin to have some clarity around the experience of pain and clarity for the nurse to make informed decisions about medication. Become your patient's partner in this process rather than judge or rescuer.

chas

[CEN35]

The thought of the two bricks.........is making me cringe:eek:

[CEN35]

OK upon further thought? How do we explain our example thouroughly to a woman? the bricks and the balls? Those are not going to work? How about.....remember the last thing you pushed out your lady parts? Imagine a VW bug now! ????????? any thoughts?

[CashewLPN, LPN]

well.. to explain the pain scale to my patients, I say that 0 is absolutely no pain whatsoever....

I say that ten is the equivalent of me dropping a cinder block on your foot, then me jumping on it 3 times, and then multiply that level of pain by 10.

(not to be evil, but I've actually used this description to my patients....)

--Barbara