Pain Seekers

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I am just wondering if other hospitals have the same colossal amount of pain seekers? I feel like every single day I work I have a patient who only wants IV dilaudid mixed with IV phenergan mixed with IV benadryl mixed with IV ativan with a roxycodone to top it off. I just recently cared for this woman who I was giving pain medication every 2 hours and her pain never got any better; mind you I gave her 8 mg of IV dilaudid in about 10 hours as well as 3 doses of Percocet. I am just so tired of being a legal drug dealer, just to give these people their fix. No, I don't believe that their pain maintains a constant 10/10 when they are given this amount of pain medication and when they look high as a kite. And we just support this behavior! Because controlling patient's pain is so important and pain is subjective so we must believe them. This is not why I became a nurse and I am just wondering if this daily occurrence is just at my hospital or if its all over the country.

you do realize that you were assaulted, yes?

Oh definitely I understand. They understood that too. Otherwise my letter of complaint to the patient advocate wouldn't have prompted the CMO, CNO, and CEO to request a meeting with me. The "O suite" of an 800 bed hospital doesn't typically have 2 hours to meet with an ex-patient. They were obviously in CYA mode.

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Um...no. In the chart or not (which I wouldn't expect it to be, since you're not allergic), you specifically told him no benzos. How fast would an RN get thrown under the bus if s/he made this same med error--and against the pt's specific wishes?

That victim-blaming you received from the CMO is shameful.

It was obviously just an attempt to CYA. They were afraid I would sue them for medical battery. I was just crazy enough to think that if I brought a problem to their attention, they would take the necessary steps to insure it didn't occur again.

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Specializes in LTC Rehab Med/Surg.

If VS are stable, does nursing judgment ever influence the administration of prn pain med administration?

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Specializes in Transitional Nursing.
but that is not the point, and the poster did have a block....this was plain and simple ASSAULT.

Right. Which is why I said I was sorry it was done.

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Specializes in Ambulatory Care, LTC, OB, CCU, Occ Hth.
If VS are stable, does nursing judgment ever influence the administration of prn pain med administration?

I say no, because according to all professional guidelines, pain is what the patient says it is. There is no objective way to determine presence or severity of pain. VS are only guideposts. VS are different for everyone, and someone with a different tolerance or chronic pain may have normal VS in moderate to severe pain.

Nursing judgement comes into play when it comes to trying non-pharmacological methods within the scope of the nurse as first line treatment of pain. In that situation, how the pain has been addressed by prior nurses comes into consideration too.

You might also say nursing judgement can influence administration when a dosage range in listed in the orders. In that case, the nurse can choose to administer the lower dose before going on to the higher dose if the patient reports pain is unrelieved on reassessment.

In any case, if the patient reports pain, regardless of what their VS show, you need to address the pain in some way and document that fact. A nurse who withholds PRN pain medication in the presence of a pain report and stable VS is not acting in the best interest of the patient and is acting outside accepted professional care standards. All grounds for negligence.

You do what's in the best interest of the patient prioritizing according to Maslow's hierarchy and that's it. Their experience of pain comes before any the fear of addiction or misuse on the part of the nurse.

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In LTC where we have them 24/7, we monitor their behavior/pain and keep track of Oxyes that they receive.

If their pain is still not managed well the ARNP increases their scheduled MS-Contin dosage.

Sent from my iPhone using allnurses

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Yes, I believe all the other IV medications potentiate the narcotic as they can (benadryl, phenergan, and ativan) cause a sedated effect. What is funny to me is when people ask me to give them together and then push the dilaudid fast. I have had patients get mad at me because I won't give them IV pain medication when they are falling asleep talking to me and their blood pressure is in the toilet.

Actually, in my experience, benedryl is given because IV narcotics can cause a patient to itch. Phenegran due to nausea and vomiting that can also occur. Ativan can and does help with any withdrawal.

Chronic pain is one of the most defeating conditions for a patient. Imagine living 24/7 in pain. Then imagine that although a pain regime is not held--it is given with a **sigh*** and attitude--whether knowingly or not.

If someone has diabetes and does what they can to control it, but still has BS issues, then the complexity of the situation doesn't stir such an emotional response. If someone has HTN and has a hard time controlling, again, not as much of a stir. But someone has chronic pain that they can not control and it becomes a character defect therefore "taking up too much time--away from the REAL patients?" Like any other chronic disease process, patients deserve to be treated. And as a nurse, one can only attempt to turn an acute exacerbation into baseline. And that goes for pretty much any and all chronic health conditions.

Another scenario--acute back pain--patient comes in saying "I am very, very narcotic sensitive, do NOT want narcotic pain medication. I do NOT like the way it makes me feel, but the pain is 10/10" I have seen just as many nurses eye roll with a "then what is it you would like us to DO then?"

Stop personalizing via your own issues/morality/thought processes, OP. Chronic illness, of which pain is one of them, is not a reflection on someone's character and is just as much a "worthy" diagnosis as any other chronic condition.

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Ive never had anyone complain of itchiness, and they specifically ask for phenergan. most seem to refuse zofran or compazine. Both those relieve nausea, but aren't sedating.

Zofran can be sedating, and for some, doesn't work. Compazine can do lots of nutty things to someone and is very sedating. If someone is given control for pain and is spending that time itching or vomiting, it defeats the purpose, no?

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If they patient comes in through the ER what are you judging by? Those labs are not frequently drawn on patients presenting with chronic pain. What if they have poor kidney function and they complain of a 10/10 scale of pain. Do you give the drugs or with hold them? Is there a narcotic you would prefer if they have poor kidney function?

ER's have protocols. And part of those protocols are basic labs. If someone is presenting with pain, there is a process that is followed, much like any other person who presents. An MD will make a decision about the patient's care based on results of tests.

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