Pain shots are us, not this nurse!

Nurses General Nursing

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Are you ever enraged by patients who really show no visual signs of pain but say that their pain scale is 10/10 and demand their pain shot every time it's due (thinking that they should know when it is due, as if it was a scheduled med not PRN).

:icon_evil: :icon_evil: :icon_evil:

I have a pt in my LTC who is in her 40's, a former nurse who got her license suspended because of diverting, and who is A&Ox3, no assist, walking the halls on her own. Yet this pt gets a HUGE dose of morphine Q8H (takes several pills to get the required dosage), and also has a PRN for roxanol Q2H, along with Ativan, Phenergan and Xanax Q4H. I'm sure this pt has pain, and I'm sure to her it IS a 10 out of 10, but yet she's always walking around, going out to smoke, etc. She sets an alarm to know when it's time for more meds, and never misses a PRN. It's frustrating, but I admin as she asks, because it's her level of pain, not mine. However, I do stagger the times, and DON'T admin a pain med, ativan, xanax, and a sleeper all at one time, which really pisses her off. I informed her as a former nurse, she knows the reasons I prefer to do it this way, and even if "the other nurses" give it to her all at once, I'm NOT the other nurses. She's now used to this routine on my shift, and tho she still follows the med cart like a puppy, respects that I will not give her everything she's "entitled" to at once.

Bottom line tho, it's HER pain, not mine, and it's MY job to keep her relatively pain free, although I refuse to get her legally stoned as she wishes.

I did speak to the MD about this, and he's fine with me staggerring the meds and actually admitted she's a drug-seeker getting stoned on our tax dollars.

Frustrating? H*ll yeah! But pain is in the eye of the beholder.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I have a pt in my LTC who is in her 40's, a former nurse who got her license suspended because of diverting, and who is A&Ox3, no assist, walking the halls on her own. Yet this pt gets a HUGE dose of morphine Q8H (takes several pills to get the required dosage), and also has a PRN for roxanol Q2H, along with Ativan, Phenergan and Xanax Q4H. I'm sure this pt has pain, and I'm sure to her it IS a 10 out of 10, but yet she's always walking around, going out to smoke, etc. She sets an alarm to know when it's time for more meds, and never misses a PRN. It's frustrating, but I admin as she asks, because it's her level of pain, not mine. However, I do stagger the times, and DON'T admin a pain med, ativan, xanax, and a sleeper all at one time, which really pisses her off. I informed her as a former nurse, she knows the reasons I prefer to do it this way, and even if "the other nurses" give it to her all at once, I'm NOT the other nurses. She's now used to this routine on my shift, and tho she still follows the med cart like a puppy, respects that I will not give her everything she's "entitled" to at once.

Bottom line tho, it's HER pain, not mine, and it's MY job to keep her relatively pain free, although I refuse to get her legally stoned as she wishes.

I did speak to the MD about this, and he's fine with me staggerring the meds and actually admitted she's a drug-seeker getting stoned on our tax dollars.

Frustrating? H*ll yeah! But pain is in the eye of the beholder.

You must be doing a good job with pain control if she's walking around comfortably. Chronic patients shouldn't have to wait until they are in pain before they get pain medicines. It's best to give the meds while they are functioning well and comfortable, so they can live life. It's frustrating to hear a 10/10 however, but perhaps she knows if she says anything less someone might argue with her and not give it. What's wrong with a patient saying "my pain is a zero and I need to keep it that way and get pain medicine now so I can function".

Overall, you have a great attitude about it.

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Hospice, palliative care, and oncology pts - I give a LOT of pain meds. Yes, sometimes I feel like people are exaggerating, but it's their pain. I'm just glad I'm not the one having the pain (usually!). The ones that annoy me are the "how come you didn't bring me my breakthrough? It was due 10 minutes ago!" after you have explained 1,000 times that they have to ASK for their prn meds.

We have a lady right now who has had chronic pain all her life. She walks downstairs (not to smoke anymore, we are smoke free now), does puzzles in her room, watches TV, talks on the phone, and she's always in a pretty good mood, until it's time for something for pain. Then she gets whiny, quiet, acts like it really hurts, etc. I don't know why she does that. She's going to get the med if she says she is in pain. I have atually noticed that with a lot of my chronic pain people. It must be something they pick up when they are younger, that they have to "act like it hurts". But when they do that and as soon as you leave the room start talking on the phone just fine, you just have to shake your head.

Oh, and how about this one? Pregnant, 8mg dilaudid HP Q4h with a 4 mg bt Q2h, plus 25 pf phenergan, 50 of benadryl, and 2 of ativan IV each prn also? Makes you CRINGE to give that one her meds!!!!!

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I figure, my responsiblity is to give them meds as ordered. I don't have to believe them. I'm not going suspend disbelief, but I don't mind giving them their meds. I figure, if it's not physical pain that motivates them, then it must be psychological pain they need to deaden.

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What enrages me is a prevailing culture that has created an atmosphere where you feel criminal just for asking for pain relief. It has done a wonderful job in creating an environment where some patients feel obligated to lay in bed white-knuckling the bed rail out of fear that they'll end up in some "reefer madness"-type drug induced haze. It's just needless, pointless suffering. In a world where there's already enough health-induced misery that we CAN'T do anything about, why on earth would anyone allow someone to endure pain when a treatment is so close at hand?

/rant off

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We have a lady right now who has had chronic pain all her life. She walks downstairs (not to smoke anymore, we are smoke free now), does puzzles in her room, watches TV, talks on the phone, and she's always in a pretty good mood, until it's time for something for pain. Then she gets whiny, quiet, acts like it really hurts, etc. I don't know why she does that.

Perhaps having chronic pain all her life, she's learned coping mechanisms that allow her to function at something near normal levels. Maybe, even though she masks the outward signs, she's still continually suffering on the inside. It might even be possible that the only thing that empowers her to continue on in that manner is that she knows that in "x" number of hours, she'll be granted some respite from her pain so that she can build up enough stamina to bully herself through for the next little while. Wouldn't it be a shame if some outside observer misinterpreted her ability to endure as an absence of discomfort? Perhaps because this has happened enough in the past, she's learned that if she doesn't behave in some "socially acceptable" way of demonstrating "real pain" then she'll be damned to having to endure even more. It's almost too much to contemplate that a person who has the guts and determination to actually live a life in that sort of condition would still have to "prove" her pain on a regular basis.

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Are you ever enraged by patients who really show no visual signs of pain but say that their pain scale is 10/10 and demand their pain shot every time it's due (thinking that they should know when it is due, as if it was a scheduled med not PRN).

:icon_evil: :icon_evil: :icon_evil:

No I've never been enraged by a patient. I only get enraged at other nurses who get angry when their patients want to be medicated.

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Oh yeah, and great topic by the way.. this is a hot one. :)

I understand where you are coming from. I too have chronic pain from rheumatoid arthritis, diagnosed a year ago. Some mornings I can hardly get out of bed but I too work long shifts and don't complain, just deal with it in my own way. I understand all about chronic pain and i do not judge a patients pain. I personally hate the pain scale because I would rather someone describe it to me. I think alternate methods of pain control should be used more often but it seems that medication is what everyone wants. Personally, I cannot stand the way these meds make me feel so I rely on alternative methods with good success. I think more people need to experience chronic pain to understand its significance and how it effects ones everyday life. One does not always have to grimace to have pain. I too have had patients tell me their pain is a 0. I always medicate because there is also discomfort involved with withdrawl and I really don't want to go there. Anyway, just my 3 cents for what it is worth.

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Specializes in OB.

:)

had a guy one time ask me to "keep bringing that Phenergan, after i get it, its the only time my legs don't hurt"

whatever, dude. He just liked it because it made him sleepy. Heck, I liked it because it made him sleepy....

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:)

had a guy one time ask me to "keep bringing that Phenergan, after i get it, its the only time my legs don't hurt"

whatever, dude. He just liked it because it made him sleepy. Heck, I liked it because it made him sleepy....

Phenergan is used for various types of pain. Had a surgeon order it one night for abdominal pain and I thought, oh great, i'll be calling him back in 20 minutes. Well, it worked great and that was all that patient used for pain until he went home. I have since used it for all kinds of pain and it also works on headaches/migraines on some patients. Too bad it is so hard on the veins.

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Specializes in OB.
Phenergan is used for various types of pain. Had a surgeon order it one night for abdominal pain and I thought, oh great, i'll be calling him back in 20 minutes. Well, it worked great and that was all that patient used for pain until he went home. I have since used it for all kinds of pain and it also works on headaches/migraines on some patients. Too bad it is so hard on the veins.

this guy wasnt there b/c of pain, he was there with Cdiff and N/V!! He thought the phenergan was a narcotic pain med they had been giving him. Once I explained the reason it was ordered for him he demanded to talk to his doc so that he could get some morphine!

I had a pt once who had a quarter sized hole in her thigh, flesh eaten away and I asked her what it was from, she said IM injections of phenergan.

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Specializes in Hospital Education Coordinator.

why is that a problem for you? There is evidence to suggest that even the blood pressure and pulse rate is not a good indicator of someone's pain. So what if you are also treating psychological pain (pain memory)? The patient has a right to be pain free.

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