pain

Maybe the pain was already too bad that oxycodone didn't work and his pain kept increasing... I'd say definitely a possibility!

If you give a med for pain, and the pain gets worse, then there are some things to assess.

1. Why is the patient in pain (is he post op from surgery, does he have a chronic condition like cancer or sickle cell, or cardiac problems)?

2. When, prior to now did they last get pain meds (lots of patients try to hold out on taking pain meds until the pain is unbearable, because they are afraid of getting addicted)?

3. Has the patient done any activity or had a bedside procedure done right after the pain meds were given (things like PT, or dressing changes can be very painful and often the med will not work because the patient is not just resting)?

4. Does the patient have a history of chronic pain and takes narcs at home for it, and is not being prescribed the same regimen in the hospital as they do at home (These people are not drug seekers, but do have a physical dependence on the meds and any change can make their pain worse)?

5. Does the patient have a history of known drug use, and is possibly drug seeking, and evidences no real pain behaviors but wants pain meds (this based on known history, problem, and observed behavior)?

Here are my answers to the assessment:

1. If the patient had just undergone surgery, or has a chronic disease, then they may need more pain meds at first to get it under control (last time I woke up from anesthesia, the first word I said was "Morphine!").

2. Educate your patients tha they will not get addicted from a short course of pain meds post op or whatever. The longer they wait to get meds, the harder it is to get the pain under control (Take the med when your pain is a 5 or 6, don't wait till it's a 10!).

3. Give your patients the option of pain meds pre procedure, or wait till after...I have found that in most cases, the pain meds work better after you do a painful procedure than if you give it before (not so much adrenaline, etc.).

4. Be an advocate for you patient. Get an accurate med rec, and discuss any pain interventions with the pt. How long have you been taking it? Why prescribed, etc. Then talk to the MD and tell him the history, and your concerns about pain, withdrawal, etc. (docs do not like prescribing lots of pain meds to pts they do not know).

5. Sadly, sometimes they really are faking it so they can get high. Your powers of observation are key here as well as your collaboration with the MD, and your team leader. These patients can be really difficult and are the first to complain you are not doing your job. This is why you document everything and let your MD know. Heres a perfect example (true story, one of my patients): This person always complained of pain 10/10 for a pyleonephritis. Person was always on time for calling for pain meds, but would walk off the unit to smoke, panhandle, and walk to the store (in their hospital gown) right after, and then be back in time to ask for the next dose. I told the MD, who immediately came to the floor and discharged the pt who was so angry that they threw a fork at a nurse and had to be escorted off the property by security. It might be obvious in this case, but you can pick up the vibes from most druggies.

Hope this helps,

Amy