Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!
Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!
I work in an outpatient surgery center and some afternoons we have a pain clinic- epidural steeroid injections, facet joint injections, etc. Anyway we see varying degrees of people with real pain, and people that probably started out with real pain but have also become addicted to all of their pain medications. One of the doctors who frequently brings his pain patients to our clinic is pretty liberal with his pain medication. When these patients come into recovery if they are having severe pain can have 1.5mg demerol per KG with 50 mg Phenergan. Keep in mind that these patients receive versed, fentanyl and diprovan during the procedure. Many of these patients know about the option for this shot and even though they can barely keep there eyes open are saying they have 10/10 pain and need that shot before they can go home. Now I am not saying that people don't have a real pain but sometimes it is so hard not to feel a little judgemental. One of the nurses I worked with in recovery had a patient that came out very sedated, snoring and would awaken insisting on his pain shot. She went back to talk with the doctor to let him know of her assessment and told him she really didn't feel he needed a big Demerol shot. His response to her was " You know what your problem is you are thinking like a nurse and you need to think of yourself as a cocktail waitress." You can imagine how well that went over. Pain scales, subjective and objective pain are very tricky to know which way to go, I tend to lean towards if they say there pain is over 3 or 4, medicate as ordered I also try to educate them about the fact that especially after surgery you will still have pain but that pain medication should make it more tolerable. Anyway definitely not a black and white area.
"You know what your problem is you are thinking like a nurse and you need to think of yourself as a cocktail waitress." ??
Ms. Hobbes . . . . and how did this doc rate his pain on a scale of one to ten after the nurse decked him? :rotfl:
Have to share about a woman who has an incredible pain tolerance.
She was in labor all day, wanted to have a vag delivery even though the baby was estimated at 5200g. She was doing all the pain control measures beautifully. She was 6-7 cm and just relaxing during cxns. Later on it got a little tougher and it appeared that this was going the way of a c/s. Asked for a HALF dose of Stadol at 8cm.
The section was particularly tough due to baby's size. While the doc was doing the section I thought to myself that she'd be hurting for several days. Not ONCE did she ask for narcs PP. She said that it was being handled OK with ibuprofen and she wasn't even taking that every often. I was so amazed.
I believe that she's the type of person who if she walked into an ED after someone tore off her arm and beaten her up with it, she'd say, "Oh. It hurts, but on the scale of 1-10, I'd say... 7."
Specializes in LTC, CPR instructor, First aid instructor..
Wow! That's one tough lady!!!!!!!!!!!!!
Have to share about a woman who has an incredible pain tolerance.
She was in labor all day, wanted to have a vag delivery even though the baby was estimated at 5200g. She was doing all the pain control measures beautifully. She was 6-7 cm and just relaxing during cxns. Later on it got a little tougher and it appeared that this was going the way of a c/s. Asked for a HALF dose of Stadol at 8cm.
The section was particularly tough due to baby's size. While the doc was doing the section I thought to myself that she'd be hurting for several days. Not ONCE did she ask for narcs PP. She said that it was being handled OK with ibuprofen and she wasn't even taking that every often. I was so amazed.
I believe that she's the type of person who if she walked into an ED after someone tore off her arm and beaten her up with it, she'd say, "Oh. It hurts, but on the scale of 1-10, I'd say... 7."
you're probably a great nurse, payed attention in nursing school, and you're probably right but it is still just a joke. laughter is good medicine too! especially for us. in time, you will realize this. maybe people are different where ever you are.
have a great day! :balloons:
what do you mean by that? are you saying that i'm different just because i live somewhere else?by the way, are you a nurse? at all?
That's one tough lady!!!!!!!!!!!!!
teeituptom, BSN, RN
4,283 Posts
I would prefer some free golf