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!
Specializes in Emergency Nursing Advanced Practice.
I hate the 0-10 scale. Everybody always says their pain is a 10 (or even higher which completely makes it unreliable).
I have started to say to people. "0 is no pain.....10 is being eaten by a lion while on fire and being dragged by a Mack truck over a bed of glass into salt water. Where does you pain fall?"
I hate the 0-10 scale. Everybody always says their pain is a 10 (or even higher which completely makes it unreliable).
I have started to say to people. "0 is no pain.....10 is being eaten by a lion while on fire and being dragged by a Mack truck over a bed of glass into salt water. Where does you pain fall?"
rarely get a "10" anymore!
one of our docs just LOVES it when people say: "my pain is a 20!!"
like he'll give them more drugs in relation to their pain number!
his response-
"well, i don't know how to treat pain at a 20. i was taught how to treat pain from 0-10, not 20. so when your pain drops to a 10 or less...you call me. i'll treat it then." :rotfl:
the first time i heard him say that to a patient i practically peed my pants!!
Specializes in LTC, CPR instructor, First aid instructor..
one of our docs just LOVES it when people say: "my pain is a 20!!"
like he'll give them more drugs in relation to their pain number!
his response-
"well, i don't know how to treat pain at a 20. i was taught how to treat pain from 0-10, not 20. so when your pain drops to a 10 or less...you call me. i'll treat it then." :rotfl:
the first time i heard him say that to a patient i practically peed my pants!!
'cay, we all understand our oath. if you are offended, just lighten up, it is only a joke! :)
i'm not offended in any way.not at all. i wasn't talking about our oath. i was referring to the nursing process. we need to rely on the subjective cues of our patients... but we also need to observe if the patient's verbal cues reflects with his non verbal cues. if the patient says he is in 10/10 pain and his face shows that he is not, well... as a nurse go for the objective cues. the patient is a drug addict. not in pain.
I'm not offended in any way.Not at all. I wasn't talking about our oath. I was referring to the nursing process. We need to rely on the subjective cues of our patients... but we also need to observe if the patient's verbal cues reflects with his non verbal cues. If the patient says he is in 10/10 pain and his face shows that he is not, well... as a nurse go for the objective cues. The patient is a drug addict. Not in pain.
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.
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:
laughter is the only survival tool we have sometimes.
Sometimes I wonder if using the 0-10 scale will ever change. As a former ER patient, I have to say it was a just a wild guess that I threw out when asked about my pain number, based on what I had experienced in my own life. Asking the patient to assign their own pain score just seems to me like asking for trouble, as you'll have pateints who under or overscore themselves. Has there ever been any research into using non-verbal cues to assess a pateint's pain? There must be a scale you use when you have an unconscious patient, is it possible to use that for conscious patients as well? I mean, come on, someone sitting there eating Doritos and telling you their pain is a 10?
I only ask because I work NICU, where we of course have to use non-verbal cues. There are several pain scales out there, and I really love the one we use. ( http://n-pass.com/assesment_table.html ) I wish that they could do the same thing for adults!
Specializes in LTC, CPR instructor, First aid instructor..
You've got that right Gompers. I know the one you're referring to. The one with all the faces, and yes, I agree with you. It should be used as a universal pain scale tool everywhere. Where's the law book? I wonder if I can write and pass the bill.
Being a veteran of pain, I definitely know that scale. When I had spasmotic pain it automatically screwed up my face. I named it #8. When I had a bellyache, I named it # 3. When I had post embolotic syndrome pain Ya know, the kind that the docs say isn't there because nothing shows up on the tests? That pain is a definite #10. It is the one I dread the most. Now; a little history on that:
In April 2001, I was admitted to the hospital with a diagnosis of Status asthmaticus R/T acute Bronchitis. I was placed on massive doses of Solu-Medrol to treat it. I was slowly improving as the days went by. On the sixth day as I was walking down the hall to do my exercise, I suddenly became breathless. I sat down in the wheelchair I was pushing. After a few minutes, I stood up and resumed my way down the hall. I was breathless once again when I got to the end, so I sat down in the wheelchair again. An on call doctor who I didn't notice, was watching me. He came to where I was sitting, listened to my lungs, and left without saying a word. I slowly made my way back to the nurses desk area where my room was located. When I arrived, I saw the doctor was on the phone talking to someone.
By that time, I felt like I had run a marathon and weighed two tons. I asked if I could go to bed. I was given permission, and as the night progressed, I got shorter and shorter of breath, and I was as weak as a newborn baby bird. The following morning and throughout the day as the healthcare people were scrambling about taking me for every test they could think of, I was eventually placed in a lung perfusion machine.
After I was transported back to my room, the pulmonologist entered, and said, "You've got a bunch of blood clots in your lungs." I had a pulmonary embolism. It left me so weak I literally could not lift my head or my arms. I was struggling to breathe, so I asked my doc if my breathlessness could be due to the steroid induced myopathy that the Solu-Medrol created as well as the embolism. Doc's response? "No! It's from the embolism." As he glanced at my diaphragm. "Your diaphragm is moving." DUH, I should have known better than to ask Doc Almighty in the first place.
The following morning, I began feeling like a red hot sword had just been thrust through my right lung and out my back, while closing off my throat from the unimaginable pain that was shooting up my jaws and into my head. My doc was there at the time and witnessed the whole thing. After an EKG was done, Doc said, "Your heart's alright Mrs LeMay. By then I was repeating over and over, "It's a ten doc, it's a ten!" He asked me if I wanted some Morphine, (a medication I have a severe reaction to) and I said, "yes! Anything that will get rid of this pain!" He then turned around and said, "But you can't take Morphine. How about Dilaudid?" I said, "Okay, anything. Just so I can get rid of this pain!"
I was given an injection of Dilaudid with Percocet as a back-up. The next day I was given two Percocets to see if they would aleve my pain. I waited an hour, but was still in pain, so I was placed on the Dilaudid, and I still use it for breakthrough pain.
Now; that's what I call a #10.
Footnote: Doc still isn't convinced I still have the pain, even though I showed him an article where post embolotic syndrome causes excruciating pain, and he still is equally not convinced that the Solu-Medrol caused the embolism. I definitely am, and it is written in the 2004 Nursing Drug Handbook in big black letters for all to see.
As far as my struggle to breathe goes? I found the answer to that too in an issue of Nursing 2003 magazine that I subscribe to. Steroid Induced Myopathy can affect an individual's diaphragm rendering the patient struggling to breathe. Imagine that now.
However; Surprise! Doc Almighty is still not convinced about my claim, and he says I need counseling. Mmmmm, hmmmmh! :angryfire
I wonder if I can write and pass the bill.
RNCENCCRNNREMTP
258 Posts
I hate the 0-10 scale. Everybody always says their pain is a 10 (or even higher which completely makes it unreliable).
I have started to say to people. "0 is no pain.....10 is being eaten by a lion while on fire and being dragged by a Mack truck over a bed of glass into salt water. Where does you pain fall?"
rarely get a "10" anymore!