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!
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!!
funny...the pt didn't see the humor!
We have one we tell people in our ER you might like as well..
This came from the frustration of the 10/10 scale. A male pt come to the ER w/ c/o penile pain (and of course you know his mister had a cold) anyway he rated his pain a 20/10 on a very busy sunday night I looked at him slightly frustrated with the rating; and said are you sure it is a 20/10, pt said yes, I said well you know, around here we cut off anything that hurts worse than 10. The look on his face was priceless.
We have one we tell people in our ER you might like as well..
This came from the frustration of the 10/10 scale. A male pt come to the ER w/ c/o penile pain (and of course you know his mister had a cold) anyway he rated his pain a 20/10 on a very busy sunday night I looked at him slightly frustrated with the rating; and said are you sure it is a 20/10, pt said yes, I said well you know, around here we cut off anything that hurts worse than 10. The look on his face was priceless.
I LOVE that...your get rid of the pain and get rid of the PAIN!!! Not to mention thinning out the gene pool!!
I LOVE that...your get rid of the pain and get rid of the PAIN!!! Not to mention thinning out the gene pool!!
well, i am not sure what this has to do with pain but i thought it funny. i told a young drunk that we had to folerize that if he kept pulling on the cathiter his member would fall off. that was a priceless look! needless to say, my foley was coveted and worshipped by that patient all night!
well, i am not sure what this has to do with pain but i thought it funny. i told a young drunk that we had to folerize that if he kept pulling on the cathiter his member would fall off. that was a priceless look! needless to say, my foley was coveted and worshipped by that patient all night!
True enough, the courts and just about everybody else requires a pain assessment and result of treatment noted on the charts. I usually chart "pt states" and use the 0-10 pain scale. Then I chart the pt appearance,i.e. laughing, smiling ,chatting, grimacing, etc. The ones that really get me are those that insist that their 0-10 pain scale is 15, 20 or some other absurd number. I tell them that that doesen't work for me and turn to leave. They usually come up with something more realistic.
Live Long and Prosper
Stoko
The miracle isn't that I finished...The miracle is that I had the courage to start" John "the penguin" Bingham
I'm thinking that when I become a nurse, and I get put in triage (god forbid) if a pt states their pain on a scale of 1 to 10, a 15 or something, I would just record it as 10. I think a lot of them are just trying to get across that it REALLY hurts. I wouldn't even waste my time saying " That doesn't exist or we only treat pain on the 1 to 10 scale " I feel the patient knows darn well what the pain scale is and he/she is just either trying to be humorous, or thinks that 10 doesn't come close to the amount of pain they're experiencing. Who cares if they say its 20 or 15. Just round it off to 10.
I do understand it could get exasperating to hear this from pts all the time. Especially when their body language might suggest otherwise so guys....go easy on my opinion. :)
Specializes in LTC, CPR instructor, First aid instructor..
Originally Posted by MAGIK GIRL
well, i am not sure what this has to do with pain but i thought it funny. i told a young drunk that we had to folerize that if he kept pulling on the cathiter his member would fall off. that was a priceless look! needless to say, my foley was coveted and worshipped by that patient all night!
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, I don't like the 0-10 pain scale, either. When I had to have an emergency appy, and the nurse asked me to rate my pain, I told her I couldn't THINK about a stupid number, but it freakin' hurt! I used the FACES scale instead. I like it, it works for me, and many kids and not-so-bright adults can use it, too.
Pain numbers don't work! I have had two babies, one an induction with no time for pain meds - now THAT hurts. However, I would rate the pain I suffered while flying with a sinus infection (knitting needle in the eye type of pain) much worse. People would think "sinus infection worse than childbirth?!". Yes - with childbirth, there is a reason for the pain, and only one way to get it to stop. With my sinuses, I couldn't do anything about it, and I couldn't get away from it, being strapped down in metal tube like I was!
Still, you gotta wonder about the patient sitting up in bed, watching TV, who says "I am in great pain - get me my morphine. Oh, and by the way, I'll take a cheeseburger with onions with that".
trsnurse
25 Posts
This came from the frustration of the 10/10 scale. A male pt come to the ER w/ c/o penile pain (and of course you know his mister had a cold) anyway he rated his pain a 20/10 on a very busy sunday night I looked at him slightly frustrated with the rating; and said are you sure it is a 20/10, pt said yes, I said well you know, around here we cut off anything that hurts worse than 10. The look on his face was priceless.