I am a RN with 2 years experience in Med-Surg and this is the first time this has happened to me. I was precepting a nurse new to our facility and we were taking care of this young patient for a kidney stone. She had came back from surgery and was sleeping. When she woke up I noticed she had tremors and was stuttering a lot. (Interesting) Family said it was new to this admission but was doing that before surgery as well.
A few hours later she started crying and reported 10/10 pain. So I had my orientee start by giving her 15mg of toradol IV. No relief, so then 2 tabs of 5/325 norco. Waited an hour or less, patient still crying, so we gave her 2mg of IV morphine.
Patient is now stating she can't breathe, we check her vitals, everything is normal except heart rate is 105 (I'm assuming from pain and crying). We put her on 2L of oxygen. The family tells me that she was receiving dilaudid at another hospital and that's all that works for her. (This patient is an adult but her parents were speaking for her).
I say OK I'll try calling the doctor and see if I can get an order for dilaudid. We called the doctor and he said no, give a one time dose of another 2mg of morphine, we wait a bit because we had just given morphine and then give the one time dose. Patient is asleep, family complain hand is swollen so I have my orientee stop the fluids for a bit and put ice on her hand.
It's now shift change, patient awake crying in pain again and family in room is yelling at my orientee that we are terrible and not helping her daughter. I'm hearing it from other family member on the phone as well. I explained to them that the doctor said no, and they told me to call a different doctor for the dilaudid.
Night shift nurse says "go home we'll handle it from here". I'm back to work again in 2 days (don't have the patient of course) but I'm hearing from the nurse who has the patient that they are going to write a complaint about my orientee and myself.
I am worried and lost some sleep over this because this is the first time this has happened to me and I'm nervous. Am I in the wrong and was there more I could have done? I feel guilty.
Now you sound angry. I know it's easy to take your frustrations out on an anonymous person on a message board. I think this discussion is over. Have a great day and I hope you are able to make the dietary changes to avoid kidney stones from recurring. Please research that because it is a vital part of preventative medicine.
I believe someone already mentioned this, but the MD needs to start evaluating the patients themselves at this point or make it a point to come in to see the pt. If the patient wants to get upset, them them get upset with the doctor. Easy for the doc to say no when he/she ain't the one in front of the patient.
You seem to be taking this personally. You are extrapolating a whole lot from one statement about drug-seekers, whose manipulative behaviors and entitled attitudes are perfectly illustrated in the opening post.
I know what severe pain is as well. I had a traumatic injury that damaged/severed nerves and tendons. I also had 6 homebirths. That never blinded me to the fact that some patients are looking for a fix. Our system has enabled them and it takes its toll on nursing.
Thank you Emergent! I'm all for giving someone the benefit of the doubt when it comes to their pain response and need for analgesia. That said, the fact is that there are a lot of drug seeking patients gaming the system in an attempt to get their next fix. I can dress it up or say it in a more 'PC' way, but this enabling behavior, HCAHPS, and the 'Pain is the fifth vital sign' campaign BS has got us where we are.
I believe someone already mentioned this, but the MD needs to start evaluating the patients themselves at this point or make it a point to come in to see the pt. If the patient wants to get upset, them them get upset with the doctor. Easy for the doc to say no when he/she ain't the one in front of the patient.
THIS! Some patients are high metabolizers and need huge amounts. 15 of Toradol is nothing. 30 IV or 60 IM is routine in the OR. If the patient says dilaudid works let her have it. But the failure here is the doc who refused. It's really important to keep your empathy but work on establishing good boundaries at the same time. Try to imagine a glass wall separating you from the patient. You can see what's going on but don't let others' maltreatment of you through that glass. Leave it behind when you leave work. You won't be a bad nurse for doing that! Don't ask for perfection from yourself....it's the enemy of good.
On 11/29/2021 at 10:14 AM, morelostthanfound said:
Personally, I wouldn't waste a minute of my time worrying about it. The unfortunate fact is that people sometimes just suck and this is the end result of entitled, narcissistic people and hospital administrators expectation of a bed and breakfast treatment for patients. If your documentation is supportive of your objective observations and interventions, let them complain!
Thank you for replying. Yes we were trying to help the patient but the family felt like we weren’t and made my orientee and I feel guilty and angry. You are right, I need to just let this go but it is something I still struggle with. Nursing gives me anxiety sometimes.
I don't like it when family is around.
5 hours ago, subee said:
THIS! Some patients are high metabolizers and need huge amounts. 15 of Toradol is nothing. 30 IV or 60 IM is routine in the OR. If the patient says dilaudid works let her have it. But the failure here is the doc who refused. It's really important to keep your empathy but work on establishing good boundaries at the same time. Try to imagine a glass wall separating you from the patient. You can see what's going on but don't let others' maltreatment of you through that glass. Leave it behind when you leave work. You won't be a bad nurse for doing that! Don't ask for perfection from yourself....it's the enemy of good.
I'm all for giving someone the benefit of the doubt when it comes to their pain response and need for analgesia. That said, the fact is that there are a lot of drug seeking patients gaming the system in an attempt to get their next fix. I can dress it up or say it in a more 'PC' way, but this enabling behavior, HCAHPS, and the 'Pain is the fifth vital sign' campaign BS has got us where we are.
Very good advice from an OR nurse who doesn't have to deal with this as his patients are under anesthesia.
I've also worked post-surgical, which is what this patient was, along with the enabling family. The patient was NOT an acute kidney stone patient! Duh...
How do YOU know what went on in that OR? Post-op is not the time to label patients and diagnose them as drug seekers. We are there to treat the acute pain of a procedure...it's not rehab. Don't make yourself crazy over it or you become no better than the enabling family.
Yeah I absolutely couldn't care less when patients threaten to make complaints. Roll your eyes at this idiocy and move on. You should be angry at them for their disrespect, not the other way around.
Oh, that would likely push some of the docs I’ve worked with over the edge! Worked for a hospital that had a large population that was admitted due to complications from injecting their drugs of choice. Call the doc too many times asking for more or different meds, the patient PRN list of meds got shorter and started dwindling down to a few choices that they were really PO’d with the doc over. Some after so many calls I would try to warn them what was coming….and it did….IV morphine got switched to Tordol or oral Norco got switched to tramadol…the doc actually started taking things away. When I first started working there I found it a bit harsh, but then I realized-this doc has had a LONG time getting to know this patient over the years and was quite over being on call when they showed up in the ER and got admitted to them.
A general comment about kidney stone pain apart from the situation described in the OP: Kidney stone pain is known to be severe. Frankly, if my family member was a patient and they were medicated for severe kidney stone pain with Morphine in a dosage that wouldn't be appropriate for their severe pain and their pain was unrelieved, and they still continued to complain of severe pain, I would be absolutely furious, and I would be complaining. And I would take this situation further formally. As nurses we are the patient's advocate.
Emergent, RN
4,304 Posts
Now you sound angry. I know it's easy to take your frustrations out on an anonymous person on a message board. I think this discussion is over. Have a great day and I hope you are able to make the dietary changes to avoid kidney stones from recurring. Please research that because it is a vital part of preventative medicine.