nopainNurse

No you can't see an epidural hematoma at the insertion site. An epidural hematoma is not just a hematoma at the insertion site (i.e. a hematoma just under the skin). The hematoma occurs in the epidural site and can push into the spinal space causin...

A patient falling asleep mid conversation is overly sedated. Passero has a opioid sedation scale that is really useful -- Assessment of Sedation During Opioid Administration for Pain Management I would not give any dose of opioid to a patient who i...

What about something around the fact that we know people in lower economic situations typically have poorer health (lots of stats about this) and typically receive poorer care. The poorer care in hospital may be a bit harder to pull out of the liter...

I wish there was a "strongly disagree" option next to the "like" button!

So what is the fear around giving the Dilaudid pre CT? That the patient isn't "really" in pain? Or that some how the dilaudid will change the CT results? There is so much lately about requiring "proof" in order to give pain meds. My attitude is t...

Wow 4 hour bed rest after dilaudid IV? Is it only dilaudid or all opioids? And is it only IV? WHat about SC or PO? What is the rationale behind such a practice?

I agree with the earlier suggestion to screen for depression. Very common thoughts/ patterns that exist with depression. Also look into Cognitive Behavioural Therapy, will help you to see which thoughts need to be "redirected" or "changed". Often ...

answers to the why phasing out demerol http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2004-08.pdf http://www2.kumc.edu/druginfo/pharmkey/Meperidine%20pharmacy%20key.htm

YES! Exactly!!! You said it perfectly ... especially "Nursing care shouldn't be something that patients get only when the ask specifically and repeatedly" If I could 100X Kudos your post I would!

Just Googled PRN -- Here are the first 3 definitions. as needed: according to need (physicians use PRN in writing prescriptions) As the situation may require, more particularly directions on medical charts by doctors for the benefit of nursing staff ...

The PRN discussion just about made me crazy, so I had to post without finishing this whole thread -- so I apologize if this has already been stated: PRN does not mean a patient must ASK for it! It means as needed at the discretion of the nurse! Do ...

The morphine/ Demerol one would be a good paper. There is +++ research out there about the problems with Demerol and the fact that it really has no different effects on the Sphincter of Oddi than any of the other opioids. Also the history behind Dem...

Yes, great book! Actually She just wrote a new one that came out this summer. I haven't gotten it yet, but have heard it is very good. "Pain Assessment and Pharmacological Management" Chris Pasero & Margo Mcaffery, 2010.

I can totally relate. My family is very similar. I grew up thinking my aunt was a nurse (was told so by her and various family members). When I decided to go to university to become a RN, the aunt responded by saying, "Why would you go to school to ...

This one recently from an older surgeon who really doesn't believe in pain management.... "Absolutely NO NARCOTICS" Next line...... 1-2 tabs of t3s q 4h prn That left us wondering........ does he not know what a narcotic is????

Kim, I really feel I can relate to your experience. I am not angry at my doctor though, (she is fabulous), and we did talk about withdrawl. Actually when I came off paxil it was a 4-6 week taper that we planned out together. The problem was thi...

Actually I had almost the exact same experience going off of Paxil. It was really the worst experience of my life and I did feel that i was going "crazy". I actually went back on, stabilized and then worked with my doctor to slow wean (like 6 month...

Great thread! This is one of the biggest challenges of pain management, the concern about addiction. What I believe (and teach) is that addiction isn't something you can discover easily or in the immediate first few minutes. I strongly believe tha...

Somehow it has to be a balance between assertive and respectful of the nurse managaer's time, but my vote is to try and get the resume into the NMs hand. My experience 10 years ago was that I went to HR and filled out forms/ submitted resume etc and...

I would look at how "generous" her dilaudid dosing actually is. Often patients with chronic pain take opioids at home and develop a tolerance -- you comment that she was on opioids previously. I would want to know how much. She will need to be on ...

The mirror idea is called "mirror box therapy." If you saw the recent House episode, he actually used it. However in the TV version the healing of the pain was miraculous and instant. In reality the pain will likely not be cured with this treatme...

Not sure from initial post if this is shingle pain (post herpetic neuralgia), or something else. But just a thought about the ativan. Ativan is fabulous for anxiety, but really shouldn't be used for pain tx, especially in populations who may not be...

I agree with you, and should have said my comment more clearly --- that internet is really broad and I would be wary about privacy/ security. My concern was that many people don't realize how unprivate various forms of communication are.

For the second question, I would answer C. I would be very concerned regarding the sending of any patient information through the internet, for security (privacy) reasons.

I have interviewed a variety of nurses, new grads and students, and I have a few suggestions: 1) Prepare!!! Make a list of all of your accomplishments, strengths, examples from clinical/ school that show how you are a patient advocate or go above and...