Request for pain meds and then asleep

Guitar_Heroine · Jun 28, 2006

I'm just a student so I haven't encountered this situation. But surely will when I'm a new grad working the night shift! I was always told to religiously give pain meds on schedule because it's easier to control pain that way then chasing breakthrough pain. Obviously there are different situations and eventually one would have to stop the meds. I wondered if anyone could explain to me when you are vigilant about meds, when you go PRN, and how/when you d/c (though I suppose the pts usually go home with the meds and deal with this on their own). thanks!

SouthernLPN2RN, MSN, RN, APRN, NP · Jun 28, 2006

I'm just a student so I haven't encountered this situation. But surely will when I'm a new grad working the night shift! I was always told to religiously give pain meds on schedule because it's easier to control pain that way then chasing breakthrough pain. Obviously there are different situations and eventually one would have to stop the meds. I wondered if anyone could explain to me when you are vigilant about meds, when you go PRN, and how/when you d/c (though I suppose the pts usually go home with the meds and deal with this on their own). thanks!

The pt's I deal with are not usually in really bad pain because they're a week or more postop. There are always exceptions. Now for a fresh postop, I would definitely give those meds when they can have them if that's the pt's wish. I assess the pt's pain every 2 hrs at least and the cna's will also ask if they need anything. Our pain treatment is pretty good on our floor since all staff are addressing it. If the pt has a pca, you can expect they may have a lot of need for oral pain meds when it's d/c'd, so bear that in mind. I also always tell my pt's to let me know they need something before the pain gets bad, for the reason you cited.

Runningnurse · Jun 28, 2006

Just remember that just because someone appears to be sleeping soundly (even if they're snoring like a chainsaw) doesn't mean they're pain-free. I work with cancer pts and often they're so used to the pain that they will sleep through it, so if they request meds and then are asleep, I wake them up.

Exceptions of course if the patient has respiratory issues, unstable vitals, already a bit too sedated, etc. But waking them up gently at midnight to give an oxycodone is, in my opinion, worlds better than dealing with pain 10/10 at 6am when they wake up because I was trying to be "nice" and let them sleep.

Other posters had a good idea...making a plan with the pt before they go to sleep. I'd bet that 9/10 of my folks would tell me to -please- wake them up.

SitcomNurse, BSN, MSN, EdD, RN · Jun 28, 2006

I work on the night shift also, and often time have gone in and my patient is alseep after requesting pain meds or a sleeper. In LTC, consider the patient pattern. I have that option, as I see these people every day. Very good suggestions were made, and always ALWAYS consider the patient when making that call. One guy consistently woke up when he knew I was on duty to ask for meds, just becasue he wanted to talk to me. After I figured that out(he worked in my dads field of business) I told him, you dont need Tylenol to get me in here, just ask to see me. Then, we had a great relationship. As for a sleeper, I always "stir' the patient from a light sleep, a heavy sleep.. I make a bit of noise and gently touch them, if they stay asleep...grrrr....come back in 10 min. but usually, they wake up and take the pill. Even runing water can do the trick. Wash your hands, and see if they wake up. I really like the plan idea, in short term or long term it is good for the alert patient.