Stroke & Pain Management?

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Specializes in Staff nurse.

I was floated to neuro the other night and had a pt. who was a new admit a few hours before I came on. She had orders for PO pain meds, but no NG to put it thru(mot able to drop X3). Before I called the doc for an IVP order, a family member told me another nurse told him the pt. couldn't have pain meds because of the stroke. The pt. was whimpering and when I asked if she had pain, she said yes. I asked her a few other ques. to make sure that she could answer more than "yes" and she was able.

So, is it typical not to medicate for pain in a new stroke pt? I realize the rationale behind not medicating to mask further strokes, but this was after her CT.

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Specializes in critical care.

Where was she having pain??? Lots of times neuro docs dont want to oversedate for CVA's because it will mask changes with LOC (she could have an evolving CVA). Ultram, tylenol, even percocet shouldn't be too sedating. Especially if the pt is truly painful.

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I was floated to neuro the other night and had a pt. who was a new admit a few hours before I came on. She had orders for PO pain meds, but no NG to put it thru(mot able to drop X3). Before I called the doc for an IVP order, a family member told me another nurse told him the pt. couldn't have pain meds because of the stroke. The pt. was whimpering and when I asked if she had pain, she said yes. I asked her a few other ques. to make sure that she could answer more than "yes" and she was able.

So, is it typical not to medicate for pain in a new stroke pt? I realize the rationale behind not medicating to mask further strokes, but this was after her CT.

Oh how ridiculous. Sure, allow the patient to be in severe pain, thereby elevating her BP even further. Makes sense to me :icon_roll

If the doc had already ordered po pain meds, why would this nurse think they couldn't be given by another route?

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Specializes in Staff nurse.
Oh how ridiculous. Sure, allow the patient to be in severe pain, thereby elevating her BP even further. Makes sense to me :icon_roll

If the doc had already ordered po pain meds, why would this nurse think they couldn't be given by another route?

Right, she had orders for PO but wasn't able to take it and there was no NGT. The relative stated his wife was a nurse in ICU and was very upset pt. had an order for pain meds. I explained to him that the doc had ordered pain meds and we wouldn't over-sedate her, but it wasn't right for her to suffer. Her pain was in her shoulder/arms from what I could gather from our "conversation" and assessment. I asked if she had fallen and he said what does that have to do with it? !!! Duh, well, if she had fallen she would be in pain. I didn't see any bruises but she could have slid "almost out of bed" as I have seen other nursing home pts.

AND her bp was sky high, which was a concern of the relative...and when I said, well, her bp may be up because of her pain, he said, it wasn't before. She was getting bp q 2 hours with prn IVP. So I showed him the trends and said, that's why we're watching it, but the pain may be causing this very high bp.

So I did give her IVP that the doc ordered and assessed her every 15 min. for mental status changes, and she was fine, calmed down, stopped whimpering, still alert. Sometimes family members make it really hard on the job...but I want to thank you all for your responses. I read what I read in my nursing texts but then protocol at work may be different and I like to know why. I am glad she was no longer in pain.

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