undermedicating pain in the elderly

what does she have ordered for pain relief? any prns? is anything being given, i.e., tylenol or motrin?

also, i have found with elderly, is when they have surgery, the effects of the anesthesia remain in their system for a while.

if she is being given tylenol or motrin and it's not helping her, i would definitely call her doc and relay her agitation.

i have found prn vicodin works very well with orif's.

and more than once, i have told a doc that i will document the s/s of pt's pain, as well as md's refusal to prescribe effective relief (if that is the case).

leslie

I know I may be a little off topic (well, depending on how you look at it)...but, where I work a mentally retarded lady sliced her neck open during a fall...all the way to the jugular vein. Thankfully, she didn't nick the vein. However, after she went to the hospital and had it sutured and stapled up, guess what she got sent home with for pain? Motrin 400mg Q4 Prn. Yep. Me or you? We would have had Tylenol #3 or Darvocet at the very least.

I guess old people and MR folks don't feel pain. Just like newborns.

this is a huge pet peeve of mine! these patients are clearly uncomfortable. medicate them!!!! a lot of surgeons that i have worked with lately have way undermedicated these pateints.......and then they wonder why they develop pneumonia or atelectasis! geesh!!!! :angryfire

the facilities can also receive deficiencies on their annual surveys, for undermedicating a patient...

there's just absolutely no reason for this.

i hope someone steps up to the plate for this poor lady.

:angryfire what boils my blood-

is when you question why "Agnes- with a hip fx" has not been receiving pain medicaiton, and you hear, "She has dementia, she doesn't feel pain." OR "Her psych meds numb her pain."

Yet--- "Bob" in the room next door gets his percocet every 4 hours on the dot.

When I was in RN clinicals at the LTC/rehab where I happed to be employed as an LPN

I noticed that ap who was 48 hrs s/p aka had not received any thing for pain since being addmitted 26 hrs prior, and that the Lortab which was ordered for him had not even been ordered. I had recently seen the pt prior to the amputation, and he was a very different person. Besides being totally confused, he was in obvious pain.

I bugged several staff and supervisors to help w/ this and got nowhere. Finally, I interupted a meeting to speak to the ADON and ask for help addressing the problem. She borrowed a Lortab from another pt and got this pt's Lortab ordered, thank God.

Another incident (as an employee) occurred when as an LPN, I could not get anthing but Tylenol ordered for a pt who had a fresh humerous fx that no surgeon would touch. It was this occurance that so disgusted me that I finally left the facility.

Oh I am dealing with this right now!!!!!!!! At my homecare CNA job I have a elderly gentleman with an ORIF, (sent home WAAYYY too soon, but thats another story) They are giving him a minimal dose of Lortab, PRN(thats on the label) THis man is miserable at night. The day help took up the subject with the home health RN (from different agency) and she suggested if Lortab wasn't enough to hold him (drum roll here) give him some Tylenol!! I have respectfully documented the next time this guuy is in misery I am calling the doc myself to complain. That got a shocked look. Hey, if they want to keep hours like a dermatologist or an accountant, they should have gone into those fields instead. (Off topic, I dont feel much sympathy for my OB who hates night shift either) I also was told to let him have a second sleeper if he is uncomfortable (yeah, so he will be groggy and in pain), What is it that these old folks dont need pain meds? While I am on the subject, isnt 12 days a bit soon to send somebody home with a fresh ORIF of a fx femur (broke just below the hip)? They sent him home with orders to stay in his wheelchair for 3 weeks, no bearing weight on the fx side. Then, PT is supposed to start. I just have real concerns on this one.

Laura

While I am on the subject, isnt 12 days a bit soon to send somebody home with a fresh ORIF of a fx femur (broke just below the hip)? They sent him home with orders to stay in his wheelchair for 3 weeks, no bearing weight on the fx side. Then, PT is supposed to start. I just have real concerns on this one.

Laura

hi laura,

12 days sounds like more than enough time for an orif. i've had sev'l pts being sent home after 4-5 days.

what i question is this patient sitting at a 90 degree angle in his wc for hours at a time.

that sounds like it would be contraindicated, as well as painful.

it doesn't sound right.

but i'm very glad to hear you advocating for his pain needs.

leslie

leslie

My great-aunt, who's in her 80s, was sent to a sub-acute after repair of a shoulder fx. (I think it's called that, we don't have these facilities here. It's kind of a cross between a hospital and a nursing home.) All she had was Tylenol. She's very stoic, of course, but when I asked her to rate her pain, she said 6/10. I was a nursing student at the time and didn't know much, but I knew that wasn't right. I asked the nurse who told me that doctor wouldn't be by until tomorrow. I asked for the charge nurse and found she WAS the charge nurse. I asked for the manager and she was very sympathetic to my complaint, thank heaven. Aunt eventually got some narcs, although even then she said it didn't help much. I couldn't believe the previous nurse wouldn't call the doc for some Percs or something on this poor old lady . . . I know you're busy but I could never let my patients suffer like that. I'd rather somebody's dressing change didn't get done than another patient be in pain. The dressing can be done later, the pain hurts right now.

Working 11-7 in LTC, there are many nurses who just "don't " give the pain meds as they should be given. I don't understand it, maybe they just don't want to document, do the paper work, actually get UP from the desk, etc. I have one gentleman who nightly moans and groans loudly - you can hear him 2 halls away - and has prn Lorcet+ for pain. I usually give him one around 2 or 4 am, and they're scheduled q6 prn. Yet, no one on day or evening shift has given pain meds to him. He did get Tylenol once for a headache. I came in the other night and the cna's said mrs. so-and-so has been on her call light for the last hour asking for a pain pill, but the 3-11 nurse said she gave her one at 8 pm. I checked the MAR and narc book.....no pain med was given since 4pm. It seems like they all wait for me to come in at 1030 pm and "dose everyone up". What I don't appreciate are the "looks" I get from certain day shift nurses who wonder why I'm giving so many pain meds on 11-7. Duhhhh.....could it be because these little people are going for hours on end without pain relief??? But I see the smiles of relief when they realize I am working this night, and they know that I will make them feel better, if only for a little while. Very frustrating.

My grandmother was 95 years old -- her spine had deteriorated significantly and she was wheelchair bound and in constant pain. Her doctor was not wanting to give her "any heavy pain medications" because "she could become addicted". HELLO! She is 95 years old!! If she gets addicted -- who cares?! All she wanted was to live out her last few months/years in some smblance of comfort!! We finally got the doctor to give in and order her a Duragesic patch -- fairly hefty one. she was far more comfortable, could tolerate being up more -- got to spend quality time with her grandchildren, great-grandchilren and great great grandchildren. She lived to be 98. The last year and a half of her life was spent with the people she loved, being comfortable and cared for....she may have been dependant on the patch, but it helped her have a quality of life that she never could have had while in the pain she was in before that!!!

One must be careful to medicate a pt. for pain that has not been medicated prior. It could look like you are giving them pain meds just so you can take it.. just a bit off topic..but so closely related. As a charge nurse, I make rounds, ask people about their pain, and medicate them if they request it....sometimes with a confused person..it is a judgement call, you need to consider the diagnosis, and would this person usually have pain with this...if confused pt. is agitated, restless..pain could be the cause. I was recently fired because another nurse said that I medicated her patient, and she ( the nurse) did not feel the patient needed pain med. There has been a gigantic push to treat pain as the fifth vital sign, and that pain is what the pt. says it is...not what the nurse thinks it is.. Well the powers that be looked at the pain meds I had given, decided I gave much more as compared to 2 other charge nurses.....so of course I must be taking them.......urine test- negative.. but I did wait for almost 2 hours before getting to outside lab...I was so upset, spent the time in my car, crying, and being so mad I could not see. Well.. since they were so sure I had taken them, but since I had waited 2 hours, they figured I some how messed with the urine test, and fired me for intervering with an investigation. So..back to main topic..even though pain treatment is being pushed...be very careful.. it seems still that under-medicating is preferred...just watch yourselves.