Wake up...Are you in pain?

sandyth · Feb 25, 2004

Can you document "No facial grimacing"? I wont wake them up for pain medication either. If they do wake up in pain after my assess, I just reasesss and medicate.

bellehill, RN · Feb 25, 2004

I don't wake patients up to assess pain level. On the floor we are required to check vital signs q4h and assess pain q4h so it works out well. If my patient isn't sleeping that is a different story, I check pain level at least q2h after surgery. Waking a patient up who hasn't slept all night is just cruel in my opinion.

Dave ARNP · Feb 26, 2004

I want my patients woken up.

Sleeping is important, but if you ignore their pain needs just to let them sleep, when they do wake up they're going to be in a pain crisis. I order meds so that the next dose is given just as the first dose is wearing off. Thus, I expect their to be no gaps in coverage.

Sleeping does not equal no pain. Patients often sleep to get away from the pain.

This is also a reason why I very rarely order PRN's by themselves. I give something round the clock which I try to make enough. Only if they have breakthrough pain is a PRN needed. I never order a PRN when I expect a patient to need it as often as it's ordered.

-Dave

sharann, BSN, RN · Feb 26, 2004

Listen, I am not talking about a patient of yours, since you KNOW how to treat pain. I am speaking of the normal run of the mill idiot prescriber who doesn't write adequate pain orders. I am also refering to immediate post op pts and not to your floor pts.

You are welcome to have your pts woken up, but when did you last work the floor Dave? You think those nurses will wake up any sleeping patient? Respectfully Dave,, this aint gonna happen, and how can we know if they are sleeping due to sleep deprivation from being WOKEN up, or to "escape"?

I am ALL FOR round the clock dosing. I am the first to run to the med drawer for anything that will ease pain whether it be MS, Toradol, Elavil or whatever. I WISH physicians would really know the pain that we inflict on patients in the name of "treating" them. I am equally sick of hearing anesthesiologists argue with me because the patients pulse is normal so they are not hurting!

All I asked is how we can work with the pt so we don't have to induce ICU psycosis from constant waking.

Thanks, as you see I am quite passionate about pain.

fab4fan · Feb 26, 2004

Sorry, but I woke my pts up.

I think it's totally unnecessary to take a tone with Dave; pain mgmt is his specialty, he answered the question, then gets blasted for answering. Really. Why not just preface the question by saying "those of you with significant experience in pain mgmt need not answer"? He gave you an answer based on years of practical experience and professional expertise; just because you don't like the answer is no reason to be snide.

Pts that develop post-op/ICU psychosis do so for a number of reasons, not just being awakened for a pain assessment. Why not just do the assessment when you do the vs, or do you skip them when the pt is sleeping?

Just wait until you have a "sleeping peacefully" pt who wakes up in a full blown pain crisis. I've seen it...it isn't pretty, and the pt was really pissed off. Rightly so. It takes forever to try to catch up with the pts pain, and the severe pain is very exhausting for the pt, much more than if he'd been briefly awakened for an assessment.

If you need my work history to prove that I am qualified to answer this question, I will be happy to provide it.

Dave ARNP · Feb 26, 2004

Thank you Fab!

As always, you're awesome.

I just want to say that if you're not going to wake your patients up, you better dang well have standing orders for Fentanyl. You'll be pushing a good 100 or more MCG's after you let that abd. surgery patient sleep through through their meds.

We'll not even mention how much more Morphine, Dilaudid or Demerol they'll need to for the next hour to keep on top of the pain, that could have been prevented.

And YES. THE NURSES WAKE MY PATIENTS UP. I KNOW FOR A FACT THAT THEY DO! I ask my patients "did you get your pain medicine, did you get woken up for it?".

Finally, yes. It's been NEVER that I've worked a shift on the floor as a RN. I'll admit it. I went straight into NP school. HOWEVER.... I routinely do bedside nursing when I'm doing rounds. Patient needs an IV, some fluids, something hung, something pushed. I know the nurses are over worked, so I do it myself. This includes waking up a patient to see if they're in pain.

-Dave

sharann, BSN, RN · Feb 27, 2004

Wow, FAB4FAN, you sure told me. Although the only TONE I saw here was your condescending tone. I am touched that you feel the need to protect poor lil ol Dave, but I was not attacking him. You on the other hand decided you needed to kick some butt here, so why not. I only asked questions to provoke a discussion here. I thought I made myself clear here, that I do not want my pts to suffer. If I have to wake them up,I will, but I wanted a dang good rationale (which you actually did provide FAB) So stop attcking me please. This forum has certainly gotten clickish.

I am sure there are some here who agree with me, and others who do not (which is the beauty of these boards. I just think some of us are so quick to jump down other's throats on the defense.

p.s: NO Dave, I did not know that you were never a bedside/floor nurse. The way you present yourself appears to be a very aware and saavy RN.

If you all want to keep exchanging harsh words, go ahead I have a thick skin, but life is too short to fight with those with a common goal.

gwenith, BSN, RN · Feb 27, 2004

Sharrann = from where I stand the answer would be "depends" ( and I do not mean continence pads lol)

The one place where it is forbidden to wake the patient to ask if they have pain is CCU. Unless you have just gotten them over a crisis and even then the relaxation of sleep is better than waking them. We do not even do obs at night anymore - just as and when at night otherwise we let them sleep through. Ya know it is difficult to stop staff waking them at night - typical - there has to be a Murphy's law that covers this.

hadrian142 · Feb 27, 2004

Pain is perception, it's what ever you believe it is. When your sleeping, you don't believe in much of anything except whatever your dreaming about. Thus the saying, "a sleeping patient has no pain". Ask any doctor.

Dave ARNP · Feb 27, 2004

Pain is perception, it's what ever you believe it is. When your sleeping, you don't believe in much of anything except whatever your dreaming about. Thus the saying, "a sleeping patient has no pain". Ask any doctor.

Just to make sure that what you were saying is the most obsurd and untrue thing I have ever heard... I did. My wife, my father, my mother, the MD I work with, and the MD my best friend works with.

That would be five DOCTORS, and they all say that this is 100% completely untrue.

If you're going to comment on pain management, please know of what you speak. Pain patients have enough problems with getting proper care without people spreading the fertilizer.

-Dave :angryfire

caffine addict · Feb 27, 2004

I know that this is unrelated and stupid but:

When we were little kids and my brother would wake us up with his snoring we (us girls) would all yell "Hey Joe, Wake up and go to sleep!!!!" just to get him to stop!

Even people with sleep apnea aren't always awear that their apnea is affecting the quality of thier waking hours. But the rest of us can tell when their functioning declines and they become depressed and withdrawn and dispondent. Not to mention that they may not be aware that they have apnea because their asleep.

Oh nevermind I'm just rambling onnnnn (sorry) :chair: