Wake up...Are you in pain?

nursepenny · Mar 5, 2004

I am occassionally awakened from sleep by miagraines. These tend to be the worst, as compared to the ones I get while awake, I am now thinking, it is because I take something sooner while awake. Tends to take more powerful pain meds when I am awakened w/ full blown miagraine.

On another note, we had a patient awhile back w/ gangrene of the left foot. All the Dr, gave pt was Tylenol 650mg q 4-6 prn. We begged the doc for stronger meds, to no avail. Finally had to go to the Cheif of Staff to get the pt something stronger. In the end both of the pt's feet were amputated and he was later sent to nursing home were he died shortly after getting there. Was in our unit approx 1 month total.

nursemary9, BSN, RN · Mar 5, 2004

I absolutely wake pt's up for there pain meds!! 100% of the time; I learned a long time ago that you give that pain med when it is due otherwise people wake up in horrendous pain that is so much harder to control;

That really was a nasty way to reply to Dave who knows what he is talking about!! I always look forward to his responses because he does. I agree with you that people need sleep, but people who sleep can still experience pain--I know that for fact because I do!!

KMSRN · Mar 5, 2004

You're close, but not quite there yet.
Chronic and pallative patients still need to be checked for pain according to the schedule the medication is ordered. Some patients, particularly the elderly, need to stay away from long acting medication. Some patients do fine not taking a long acting, but still need breakthrough coverage. You'll not know they need it if you don't ask.
Patients getting a PRN for breakthrough, in addition to their long acting medication, also need to be awoken. Breakthough meds are given in the event of b/t pain, and are best given in the early stages. Pain may be onsetting during sleep, and if given early, less medication will be needed. They could be sleeping to avoid the pain, thus they'll need their medication. More and more and more reason, but you get my general idea.
Very good logic, though. I totally see where you're comming from~!
-Dave

Pain medication for palliative patients in chronic pain is usually long acting opioid bid with prn for break through. Waking someone consistently through the night to check for pain in these patients is entirely unacceptable. If it becomes necessary, as it sometimes may, then the plan and medications need to be adjusted to make it unnecessary. I have been in palliative care for several years and managed many people with chronic pain and pain crises and the object is to get the pain controlled so the person may lead as normal a life as possible and that does not include being awakened. When patients are no longer able to take po meds, then very often it is continuous IV or SC meds with prn boluses. Again the object is to get to a level where boluses and prns are at a minimum and a consistent level of relief is maintained.

kyti · Mar 6, 2004

Where is Dave. Haven't heard from him lately. I would really like his advice.