What Baffles You?

uRNmyway, ASN, RN · Dec 10, 2013

Pain is subjective. What might not be THE worst pain to you might be to someone else whose never had to go through childbirth or have to suffer from kidney stones. Do your job and leave the judgemental attitude at the door of where you work. You're not being paid for your opinion on whether someone is or isn't in the worst pain of their life.
And when I mean you, I'm referring to anyone who rolls their eyes and gets annoyed with the "dramatic hyperbole" because a patient doesn't "understand the question".

I'm not disputing whether or not it's the worst pain they ever had. The examples I cited were of the worst pains I have personally experienced. My point is that on the pain scale, the way I was taught, 10/10 is not the worst you have ever had, but the worst it can possibly be, the worst you can imagine. So on that scale, How can you have pain worst than 10/10?

uRNmyway, ASN, RN · Dec 10, 2013

Pain is subjective. What might not be THE worst pain to you might be to someone else whose never had to go through childbirth or have to suffer from kidney stones. Do your job and leave the judgemental attitude at the door of where you work. You're not being paid for your opinion on whether someone is or isn't in the worst pain of their life.
And when I mean you, I'm referring to anyone who rolls their eyes and gets annoyed with the "dramatic hyperbole" because a patient doesn't "understand the question".

And who cares about the occasional judgement? We are human, and I'd like to know if any of us can honestly say they have NEVER judged any patient. Regardless of judgment though, if a pts respirations are not dangerously depressed, and the meds are ordered, I'll give them. Whether you tell me your pain is 6/10 or 250/10.

BrandonLPN, LPN · Dec 10, 2013

I'm not disputing whether or not it's the worst pain they ever had. The examples I cited were of the worst pains I have personally experienced. My point is that on the pain scale, the way I was taught, 10/10 is not the worst you have ever had, but the worst it can possibly be, the worst you can imagine. So on that scale, How can you have pain worst than 10/10?

But why do you expect patients to know and/or care about the integrity of the 10/10 pain scale?

Saying "my pain is 20/10!" can more or less be considered a figure of speech. I mean, does it bug you when people say "It's raining cats and dogs" because it's not literally raining cats and dogs?

Pretty much the same priciple. People know that there is no "20" on the 10/10 pain scale. Just like people say "110%" when they know that's not possible. All just expressions....

uRNmyway, ASN, RN · Dec 10, 2013

But why do you expect patients to know and/or care about the integrity of the 10/10 pain scale?
Saying "my pain is 20/10!" can more or less be considered a figure of speech. I mean, does it bug you when people say "It's raining cats and dogs" because it's not literally raining cats and dogs?
Pretty much the same priciple. People know that there is no "20" on the 10/10 pain scale. Just like people say "110%" when they know that's not possible. All just expressions....

Sure, expressions. Sometimes. And there's a difference between getting annoyed at an expression vs getting annoyed over a dramatization. If it's drizzling outside and someone tells me it's raining cats and dogs, that's an eye roller. Now sure, you might come from a place where it barely ever rains, so for you, it's pouring. So subjectively, yea, for you, it's pouring.

Either way, pouring or drizzling, if you have an umbrella, and it's not broken and likely to hurt you, I'll just hand you the darned thing, even if I think you are exaggerating the amount of precipitation.

BrandonLPN, LPN · Dec 10, 2013

I'll agree that there's more than a few patients who are very melodramatic about the slightest pain. And it makes me inwardly roll my eyes sometimes, too.

I think the ideal in nursing is to never be judgemental. But judging others is human nature, and we all do it to some degree.

I'll also admit that pain control can be a "hot topic" for me here, due to some of the horrible attitudes toward chronic pain I have seen from other nurses where I've worked.

TopsDrop, RN · Dec 11, 2013

ATTN:

Don't ruin an awesome thread with this pain scale and your personal views on it's usefulness or views on patients abilities to use it appropriately. Start a new thread to discuss this if you must. This has been a very entertaining read, let's not debate on something so silly. If they have the meds ordered, we will give them or notify the MD of our assessment that is how it should work.

BACK ON TOPIC:

I can honeslty say I have experienced 98% of everything in this thread and it has made me laugh lots.

I have to say the one that baffles me most of all are the patients who are admitted and proceed to refuse new meds, labs, insert misc. test here. Why did you bother coming to the hospital? We can't treat your "problem" if we have no clue what it is we are to be treating. And for whatever reason all the education in the world makes no progress.

martymoose, BSN, RN · Dec 11, 2013

I have to say the one that baffles me most of all are the patients who are admitted and proceed to refuse new meds, labs, insert misc. test here. Why did you bother coming to the hospital? We can't treat your "problem" if we have no clue what it is we are to be treating. And for whatever reason all the education in the world makes no progress.

Amen!! you're not kidding.

I also like when they threaten to leave AMA, like it's going to hurt me or something. No skin off my teeth- don't let the door hit you.

Aaaaand , they usually don't refuse the pain meds

Mommy&RN, BSN, RN · Dec 11, 2013

Please don't eat from the dirty tray cart. No, I can not give you peanut butter and crackers every hour. We are attempting to get some control over your blood sugar since you are here with DKA.

T-Bird78 · Dec 11, 2013

For real. It's baffling how so many healthy adults have a hard time swallowing pills.

As one of those adults, I have a very strong gag reflex and will gag the pill back into my mouth or choke it down (literally choking) if I only have water to drink. Most pills, bigger than a Motrin tablet, will only go down if I eat a cracker, chew it well, and stick the pill in my mouth as I'm swallowing the cracker. I had to switch to liquid phenegren during my pregnancy because I'd gag so hard on the pills that I'd start throwing up--again. And I pity the nurse who has to do my swab for strep throat. I apologize in advance.

And regarding the pain thing, I rated my contractions a 10, hands down worst pain ever. This past summer, however, I was in a motorcycle wreck and high-sided (was flung over the front of the bike and landed in front of it and the bike I ran into--still don't know how I didn't get run over by either one), hit the ground, slid, and rolled. I sprained my knee, ankle, foot, and had a 4x4 road rash on my sprained knee and about 8x3 road rash on my right side just above my jeans. The knee was 3 times its normal size, zero ROM, ankle/foot hurting, but when the ER nurse was cleaning my road rash I was at a 15/10 pain scale. That was the worst hurting I've ever been in in my entire life, it made my labor pains feel like a stubbed toe in relation. You know it's a bad wound when the ER nurse says "ewww" and makes that hissing sound through her teeth. Pain is subjective and it's not up to us to judge.

T-Bird78 · Dec 11, 2013

Yes, the BP cuff dilemma. I've just finished taking pulse/respirations and am standing there, stethoscope around my neck, holding the cuff, and pull their arm gently away from their body--only for them to snug their arm right back against their side. When I get their arm back out, they put their hand prone (palm-down) and won't turn it over for me to access the right part of the elbow!

Also, I work in a specialist's office, so we see pts on a regular schedule. I get sooooo tired of asking pts what medications they're taking and which ones they're allergic to and getting "you have my chart right there, you tell me" as an answer. I snapped at one pt and told them that they need to know what they're taking and allergic to, and your chart is in our office but it's NOT in the ER, so in an emergency you'd be up a creek. Pt replied that they'd call me en route to the ER and ask me what they were taking. I tell all my pts, especially those on more than one med, to print a list of their med names, strength, directions, and prescribing doc and KEEP IT WITH THEM. Grrr.

When I'm reviewing med lists, especially asthma meds with teens, I don't ask "are you using your Flovent?" but I'll ask how often they're using their maintenance meds--it's usually not the same as we ordered!

Smokers who call our office or come in frequently to complain that their Advair isn't helping their breathing (put down the Marlboros!) or pts say they only smoke 2 cigarettes per day and you can see the smoke hovering around them like a cloud. Do they think I can't smell it?

When pts don't say anything about chest sx after receiving their allergy shots. I've had two this week that wound up having a systemic reaction and it was only detected because I heard one cough and one sneeze, and neither pt was doing that prior to receiving their shot. After assessing and getting the epi, the pts finally admitted that they'd had chest tightness or wheezing after several previous shots but never said anything. Yes, we ask every pt if they had any problems with their previous allergy shots and both these pts said no.

ausrnurse · Dec 11, 2013

Oh man, when patients will not lift their arms to let you put the BP cuff on, it absolutely makes me wild!

BrandonLPN, LPN · Dec 12, 2013

One of the few things I miss about correctional nursing was that I could "order" the inmates to put their arms out with palms up so I could take their BP. With the guards standing nearby they complied quickly! Manual BPs made easy and fast!

Can't really bark commands like that with my NH residents...