As a longtime RN and a chronic pain patient for over 14 years, it is a difficult situation. I try to always believe that pain is what the patient says it is. Yes, there are many that you doubt, and many abusers. Please bear with me as I relate my hospital stay. I was admitted to have a total knee revision. I was told that my pain would be managed while I was there. I spent over 6 hours in recovery, as I awoke from surgery screaming and cussing in pain .( I was not aware of this as it was told to me by the friend who accompanied me, when my doctor went out to tell her why I was spending so much time in recovery) Everytime I screamed in pain, they gave me more versed, instead of a pain med. I had refused a femoral block, and yet somehow they went ahead and tried it , without my knowledge or consent. I went to surgery at 10 am, and it was 8m when Iwas finally taken to my room. I was told by the anesthiologist that I "had multiple meds ordered for pain, and would not hurt all night." In my room, I was never given my cpm, or my ice pack, and I had a dilaudid pca, I believe, which I used but it did not control the pain. When I asked for ice I was told:" We do not do that here." When my nurse came in to do her half a** exam, she kept yelling at me to move my foot. I tried but could not , and she got madder and madder. She told me I was able to do it in right after surgery so "DO IT NOW", but I could not and told her I would if I could. I begged her for meds, and told her I was supposed to have them, ( I had not received any of the methadone I took on a daily basis twice a day) and she told me that the "pca is all , use it, that is all you get and need." Eventually we found out I could not move my foot because of the femoral block numbed my foot, not my knee, as it was not performed correctly. I cried most of that night, and dozed off and on, and awoke to see some dr I had never seen and asked about
who he was and he told me he was the hospitalist and I would see him everyday, I NEVER SAW HIM AGAIN> The next morning after shift change, my nurse came in and when I rated my pain at 8-9 she bawled me out for not asking for pain meds before it got to that point. I explained I had begged , litterally begged for meds since the night before, but was told I could not have any. She told me I was a nurse and I knew it was much easier to stay on top of pain, than play catch up. she went and gave me a bolus of dilaudid, and then brought me my methadone, and after an hour or so, it got better. Just for information, I had ice packs ordere around the clock for the first 48 hours, and constant cpm if not up, and received none of that. When I was sent home the day after, it was a Saturday, my own doc made rounds on Friday, and wrote my script
s, TWO oxycontin, and 30 percocet. I lived three hundred miles away. I explained that I took two percocet four times a day, they would be gone by Tuesday mrning, and the mail would take much longer for me to call the office on MOnday, and have the script
mailed to me (3-4 days) . By the way, I DID NOT GET THE script
for over a week, and had to take my pills one two times a day to last. (As I had taken them as prescribed over the weekend) IT was a hellish experience. AND there was NO NEED for anyone to have gone through that. I wrote to the hospital, and found out so many "LIES" charted in my chart. This is how chronic pain patients are treated. Most nurses will read that the dr has prescribed their regular pain meds, and if they have had surgery, and have a pca or optional meds prescribed, witll take it upon themselves to not give them the regular meds, as "they do not need it. This is why patients are so protective of their meds, schedules, etc. I do not believe that every time you ask somebody that pain is 10 or 10, as that would mean that none of the interventions, meds included are working at all. I have a friend who will answer 15 when asked, andI have tried to explain to her, that is not the best answer, and will most likely make the caregive less likely to bring meds. I hope the worst pain I ever had (10 0f 10) will never be constant, as I work hard to prevent that. I do know that certain meds do not work well for certain people. I , for instance, can take enough morphine to put a normal person out for hours, and it does not affect my pain, it makes me crazy, and itch. Fentanyl works for me as does methadone, but I went off methadone at the advice of my new dr, as he did not want to prescribe it. I do not like meds like percocet, or the feeling that so many love. I like sustained pain control. Not easy to come by. I think that a savy nurse, can tell by the way somebody moves, guards their painful area, (like an incicion after surgery) etc, how much pain is interfering at the time. Yes, I , too, try to be pleasant when asking for my meds, and do not writhe around, or swear, etc. If a patient has had the same dose and med for a day or so, and is constantly asking for it early, perhaps that med does not work for them. Often, a little anti nausea med, or toradol IV will potentiate and help, if there are orders for them. A massage, sheets straightened, pillows placed all can help, AS WELL as nurse who responds quickly, and respectfully,with the meds. Anxiety plays an important role in the control of pain,and if thepatient does not feel tey can trust the nurse, pain escalates. I always ask if there is anything else I can do every time I leave a room, I rearrange so they can reach everything on their bedside table, and make sure they have something fresh and cold to drink. It saves time in the longrun. You can not imagine how trapped anddependet chronic pain patients really are. THEY are dependent on the meds, and on the dr that prescribesthem. They feel powerless. Clock watchers are afraid,and that is why they are asking right before time for the meds. Please be patient and believe them when they say they have pain, but it does not alway require meds.
Sorry purplereading I hit the edit button on the wrong post I meant to do mine,! nothing is changed! White Beard
Post Edited By Moderator (White Beard) : 1/18/2011 11:02:02 PM (GMT-7)