Any nurses?

Question

I am a 2nd year nursing student and the other day during a lecture, my lecturer brought up an interesting question.."Why do RN withhold schedule 8 (Drugs of Addiction) from patients who are suffering from pain?..e.g. why is that when a patient is written up for PRN morphine some nurses do not give it reguarly?"
I know that it depresses the respiratory system and etc but if a patient is written up for it shouldn't the nurse give it esp. if the pt. is in pain?..As a nurse, do you do this? Thanks for answering.

Answer 1

Pain management is not a all or nothing thing, it is management. You are responsible to ease your patients pain as you are responsible to keep them safe. I think it could be considered inappropriate for a lecturer to make such a blanket statement without reviewing the very well known concerns for narcotic medications. Here are some of mine.

Yes, it can depress the respiratory and cardiac funtion, but it may have been a while since your lecturer has had to push narcan to keep their patient alive and then send them to ICU or spend the night with them throwning up their toes and screaming in agony until the narcan wears off and the pain medication will work again. Not all people react the same, some times a little goes a long way and sometimes it seems to store up in the fat and get released much later. Hate when that happens.

Many patients get so much pain medication they do not remember that it has been given and report that it was not.
Wouldn't it be nice if morphine fixed everything, but it doesn't. Some types of pain (neuro, pressure) don't respond well to narcs, If your patient is preop for an appe, you don't want them so zorked that they don't wake up for a rupture. Sometimes a muscle relaxer, or anxiety meds, applied heat or cold, walking for gas pain from a lap procedure, or even tylenol will work better then just giving more morphine. More is not always better. You are suppose to be using your brain and dealing with the symptoms, not just following your marching orders.

Narcs also slow down the bowel of post surgical belly and make some folks very comfortable to just "sleep till I get better", which most of the time is not what the doctor expects or orders. I would love to keep my patients long enough to mend them at the rate that I believe would be best, but we live in a world where nurses had to fight to keep insurance agencies from changing most masectomies to an outpatient procedure. If I only get to keep my patients for less then 24 hours for a gallbladder, appe, mastectomy, simple toe amputation, hand surgery, wiring of jaw fracture, broken arm, broken leg ect., I have to show safe activity and complete education within that window. It does not allow much time for pain control when you need to wake up, pee, walk, and demonstrate understanding of post surg education. We are sending all of these patients home before the dressings are dry and nobody is on a soapbox complainig about their lack of pain control when they get home. I guess their pain is handled by pixie dust or something. How could we have had such a revolution of the handling of a large segment of our patient population, as directed by our financial providers, and yet attempt to continue to look at things the same way. Ten years ago a lap gallbladder needed two days and morphine, now all they need is to pee and take vicodin becuase they are off my floor and no longer under my care. I didn't choose this. When did the nurse become the villian in this?

Pain management is a very complicated field that requires skill. understanding, and appreciation of the individual. I would suggest some addition review of all of the concerns. Remember that most doctors will write enough medications for you to determine what will work without undue risk to the safety of the patient or risk that you are going to wake them up at 3AM for more orders. I tend to judge my pain management by the standard that if you can do all the things I need you to do (walk, cough, sleep, pee, use IS, behave safely) then your pain is in control. If you are too zonked or in too much pain to do these thing, then your pain is not in good control. This usually gives me room to work and cover symptoms.

Answer 2

I always offer and never withhold pain meds from people. Why would I do that? I am not an addictions counselor and I do not work in a drug rehab. It's not my job to determine if the patient is a drug addict and withhold narcotics, that is the doctor's decision. If the doctor asks my opinion on the patient, I will give it, otherwise, not my business. So - I give pain meds as prescribed whenever the patient needs them. If they don't ask, I ask them if they need something. If they need something else, I call the doctor and ask for what they want.

Of course I wouldn't give them if I felt they were going to harm the patient in any way (overdose, respiratory depression, etc) I think some nurses project their own personal feelings and morals onto the patient and that is their reasoning for withholding narcotics or other addictive drugs.

Answer 3

I know some nurses are very stingy with pain meds. I think they may feel that the patient isn't really in as much pain as stated. Some are afraid to give too much. Pain is objective. You need to be a compassionate nurse and give pain medication when available to cover pain, but at the same time, be a good teacher to your patients and let them be aware of the potential for addiction and offer other means for pain control such as ibuprofen or Tylenol, massage, darken the room, focusing on something other than pain, etc. Even if you are sure the patient is just a pain seeker, it is your responsibility to give the care that you were hired to give.

Answer 4

Your milk is done of white blood cells, that certainly save the nipples germ loose sufficient to be probability-free on your toddler. My lactation representative advised me no longer to bathe my nipples earlier or after nursing. extraordinarily not at all with cleansing soap, which has a tendency to dry pores and skin. I solely nursed for the first 14 months and my son became in simple terms as healthful as he will be! Your toddler will be in simple terms superb.

Answer 5

no So long as the patient mees a set of standards (pulse b/p etc) I firmly believe that if I have and can use it I will if its safe

Answer 6

HEY GUESS WHAT. MY MOM IS AN RN. AND SHE IS AN CNLCP AND AN INSUREENCE THING WITH NURSING SOME HOW MIXED IN.

Answer 7

My boyfriends mom used to be a nurse.