Tuesday, May 5, 2009

Pain control

In nursing school they teach you that pain is a subjective experience and that we as nurses are to do our best to help our patients in pain.

I wonder if they were prepared for a case like this:

30 year old person comes into the ED with 'epigastric' pain. They have been worked up extensively for this pain and have diabetes, but no medical condition that affects the abdomen specifically. Already referred to a pain specialist, the patient was on 500mcg of fentenyl patches changed every 2 days, 10 oxycodone controlled release BID PO, as well as a PCA pump with hydromorphone which gives 10mg/hr as well as potentially 2 patient initiated boluses of 5mg/hr prn. This patient, because of the investigations and interventions, also had a J tube and was on dialysis for renal failure.

We had nothing in the ED that would really touch her additional pain. Giving 5 of hydromorph every hour (per MD order) seemed pointless, the patient would settle for 5 minutes and then act up by slamming their body against the side rail and screaming. THe patient had no problem getting out of bed to get to the commode. Some of this I'm sure is behavioural and some of it could be actual pain, but this seems to be an extreme form of drug seeking.

At what point should we be treating the behaviour versus the 'pain'?

1 comment:

Anonymous said...

I have nursed a couple of young people with end stage Diabeties who have had many of the sorts of problems that you discuss. in some ways through lack of compliance with their therapies they have definately contributed to there poor state of health which I guess is behavorial but because the high sugars dont descriminate which capilaries to damage they had developed nerve damage to there guts as well leading to lack of peristalsis and chronic (abdo) nerve pain