This one's dedicated to all the drug-seekers....
Female patient in mid-20s undergoes a simple procedure in the OR, extubated shortly after arriving in the PACU. First words out of patient's mouth were complaints of pain. Not an unusual complaint, after all, she just came out of the OR. However, 99.9% of patients that undergo this particular procedure never complain of any pain whatsoever (no incision involved.) This chick is the other 0.1%. Obnoxious, agitated, demanding and just plain old nasty.
Review of her chart reveals an allergy to Morphine and "Narcotics" without any further specifics. She goes on to state that she is not allergic to morphine, she just has "some itching." Uh-huh. This is going to be good. Patient states that she is hurting and wants to "go back to sleep." I ask her if she has any reaction to Demerol to see what she says. She doesn't even ask what Demerol is and goes on to state that she has no reaction but it doesn't help her "at all." Um- hum...
This particular PACU has standing orders that permit the RN to decide which pain med and how much to give based on patient need and nursing judgement. (I also work at another PACU in which the specific order has to be written by anesthesia before giving any med. That's another story.) So, she's allergic to morphine and "narcotics" therefore, I'm not giving her any. After telling her, "I'll be right back, I'm going to get your pain medicine," I walk to the Pyxis to pull it. Of course, she's watching my every move. I promptly return to the bedside with a vial of Toradol. (Non-narcotic pain med for those that have not heard of it.) She's looking extremely pleased as I draw it up and proceed to push. At this point, another nurse has returned to take this patient because I have another one in the next bed.
She asks, "Was that morphine?"
Me: "No."
Patient: "What was it?"
Me: "Toradol."
Patient: (Screaming) "TORADOL!!!!!!"
Me: "Yep."
Patient: (Still screaming) "I thought you were giving me morphine!!!!! Toradol is useless!!!!"
Me: "I'm not giving you anything that you are allergic to."
Patient: "But I'm not allergic! I just itch!"
Me: "That's an allergy. We can't give anything that you're allergic to."
Proceed to give a full report to her new nurse victim. Patient continues to complain of pain, decides to tell nurse that she will try the Demerol, "even though it doesn't work" for her. Nurse gives 25 of Demerol. Patient has a huge histamine release, redness, itching, whelps...
So, she gets Benadryl IV. States she just wants to go to sleep. Nurse finally convinces her to settle down and close her eyes. Within a few minutes, we have peace and quiet.... finally.
Thought for the day:
It may be that your sole purpose in life is to serve as a warning for others.
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3 comments:
I remember when I had Carpal Tunnel Surgery, my warning were ignored that I was allergic to latex. No one really believed me until I started getting a rash on my skin.
I was in the hospital for "other reasons," and basically was ignored when I had stated over and over again, I am allergic to latex. I believed I was ignored considering the circumstances and the "reason" of my hospital visit. Coming into recovery I was awaken from the anesthesia, plus given IV pain meds.
I was very surprised at the well manner and great concern of the Recovery Room Nurses, because prior to that I felt I was a "second class patient" because of how everything I warned the nursing staff of what I was allergic to was ignored.
The nurses in Recovery were very compassionate, caring, and understanding. The first thing I asked for was to be put back to sleep, because in my groggy state of mind I admitted I was bipolar and I had very good sleep. I remember my arms being numb because there was some type of numbing agent(lidocaine or some simular anesthetic, I assume). I asked because of where I was going next and was not going home that day, whether I could be placed back asleep.
The nurses were understanding and spoke with the doctor, who later prescribed a sedative,( not sure what it was) but it made me very sleepy and I slept really good that day. LOL.
Levi
ahhhh... there's a big difference though. You don't know what the names of the meds were. Generally speaking, when someone has as much knowledge as this particular patient did and gets as upset as she did about receiving Toradol, it's like a giant red flag. Now, that being said. Certainly there as people with nervous disorders, anxiety, or what have you, that will request something to ease their nerves, to make them less jittery. Not a problem. A nurse can *usually* get an order for a sedative, especially with a prior history. But even that can be a problem at times depending on who the anesthesiologist "on call" is.
I'm glad that you had a good experience in the recovery room. Each patient is different with different needs and med have to be individualized.
We see the same thing in ER. With experience comes the ability to weed out the seekers. Some of them become "frequent flyers".. best way to be rid of them is to give them what they want.
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