Pain, Medication and treatment

Discussion in 'Health and Fitness' started by mercurydancer, May 1, 2008.

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  1. mercurydancer

    mercurydancer LE Book Reviewer

    My ears pricked up on the comment about "pain medication arriving hours late" This is a situation I encounter regularly in my professional capacity. In general, pain medication doesnt arrive late, but is generally given withhin an acceptable time frame. What is much harder to do is to actually give enough pain medication to control the pain. Side effects from analgesia can be very severe, including stopping breathing, so we usually work to an "analgesic ladder" where the minimum pain relief is given, then a period is taken into account for it to work, then more given if the patient is still in pain, until comfort is reached. This may take several hours to achieve satisfactorily, but its way different from a patient not recieving any medication whatsoever.
     
  2. That is all very convincing, but having spent a considerable time in NHS hospital in considerable pain I can state categorically that analgesia is often late, not strong enough and can be completely different depending on which nurse gives it to you.

    This is down to the shocking organisation on wards, too much pressure on nurses (not enough of them) and general lacsidasical practices

    I have had to get out of bed and actual grip nurses to get post op pain relief to patients rolling around in agony

    I had to "Negotiate" with a nigerian nurse who thought I didn't need any oramorph, even though it was written up

    Nurses missing doses, not sticking to the timings, dipping off the pain plateau

    Don't even start me on hand washing etc
     
  3. mercurydancer

    mercurydancer LE Book Reviewer

    Gimp

    That is exactly what I'm getting at...

    Analgesia not being strong enough? Usually it is but needs carefully evaluating otherwise it can go pete tong and I mean death pete tong. Respiratory depression? toxic overload? liver failure? If these things dont mean anything to you then they should.

    Being written up for an opiate doesnt mean it has to be given, and if I was a nurse, which I am (the implicit racism that the nurse in your case was Nigerian will be overlooked) I would carefully measure if the patient seemed to be in pain or not. If you think this is negotiation then so be it. I would call it assessment. Also if there wasnt enough time elapsed between the last dose or that there was any kind of anomaly then I would defer giving the medication. Often people recieve opiates then go to sleep, then wake up when the pain stimuates them to wake up. I would be cautious about giving another dose to a newly awakened patient.

    The pain control regimes are broadly the same but may be applied in differing ways according to the analgesic ladder. Another medication may be given as well as opiates, eg paracetamol may be given with opiates but as your liver may completely feck up and kill you if you exceed a certain dose of paracetamol, the nurse may not wish to give you more than 8g per day.

    Oh... you have "gripped" nurses??? Do you mean assault them? Do you think its acceptable to EVER do that? I assure you that if you "gripped" any nurse I had responsiblility for you would be facing a criminal charge. If you "gripped" me I would warn you not to do it and if you persisted I would deck you. Self defence.

    And for interfering with care for other patients? Are you qualified? Even so, if you have had oromorph then I would trust you to evaluate medication in the same way I would trust someone to drive me home after 8 pints of Stella.

    Gimp.. leave it to the professionals. We know what we are doing. Please dont use pseudomedical phrases like " dipping off the pain plateau" as you clearly have no idea.
     
  4. mercurydancer.... with respect.....you clearly have never served in the military if you do not know what being "gripped" is , having spent time in military hospitals in the 70s......and spent time our current civilian hospitals which are "cr*p" with poor hygiene, poor care and very poorly managed...I am not sure "professional is a word I would use for your trade!
     
  5. mercurydancer

    mercurydancer LE Book Reviewer

    dante

    With respect I have served in the military. Your assumption is incorrect.

    As the local military hospitals have been closed, at the Trust I work for we have a sizeable cadre of military medical and nursing staff for whom I have some responisbility, so I do have a considerable insight into the way soldiers are treated within an NHS environment. As with everything else I will serve the military with profesional skill.

    If its a reference to "gripped" it can mean anything from a verbal admonishment to an assault, but I think you know that.

    I will take exception to your comment that nursing is a trade. No, its a profession and I will defend that extensively. Professionalism is something I maintain and will do as long as I deal with patients be they military or civilian. Would you rather have someone like me caring for you who takes pride in thier career or someone who doesnt give a shit?

    BTW I am a severe critic of the NHS system as much of the way it is being managed both locally and governmentally is abysmal but I try to make the criticism constructive (OK I might take the p*** sometimes) and not to perpetuate misconceptions hence my comments to gimp.
     
  6. Exactly what I'd expect from a fecking nurse, got an answer/arguement for everything. Just fails to address the simple, basic stuff like hygiene, basic care, etc etc

    I hope you pick up on the fact that I have mentioned nurses of different nationality again, (not implicit racism) this is because from my point of view they provided me with a less professional service, perhaps this is why they are "Hidden" on the nightshift and the UK nurses appear to do the day shifts (Not sure whats that is pointing to but something isn't right with the management system, you tell me )

    The nurses I have experienced have been demoralised, angry and bitter and defensive if any part of their daily activities are questioned ( an example would be asking a nurse to alcohol gel her hands after handling another pt then moving on to me)

    What apppeared to be left on the wards were the nurses that hadn't managed to escape to some exotic nursing speciality or management

    The plural of anecdote perhaps isn't evidence. But my experience in an NHS has been terrible and I'm more than happy to pay my private health insurance now

    To finish on a positive note, all the military nurses I saw were motivated, seemed to work harder and faster than their civvy counterparts and had better rapport with the pts
     
  7. Exactly what I'd expect from a fecking nurse, got an answer/arguement for everything. Just fails to address the simple, basic stuff like hygiene, basic care, etc etc

    The Pete tong death blah blah blah bit is hyperbole, drugs are written up by doctors, nurses need to dish them out as prescribed, being told by a pt that they are in pain and having a dose written up (and due) but not given by a nurse is not good. Argue as much as you want, I knew what was on my chart, I knew when it was due and I certainly knew I was in pain

    I hope you pick up on the fact that I have mentioned nurses of different nationality again, (not implicit racism) this is because from my point of view they provided me with a less professional service, perhaps this is why they are "Hidden" on the nightshift and the UK nurses appear to do the day shifts (Not sure whats that is pointing to but something isn't right with the management system, you tell me )

    The nurses I have experienced have been demoralised, angry and bitter and defensive if any part of their daily activities are questioned ( an example would be asking a nurse to alcohol gel her hands after handling another pt then moving on to me)

    What apppeared to be left on the wards were the nurses that hadn't managed to escape to some exotic nursing speciality or management

    The plural of anecdote perhaps isn't evidence. But my experience in an NHS has been terrible and I'm more than happy to pay my private health insurance now

    To finish on a positive note, all the military nurses I saw were motivated, seemed to work harder and faster than their civvy counterparts and had better rapport with the pts
     
  8. Goodness me! I hope you are not claiming to be a qualified professional when you say that a nurse may not want to give more than 8g a day. If they did, they should be disciplined! The maximum dose is 8 x 500mg tablets (4g) a day. It's mistakes like that that cause toxicity problems.

    Before spouting off, please check your facts.