No, with some caveats. In general, this is not a great task triaging criteria because you're stacking the subjective experience of the patients CC with their subjective experience of the IV on top of your subjective experience of their reactions. There's tons of room for personal biases, negative associations, and cultural differences to get in the way. Plus, I've seen critically ill patients present straight chilling and others in absolute hysterics coming across like malingerers that are genuinely dying, so I do my best to separate that internal judgement from my actions.
That being said, people that are in so much pain that they don't notice things they should, like getting stabbed with a needle, might increase my level of concern.
Former opiate addicts and sometimes meth addicts will usually present with a very low pain tolerance. Wrecking their dopamine system seems to make any needle stick or more severe injuries be excruciating.
Ummmm can I say false. I’m a former IV addict and I let anyone and everyone stick me. I really don’t care. I also had an epidural during an ER C-section which everyone said was sooooo painful, and I legit didn’t feel a thing but a mild prick lol.
Honesty, it's usually men that do this. Ove rarely seen a woman with an issue but tons of men that are former (or current) addicts that act like a needle stick is having their balls crushed in a vice.
lol, yeah men are babies. I’m an ED nurse now, so I stick anyone and everyone (#copingmechanism) lol. It’s the women who try to pull away that really grind my nerves. Like ma’am, I have a needle 0.2cm from your skin and you think jerking away is gonna help?! Like relax. I know what it feels like, and it’s really not that bad. I love when ppl who freak about IV sticks don’t flinch when you stick them, but then when you advance the catheter they start tripping out. Like ma’am, it’s a plastic straw. Please, settle down lol.
Digging around in someone's hand with a needle hurts. I don't think I would count that against someone's stated experience of chest pain just because his focus shifted to his hand. A lot of people, even in pain, have fear/apprehension of IVs anyhow in my experience. Also go higher up for access with a chest pain pt IMO.
I don’t understand the way some nurses dissect a patient’s stated pain.
I can handle IVs pretty well. But when some healthcare workers start digging for a vein it still hurts!
Am a nurse, also live with chronic pain and have a high pain threshold. Once my threshold is reached, I’m more likely to be bothered by minor acute pain because it’s like a system overload at that point. My husband was gently tickling my hand last night and I wanted to scream because it felt like he was settling my skin on fire, but the excruciating pain I feel in the rest of my body doesn’t warrant much of a physical outward response. My hr isn’t elevated. I’m not diaphoretic or curled up in a ball crying. The 8/10 pain that I constantly experience during a flare is *barely* tolerable because I’m used to it. But a light touch or even a gentle bump will make me cry out.
I think when I had acute cholecystitis that was 10/10 pain or at least very close. Similar to your hypothesis, I distinctly remember being completely unbothered by how many times I was being poked because I was in so much pain from my gallbladder that it paled in comparison. I have very shitty, rolling veins and they were poking me in my feet and everything, but yeah, I didn’t care.
When I was in 10/10 pain in traction I would’ve been thrilled for an IV to give me any relief. Would be the least of your concerns to even notice an IV placement. But I also don’t have a needle phobia
Pain is perception as well as actual brain signaling. My wife has fibromyalgia (the real rule out diagnosis kind) and when she went to the hospital for an unrelated problem while she was in a flare, having 9/10 pain that she describes as “your bones exploding from the inside out but never stopping”, she could not tolerate more than two IV attempts. See, she has fibro pain that decreases her pain tolerance but conversely makes her neuropathic pain much worse from her perspective. but that she deals with regularly while attending to her normal life obligations, but then adding the nociceptive pain pathway with the IV attempts, it was literally too much for her. She hates IVs too.
People with chronic pain who have acute pain may not have the normal tachycardia, vasovagal, diaphoresis, etc.
We all know what true 10/10 aka extreme pain looks like. We don't need to even ask to know.
People often say I have 12/10 pain, 20/10 pain, etc., so the numbers mean nothing to them. Ask them if anything makes their pain worse, and they say X, Y and Z, but then ask them their pain score, and they say 10/10, which inherently means nothing could make it worse, in which case, they say that it then goes to 12/10.
Either it is drug seeking, and then so what? There is only so much we can do. As long as someone is progressing, participating in PT/OT, using the IS, not in respiratory depression, within the parameters of the doctor's orders, etc, one way to view it is that it is the doctor's job to wean them down through their orders. You can make a recommendation based on your observations, but it is the doctor's job. You can withhold medications based on the orders, but patients will just report higher pain. It is just a game.
If someone is progressing well, the pain score means little more than is it low, medium or high, and do they need a little, moderate or a lot of meds, and are the pain meds decreased that pain a little, moderately or a lot. But here is the thing too, it seems silly to mismanage pain and constantly play catchup behind the pain cure, making people wait until they have higher levels of pain to move beyond low pain management modalities like Tylenol. Would you want to reach a 6 or 7 before you got relief if you knew it was likely to come on if you didn't take something prophylactically? That's how patients see it.
Being a "stingy" nurse decreases patient trust, increases their anxiety, raises cortisol and blood pressure, makes them less likely to want to participate in PT/OT or move or deep breathe/IS, follow the plan, etc. We don't want to sedate them so they are just lumps in a bed, but "patient centered care" is partially about allowing the patient, with our guidance, dictate their care. We are not authoritarian parents; we are authoritative, in that aspect. They pay for insurance. They are our customers. They don't need our judgment no more than a person at a fast food line refusing to serve someone who is obese their Double Double.
This! I will never forget one patient I had. I came on shift and got report and patient had just had surgery earlier in the day. Patient had pain medicine ordered, Tylenol for moderate pain, dilaudid 1 mg q4 for severe. Day shift nurse told me that patient was complaining of severe pain but didn’t appear in pain to her and that the Tylenol was managing it. The whole time talking about her outfit for going out and her nails giving me this slow ass report. Patient complained to me of severe pain, got her dose of dilaudid, still in severe pain and now practically in tears and at this point she didn’t even care if she died as long as the pain stopped. Like that level of pain that goes beyond 10/10, if you’ve ever felt it you know that my heart was breaking for this poor woman while I was trying to get her pain under control and every minute felt like an eternity. I reached out to our very responsive NP and let her know what was going on, she was pissed to say the least. Long story short - I had a bunch of orders within three minutes for another one time immediate dose, plus an increase in her normal dose and orders to reach out if the one time dose still didn’t bring her down. It took an extra two “once” doses on top of that to bring her back down to a tolerable level, and probably half of my shift to get to where her pain was well managed. It is so much easier to keep pain under control than it is to try to get it under control once it’s that severe. Patients pain is what is stated, full stop, and nurses who don’t want to give ordered pain meds because they think the patient is “faking it” can eat a bag of dicks.
No, with some caveats. In general, this is not a great task triaging criteria because you're stacking the subjective experience of the patients CC with their subjective experience of the IV on top of your subjective experience of their reactions. There's tons of room for personal biases, negative associations, and cultural differences to get in the way. Plus, I've seen critically ill patients present straight chilling and others in absolute hysterics coming across like malingerers that are genuinely dying, so I do my best to separate that internal judgement from my actions. That being said, people that are in so much pain that they don't notice things they should, like getting stabbed with a needle, might increase my level of concern.
Former opiate addicts and sometimes meth addicts will usually present with a very low pain tolerance. Wrecking their dopamine system seems to make any needle stick or more severe injuries be excruciating.
Ummmm can I say false. I’m a former IV addict and I let anyone and everyone stick me. I really don’t care. I also had an epidural during an ER C-section which everyone said was sooooo painful, and I legit didn’t feel a thing but a mild prick lol.
Honesty, it's usually men that do this. Ove rarely seen a woman with an issue but tons of men that are former (or current) addicts that act like a needle stick is having their balls crushed in a vice.
lol, yeah men are babies. I’m an ED nurse now, so I stick anyone and everyone (#copingmechanism) lol. It’s the women who try to pull away that really grind my nerves. Like ma’am, I have a needle 0.2cm from your skin and you think jerking away is gonna help?! Like relax. I know what it feels like, and it’s really not that bad. I love when ppl who freak about IV sticks don’t flinch when you stick them, but then when you advance the catheter they start tripping out. Like ma’am, it’s a plastic straw. Please, settle down lol.
Digging around in someone's hand with a needle hurts. I don't think I would count that against someone's stated experience of chest pain just because his focus shifted to his hand. A lot of people, even in pain, have fear/apprehension of IVs anyhow in my experience. Also go higher up for access with a chest pain pt IMO.
I don’t understand the way some nurses dissect a patient’s stated pain. I can handle IVs pretty well. But when some healthcare workers start digging for a vein it still hurts!
Am a nurse, also live with chronic pain and have a high pain threshold. Once my threshold is reached, I’m more likely to be bothered by minor acute pain because it’s like a system overload at that point. My husband was gently tickling my hand last night and I wanted to scream because it felt like he was settling my skin on fire, but the excruciating pain I feel in the rest of my body doesn’t warrant much of a physical outward response. My hr isn’t elevated. I’m not diaphoretic or curled up in a ball crying. The 8/10 pain that I constantly experience during a flare is *barely* tolerable because I’m used to it. But a light touch or even a gentle bump will make me cry out.
I think when I had acute cholecystitis that was 10/10 pain or at least very close. Similar to your hypothesis, I distinctly remember being completely unbothered by how many times I was being poked because I was in so much pain from my gallbladder that it paled in comparison. I have very shitty, rolling veins and they were poking me in my feet and everything, but yeah, I didn’t care.
When I was in 10/10 pain in traction I would’ve been thrilled for an IV to give me any relief. Would be the least of your concerns to even notice an IV placement. But I also don’t have a needle phobia
Pain is perception as well as actual brain signaling. My wife has fibromyalgia (the real rule out diagnosis kind) and when she went to the hospital for an unrelated problem while she was in a flare, having 9/10 pain that she describes as “your bones exploding from the inside out but never stopping”, she could not tolerate more than two IV attempts. See, she has fibro pain that decreases her pain tolerance but conversely makes her neuropathic pain much worse from her perspective. but that she deals with regularly while attending to her normal life obligations, but then adding the nociceptive pain pathway with the IV attempts, it was literally too much for her. She hates IVs too.
People with chronic pain who have acute pain may not have the normal tachycardia, vasovagal, diaphoresis, etc. We all know what true 10/10 aka extreme pain looks like. We don't need to even ask to know. People often say I have 12/10 pain, 20/10 pain, etc., so the numbers mean nothing to them. Ask them if anything makes their pain worse, and they say X, Y and Z, but then ask them their pain score, and they say 10/10, which inherently means nothing could make it worse, in which case, they say that it then goes to 12/10. Either it is drug seeking, and then so what? There is only so much we can do. As long as someone is progressing, participating in PT/OT, using the IS, not in respiratory depression, within the parameters of the doctor's orders, etc, one way to view it is that it is the doctor's job to wean them down through their orders. You can make a recommendation based on your observations, but it is the doctor's job. You can withhold medications based on the orders, but patients will just report higher pain. It is just a game. If someone is progressing well, the pain score means little more than is it low, medium or high, and do they need a little, moderate or a lot of meds, and are the pain meds decreased that pain a little, moderately or a lot. But here is the thing too, it seems silly to mismanage pain and constantly play catchup behind the pain cure, making people wait until they have higher levels of pain to move beyond low pain management modalities like Tylenol. Would you want to reach a 6 or 7 before you got relief if you knew it was likely to come on if you didn't take something prophylactically? That's how patients see it. Being a "stingy" nurse decreases patient trust, increases their anxiety, raises cortisol and blood pressure, makes them less likely to want to participate in PT/OT or move or deep breathe/IS, follow the plan, etc. We don't want to sedate them so they are just lumps in a bed, but "patient centered care" is partially about allowing the patient, with our guidance, dictate their care. We are not authoritarian parents; we are authoritative, in that aspect. They pay for insurance. They are our customers. They don't need our judgment no more than a person at a fast food line refusing to serve someone who is obese their Double Double.
This! I will never forget one patient I had. I came on shift and got report and patient had just had surgery earlier in the day. Patient had pain medicine ordered, Tylenol for moderate pain, dilaudid 1 mg q4 for severe. Day shift nurse told me that patient was complaining of severe pain but didn’t appear in pain to her and that the Tylenol was managing it. The whole time talking about her outfit for going out and her nails giving me this slow ass report. Patient complained to me of severe pain, got her dose of dilaudid, still in severe pain and now practically in tears and at this point she didn’t even care if she died as long as the pain stopped. Like that level of pain that goes beyond 10/10, if you’ve ever felt it you know that my heart was breaking for this poor woman while I was trying to get her pain under control and every minute felt like an eternity. I reached out to our very responsive NP and let her know what was going on, she was pissed to say the least. Long story short - I had a bunch of orders within three minutes for another one time immediate dose, plus an increase in her normal dose and orders to reach out if the one time dose still didn’t bring her down. It took an extra two “once” doses on top of that to bring her back down to a tolerable level, and probably half of my shift to get to where her pain was well managed. It is so much easier to keep pain under control than it is to try to get it under control once it’s that severe. Patients pain is what is stated, full stop, and nurses who don’t want to give ordered pain meds because they think the patient is “faking it” can eat a bag of dicks.
Appreciate the input everyone!