Hello all
My blog this week is about how high levels of pain can greatly affect treatment, which I know has been brought up as an issue by other people. A lady that I am treating as an inpatient at of the major hospitals is suffering from severe back pain which she is rating at 9/10 at rest and 10/10 with any movement. She claims that the only thing to relieve this pain is supine lying and subsequently this is all that she does, and she did not get out of bed all one weekend. Now obviously we all know how bad this is for pretty much every system of the body, and to add to it she is elderly and so is at increased risk for developing complications as a result of bed rest.
However, when I have tried to get her out of bed on two occasions and try to make her walk she is in such high levels of pain to the point that she is screaming, crying, hyperventilates after a few metres of walking and once vomited as a result of her pain. She is already taking extremely high doses of pain medication, predominantly narcotics. I find it quite distressing to continue to try and make her get up out of bed as it is clearly so painful for her, and I feel as if the nursing staff see me as being cruel to her.
This is where having a really open, supportive supervisor is appreciated, as I brought it up with her and we then saw the patient together. The supervisor was able to make the judgement call that continued attempts to mobilise is important and I should keep up with it, however discussed with me that fact that issues needed to be brought up with the doctors as soon as possible as a patient experiencing this level of pain should not be happening, which she then fully backed me up on when I spoke to them.
I feel that sometimes it is hard to weigh up how far you can go with someone who is in extreme pain, as we know the consequences of prolonged bed rest, and at this point it is still really good to have an experienced supervisor to help me to make the judgement call and reassure me that what I was doing was correct.
Has anyone else had similar dilemmas when treating inpatients?
1 comment:
Hi Mel,
On my last placement I had an outpatient with similar pain levels, 9-10/10 but the pain was in her knee. Like your patient, she was on really high pain meds. The thing she found most excruciating was moving her knee into extension and adducting her leg. To treat her I had to get her into supine and straighten her knee, and this always caused agony and she would sometimes cry or yell. It really distressed me too because I felt like I was harming her and that the people on the other side of the cubicle would think I was doing something wrong. Like you, I spoke to my supervisor to check that my treatment plans were the best option and she reassured me that it was in the patient’s best interest to continue even though the patient was in so much pain. I was able to follow this patient over the next four weeks and she actually made some improvements in pain toward the end which was great to see and improved my confidence.
I think you did great by checking with your supervisor that you were doing the right thing because it is not the norm that patients are in such high levels of pain. I also think it’s great that you were able to discuss the patients pain levels with the doctors. I wish I had been able to do that with my patient because changing pain meds may have enabled us to do more with her rehab.
Mel H
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