 Hi guys! Today I want to talk about when your patient says their pain is a 10 out of 10 on the pain scale and you clearly know that their pain is not a 10 out of 10. Recently I had a student who actually helped inspire this idea because we had a patient who was saying that pain was a 10 out of 10 but clearly it was not a 10 out of 10 and she said to me you know actually in nursing school we're taught to like when a patient says they're in pain they're in pain and that you treat that pain no matter no matter what and I said I agree that's what I was taught I was taught that when a patient says their pain is a 10 out of 10 you treat it like it's a 10 out of 10 but as I have worked as a nurse I have realized that there are several situations where patients say this and you know it's not a 10 out of 10 and you have to in a respectful way elaborate that to the patient and usually they don't take it very well but our job as a nurse is solely to keep patients safe and if by giving pain medicine to treat a patient's pain that's a 10 out of 10 if that's going to compromise their safety then that is a situation which it is not okay to give that patient pain medicine so a lot of the times the situations you see people who have 10 out of 10 pain are patients who are drug seekers or who have a history of drug abuse who come to the hospital and the medications that are ordered for them for their pain are in no way going to add up to the amount that they were taking on the streets for example I had a patient who was in who had um prniv morphine and then also uh prn oxycodone that was pio and the patients said they were in pain I went and grabbed the two milligrams of morphine because that was ordered and um as I'm giving it to this patient this patient said like how much I said well it's two milligrams and they said well I was taking up to 500 milligrams a day on the street of morphine and I'm like you know I'm sorry but like that's not safe we're unable to meet that so a lot of times these patients are ones who have a very very high pain tolerance so to them their pain is a 10 out of 10 but what we're seeing is something different so when back when I worked med surge uh little story time I had a patient who used a lot of narcotics and um basically was using these narcotics to kind of numb herself to the world and I every time I walked past this room the patient was literally falling asleep almost like falling out of bed because she refused to put the side rail up or lay back she was sitting on the edge of the bed like slumping over almost falling out of the bed and several times I mean I educated this patient on you know safety and risk of falling all those things but you know in the end patients sometimes choose to do what they want to do and you just have to respect that and they know the risks and they know the benefits and you just leave it at that and this patient would constantly tell me their pain was a 10 out of 10 obviously if you've been a nursery and nursing school you know that pain medicine makes you sleepy part of an effect of pain medicine is making you uh more tired or is a sedative and this patient said my pain's a 10 out of 10 and as a nurse I knew that it was not safe for me to give this patient more pain medicine because every time I walked by her room she was asleep slumping over getting a little bit confused things like that so I respectfully told this patient when she said her pain was a 10 out of 10 I said I understand that you're telling me your pain is a 10 out of 10 but what I'm seeing is that every time I walk by your room you're very very sleepy and if I give you more pain medicine that's just going to make that effect worse and my job as a nurse is to number my number one priority is to make sure that you're safe and giving you more pain medicine means that you're not safe and I'm not doing my job as a nurse if I give you too much and you're too sleepy you can lose your airway you can your breathing can be compromised and those are all things that are very harmful to your health and of course this patient didn't agree with me but you just have to stand your boundaries and yes you'll chart that the patient states that their pain's a 10 out of 10 but then in a nurse's note you can write patient's pain's 10 out of 10 nurse is observing this patient is very lethargic falling asleep at the bedside blah blah blah all of the subjective and objective things that you are seeing when you assess this patient so yeah I'm not saying that you should tell a patient your pain is not a 10 out of 10 you should acknowledge what they're telling you but then if it's getting to a point where like you know it's not safe to give them more pain medicine you really need to help educate this patient and be respectful be appropriate and just tell them what you're observing and what your role as a nurse is of course our role is to treat pain but our number one role is to keep patients safe and if treating their pain is not making them safe then you don't treat it I hope that kind of simplifies things for you guys I know when you're first a new nurse I did the same thing it's very hard to stick up for yourself and tell patients things when you know it's just going to make them angry when you say no I'm not going to give you any more pain medicine but I guarantee doctors will back you up on this oh hey isn't that a beautiful face so I wanted to add in here really quick that you can always blame it on the doctor like you've reached your max limit of pain medicine the doctor hasn't ordered anymore the doctor said that they were not going to order any more pain medicine for you and you can always blame it on the doctor so to speak that that is the reason why you can't give them any more pain medicine at least in my experience they have if you tell them hey this patient is going to ask you for more pain medicine but this is what I'm observing then the doctor is going to say sorry I'm not going to give you any more or we're going to change this because it's obviously making you too sleepy thank you guys for watching this video if you have any other questions leave them in the comments below if you have any situations where you've dealt with something like this what did you say what did you do what did you observe leave that in the comments below give us a thumbs up and subscribe to my channel and I'll see you guys next time bye