First I would like to preface this by saying I am a new nurse, with 4 months on the floor experience only.
Second, I have limited access to net these days, so I may not be able to respond frequently to any replies on here, but will greatly appreciate any and all posts
Okay, so I work on a busy TCU, alst week new patient "Jane" comes in. Jane is a 40 something yr old, morbidly obese diabetic with many mental health dxs. She is admitted for recovery from a fall she had in which she fractured her left elbow, fractured two ribs on the left and bruised some on the right. By her own admission, she was on vicodin when she fell, for no apparent reason.
Okay, so when I go to meet her, Jane is slurring her words and slumped over in bed- I go to double check her meds, and this is what I find
zoloft, 150 mg
Ultram 100 mg q4
(I don't remember all the doses off hand, but I know they were all at or near the highest allowable limit)
Umm, what? I know breaks are painful, and pts who have abused drugs have a high tolerance, but holy crap..
I did NOT feel safe giving this person this many drugs- she was injured due to a fall, are we trying to have that occur again???
So I pass it along to the NP on call and she dc's several ( vicodin and roxenphol) and chages the perc and oxy to q8
Now the patient is all over me, asking for pain meds EVERY HOUR ON THE HOUR, but also flat out refuses to try any other non-pharm methods, such as an ice pack or guided relaxation/imagery that our OT's offer.
She is driving me NUTS but now I feel bad too- did I do the right thing? This pt seems to feel there should be NO pain, but that is also not reality- any insight would be much appreciated!