Medication tidbits an ER nurse should always know - page 5

Hi all...I am currently doing an externship in the ER and even though I can't administer medications, I've picked up on a lot of important facts you have to remember about certain medications from... Read More

  1. Visit  Anoetos profile page
    2
    I read up on the hypotensive effects of dilaudid and they're actually negligible except with chronic use. I did this after a patient died on me.
    turnforthenurseRN and psu_213 like this.
  2. Visit  turnforthenurseRN profile page
    0
    Dilantin should only be mixed with NS; other diluents can cause it to crystallize.

    Valium cannot be mixed with anything, not even NS.
  3. Visit  Sassy5d profile page
    0
    [QUOTE=

    Valium cannot be mixed with anything, not even NS.[/QUOTE]

    I have not given Valium iv yet, if u can't mix due to potential for crystallizing, how do you give it? And there's no risk when u flush the line?
  4. Visit  CP2013 profile page
    0
    Quote from Anoetos
    I read up on the hypotensive effects of dilaudid and they're actually negligible except with chronic use. I did this after a patient died on me.
    I just didn't want her to get the high. She kept showing up with vague complaints and hopping from ED to ED and managed to convince a doctor admit her AND prescribe dilaudid for toe pain.

    No fast push for you! Over 1 minute per syringe! She was getting 2mg q6h and was requesting morphine q4h for "breakthrough" toe pain.

    It took everything I had not to roll my eyes.
  5. Visit  emtb2rn profile page
    1
    Quote from turnforthenurseRN

    Valium cannot be mixed with anything, not even NS.
    Dunno about that. There are 2 studies that say it can be added to NS or D5W. Check RxMed: Pharmaceutical Information - VALIUM and Compatibility and stability of diazepam injection following dilution with intravenous fluids (yeah, yeah, I know it's from '78). Interestingly enough, our internal medication program returns a message of "]Results uncertain, variable or dependent on conditions"
    turnforthenurseRN likes this.
  6. Visit  Anoetos profile page
    0
    I think sometimes patients get caught up in a cycle which ends up generating narcotic dependency and we are as at fault for this as they are.

    Let's say they get a spinal fusion which never really takes, sure, their spinal cord is now protected and intact, but they still are dealing with chronic pain. They get scrips for Vicodin and Oxy which they never really get off of and they require higher and higher doses just to manage the pain and they don't really have anything for breakthrough. So they come to the ED, where we call them "seekers" and deny or at best dilute their pain control measures.

    CP I am NOT saying this is the case with the pt you're talking about. I am just pointing out that we, just because we're nurses, don't necessarily always know what is best for every patient.

    Frankly, if it's ordered, I give it. If the pt isn't opiate naive, I don't cheat them just because I have moral qualms about the choices they may have had to make due to a medical condition.
  7. Visit  Anoetos profile page
    0
    But more directly to your case, why deny the pt what they want? If they have a high tolerance to opioids it's unlikely that 1mg of dilaudid is going to do much for them. Certainly not as much as for the naive. The likelihood that you'll do them harm is very small also.

    Again it comes down to judging our pts and while it's certainly true that we use our judgment to assess them, that's not the same thing. I guess I just don't understand the gatekeeper mentality many nurses have about opioid pain meds. They are actually metabolically, very benign and only a hazard to a pt who is already severely hypotensive or in respiratory distress.
  8. Visit  Sassy5d profile page
    0
    But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it, and I know the pt will be so thankful I just got them high.
  9. Visit  Anoetos profile page
    0
    Quote from Sassy5d
    But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it, and I know the pt will be so thankful I just got them high.
    Ok, but how do we know that? If pain "what the patient says it is" and if people living with chronic pain are able to sleep with it except when it flares into breakthrough and otherwise might not show vital symptoms, how do we know?

    All I know is that I didn't become a nurse to be a judge. If I wanted to be a judge I'd have gone to law school, and if I'd wanted to be a cop, I'd have gone to the academy. Patient safety is one thing. Would I give dilaudid to someone who was in severe respiratory depression just because it was ordered? Of course not. But that's not what we are talking about here. Here we are talking about nurses who take it upon themselves to decide when and how much pain medication the patient needs.

    As for the real seekers: the IVDA's who hop from hospital to hospital, our docs don't give them anything but Tylenol or Motrin, maybe Toradol if it's flank pain this week.
  10. Visit  Anoetos profile page
    0
    But I feel like I've derailed the thread with my rant. Sorry about that folks. I yield.
  11. Visit  Esme12 profile page
    0
    Quote from Sassy5d
    But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it, and I know the pt will be so thankful I just got them high.
    while I don't always mix it in a IVPB I never push it fast...that is not how the PDR says it can be given.

    Dosing:
    IV: (opiate naive) Start: 0.2 - 0.6 mg q2-3h prn. Pain, acute: 1-2 mg IV (slow - over 2-3 min) q3h prn.

    If they complain that is too bad.
  12. Visit  lvnlrn profile page
    1
    I drew up Valium and put it in a 10 cc syringe of saline. Immediately it precipitated, turning into a nice cloudy mixture. I had to waste the syringe and put the second dose in a 3 cc syringe. I had no precipitate in the pts line when I flushed with saline after giving it. Hth.
    turnforthenurseRN likes this.
  13. Visit  lvnlrn profile page
    0
    Artemis Safe Dose Pro iPhone app is my go to app for double checking peds meds before giving them. I've caught overdosages with it. You just enter how many kgs they weigh, the med you're giving, and it tells you how many mgs to give, and figures out the mls to give based on different strengths of the med available.

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