Sickle cell - page 2

Ok...here's a question that I've asked frequently at work, but I'm not totally satisfied with the answers I get. We seem to get sickle cell patients (whom many we find are not sickeling at the time) who come in to the ER for... Read More

  1. 1
    Quote from CamaroNurse

    And when I was having surgery, I had to receive Benadryl for narcotic-induced itching, so it's not just Sickle Cellers, but it makes sense that they ask for it. After all, they receive TONS of narcotics due to tolerance and they already know narcotics cause itching.
    I agree. They have usually dealt with it for so long, they probably know to ask for Benadryl. I'm sure other chronic pain sufferers know that, too, but maybe the OP hasn't had any patients like that? I read that Phenergan can cause dehydration, so that would intensify a sickle cell crisis. Maybe some patients have had that reaction and feel Benadryl is safer?
    Last edit by AnaCatRN on Apr 21, '10 : Reason: Clarification
    DeLanaHarvickWannabe likes this.

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  2. 1
    Quote from AnaCatRN
    Oh, well if she doesn't have any sickled cells, she most likely doesn't have it. It is possible for someone with sickle cell trait to have pain, but that would involve rapidly entering high altitudes or extreme dehydration, but there would be sickled cells present in the blood if that were to happen. I guess she would be a drug seeker, possibly, then. That's even worse than people ignoring a true sickle cell patient's pain. To pretend to have it to get pain meds is evil! As far as the benadryl goes, I looked it up in epocrates, and it does potentiate narcotics, so it would, indeed give the patient more pain relief, but I can't imagine it giving a high to anyone, unless they think feeling high is like having a bad hangover. I never could understand how anyone would want to get high on narcotics. They make me feel absolutely awful, so I avoid them. But that's just me, I guess.
    I totally agree...I have never even had a narcotic, they must be pretty good considering the amount of people who walk in demanding more and more! All the dr.s I've asked have said it potentiates narcotics. How come all the drug seekers we see in the ER haven't figured this out?? lol We give alot of phenergan with pain which is alot like benedryl, but the sickle cell patients dont like it. I dont know. Im so glad that the dr. last night had the b**** to run the test. I'd like to treat people who are truly sick and in pain....
    AnaCatRN likes this.
  3. 0
    Quote from inteRN
    There is no way you would not get addicted to pain meds if you were constantly in pain. If I took narcotics everyday for a month, I would build up a tolerance I think. Its sad I agree, and yes they are dependent somewhat on pain meds.
    But, we have had some patients come in claiming they are having a sickle cell crisis and labs are done which prove they are not in a crisis. The lying, making up fake names, telling nurses and dr's how to do their job, and deceitfulness is what is sickening. We do get a fair share who are in crisis, but they don't act that way...
    Wow. I can't imagine being so bold as to lie about something like that. That's ridiculous. All sickle cell patients have at least some sickled cells in their blood. Don't the fakers know how easy that would be to check? Are they that shameless? Wow. All I can say is wow. Real sickle cell patients may have a tolerance or dependency, but if you asked them, they'd tell you they'd love to never need the stuff again.
  4. 1
    We have several regular SCA pts on my floor, surgery/hem-onc. One of the physicians told me that the Benadryl works as an adjuvant to the Dilaudid or Demerol and allows for more effective pain relief. We routinely give Dilaudid 2-3mg q2-3h (or Demerol 50-75mg) with Benadryl 50mg q4-6h. This seems to work the best for our pts, most of whom are very polite and respectful, and they are very good about not demanding their pain meds before the next dose is due...sure, there are the occassional SCA pts who are a PITA, but the majority on this unit are actually some of my favorite pts.
    wooh likes this.
  5. 7
    I take care of sickle cell pts on dialysis.

    Opiates cause histamine release and benadryl relieves this.

    A peripheral blood smear isn't going to show much except whether the pt has sickle cell disease or not. It does NOT indicate crisis.

    SC pts get started on narcotics early in life, usually tylenol with codeine for pain. So...by the time they are adults, they are very narcotic-tolerant and may require high doses for adequate pain control.

    Of course along with meds should come education:

    1. Stay away from sick contacts.
    2. Stay hydrated.
    3. Try to reduce the amount of stress you are under.
    4. Make sure you follow-up with your hematologist regularly.
    5. Take meds as directed.
  6. 0
    Quote from traumaRUs
    I take care of sickle cell pts on dialysis.

    Opiates cause histamine release and benadryl relieves this.

    A peripheral blood smear isn't going to show much except whether the pt has sickle cell disease or not. It does NOT indicate crisis.

    SC pts get started on narcotics early in life, usually tylenol with codeine for pain. So...by the time they are adults, they are very narcotic-tolerant and may require high doses for adequate pain control.

    Of course along with meds should come education:

    1. Stay away from sick contacts.
    2. Stay hydrated.
    3. Try to reduce the amount of stress you are under.
    4. Make sure you follow-up with your hematologist regularly.
    5. Take meds as directed.
    My question is why is it only and every SC patient I have ever seen in the ER wants benedryl. Does it have to do with the actual SC causing this "itching"??
    Every non sickle cell patient I have ever given an opiate to never has asked for benedryl...
  7. 2
    I've had plenty of non-SC patients want their benadryl. But benadryl is a standard part of the orders when I care for a SC patient. SC patients tend to have docs that actually care about controlling their pain, they standardize the care, and the patients get used to getting benadryl, and they know to ask for it.
    The patients who know what to ask for are the frequent flyers. SC patients tend to be frequent fliers because they need their fluids and O2, which you can't do at home.
    hiddencatRN and AnaCatRN like this.
  8. 2
    Quote from inteRN
    My question is why is it only and every SC patient I have ever seen in the ER wants benedryl. Does it have to do with the actual SC causing this "itching"??
    Every non sickle cell patient I have ever given an opiate to never has asked for benedryl...
    I don't think the SC causes the itching. I'm thinking it's because that is what they've been given before, not only for the itching, but for the added pain relief. Also, perhaps the continuous exposure to the narcs makes the itching more prevalent or intense. The more exposure you get to an allergen, the more severe the reaction. They know their disease. They know what works. Most other patients may not be chronic pain patients, so they haven't had that combination, and it wouldn't occur to them to ask for it. Pain medicine is not understood by everyone, and most chronic pain patients don't get adequate treatment at all. I'd bet that as more chronic pain patients (non-SCA) get better treatment, they'll start asking for the Benadryl, too.
    canoehead and wooh like this.
  9. 0
    Quote from AnaCatRN
    Pain medicine is not understood by everyone, and most chronic pain patients don't get adequate treatment at all.
    SC tends to be one of the few diagnoses that are treated seriously for pain control. And I'd agree, they know what works. And they aren't going to give up something that treats their pain just because it itches a bit.
  10. 5
    Also - you need to look at the dosing of the opiates given for SC pts: most are very tolerant and need much bigger doses than someone who is opiate-naive.

    With the higher doses of opiates, you have more histamine release so that is why it is routine to give benadryl with the opiates.


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