[cotjockey]

I have the same sort of reputation...only my coworkers feel that I am too generous with narcotics. We have a resident with a long history of drug and alcohol addiction. He also has a history of several MVAs, arthritis, falls, and a work related back strain. He has taken percocet on a routine basis for years. Now, he complains of pain on a regular basis...he says no matter what we give him, he is never pain free. So, I routinely give him the dilaudid and percodan he has ordered...he can have them each every 6 hours, so unless he is asleep, I give him something every 3 hours. Usually, he asks for his meds, so it's not like I am just giving them without assessing or anything. I honestly think he is in pain...I also think he is an addict. I worked with a physiatrist for a while and I agree with his belief that addiction is a choice...I shouldn't encourage his addiction, but if he says he needs the meds, then he needs the meds. A lot of the other nurses will tell him he still has an hour before his next dose even if it is time or who will give him an ativan instead of dilaudid. We also have nurses who will make him go for long periods without narcotics. He has a habit of staying awake for the greater part of three or four days and then crashing for 24 hours straight...it is something he has always done. When he is on his 24 hour crash, I will wake him up at least once to take either the dilaudid or percodan...otherwise, he has been known to go up to 36 hours without anything...then we have a hard time playing catch-up with his pain (and his addiction).

I have no problem giving pain meds to other residents on a routine basis as well. A lot of times, even the residents who are not cognitively impaired either don't ask for pain meds, don't want to become addicted, don't want to make extra work for nurses, or whatever. It is our job to look for the cues that they are in pain and assess and medicate appropriately. I don't think it is my place to decide that they are taking too much of something or that they don't need something (unless there are definite signs that they are). Simply because I don't think they are in pain does not mean that they aren't.

[cookie102]

how wonderful it is that someone takes the time to assess/address ALL pt needs, if anyone of us has dementia, won't it be great to know there are nurses out there that really will take care of us. thanks!!!

[Patti 2nd gen RN]

Don't worry--you will be called much worse things than someone who is extra concerned about something. But be careful you are not masking a temp, and watch Liver functions. We have a psych CRNP who writes Tylenol orders Q 6 hrs standing--I hate that--because why wake someone with no s/s of pain? Follow your nursing judgement--it is your name and your license--MAKE a name for yourself, before they call you something worse. And if you laugh about it, and keep doing what you know is right, they will get over it. And your confidence may start themlooking at thier own practice.

[RGN1]

Originally Posted by TheCommuter

Unfortunately, I work at a facility that will scrutinize nurses who sign out "too many" pain medicines because they're suspected of stealing. The nurse who signs out more medications than any other person is suspected of pocketing the extras. Therefore, I try to avoid giving "too many" pain meds because I need my job right now.

I think that's ridiculous. Surely you sign the patient's chart each time you give the med, so they can see it all ties in? I think it comes to something when a patient has to suffer because their nurse is worried about giving them their pain meds!

This is a criticism aimed at your facility by the way & in no way at you personally at all. I fully understand your reasoning but I just wonder how your management would feel if it was them or their relatives that were suffering?

[suebird3]

I would continue the pain meds, too; just remember the Max. dose of Tylenol (and tyl. containing products) can be 2400 mg. a day.

I would love having you work with me!

Suebird

[rn/writer]

Originally Posted by suebird3

I would continue the pain meds, too; just remember the Max. dose of Tylenol (and tyl. containing products) can be 2400 mg. a day.

I would love having you work with me!

Suebird

Is the standard 4000 mg/day reduced for the elderly?

To the OP: you are doing for your patients what I would want done for me. Unless there are contraindications, most older folks could probably benefit greatly from routine doses of Tylenol. Few people over the age of 60 don't have some arthritis and stiffness. Pain can be an unarticulated source of agitation in dementia patients. Your patients are fortunate to have someone like you looking out for them.

[MarySunshine]

I'm the exact same way. It's more difficult on my unit sometimes because I work in neuro and the physicians are always terrified of "oversedating" someone and masking real neuro changes. However, I assess pain as regularly as all my other vital signs and I treat it efficiently if it is within my ability to do so.

If someone has a cardiac problem they are not "addicted" to their cardiac meds, so that if someone has a chronic pain problem I would not say they are "addicted" to the pain meds unless the med use itself is HURTING the patient in some way (health/family/job/relationships) or they use it inappropriately (for a high).

I don't think that all health care professions actually realize how much pain affects a person's hemodynamics. You're not just going to have a calmer patient -- you're going to have a healthier (aka EASIER) patient if you just treat their pain!

[suebird3]

OK..was half asleep here.....sorry! Was trying to remember the max dosage and ditzed.
I have so many rezzies who try to get 500 mg of ES Tylenol every 4 hours, PLUS other Tylenol based products, we devised a plan incorporating said products. So far.....seems to be working. That is where the 2400 comes from.

[rn/writer]

Originally Posted by suebird3

OK..was half asleep here.....sorry! Was trying to remember the max dosage and ditzed.
I have so many rezzies who try to get 500 mg of ES Tylenol every 4 hours, PLUS other Tylenol based products, we devised a plan incorporating said products. So far.....seems to be working. That is where the 2400 comes from.

2400 mg is also the max for ibuprofen.

On our postpartum unit almost all patients start with ibuprofen for pain management. Then the vag deliveries with severe cramping, perineal trauma, and almost all c/s patients can have either Percocet or Darvocet. The problem is that some of the docs prefer that we give Darvocet which isn't as strong narcotically AND has twice the Tylenol (650 each as opposed to 325). I prefer to give 2 Percs q 4 hours (total for the day--3900 mg) which seems to give very good coverage vs. 1 Darvocet q 4 (also 3900 but far less narc analgesic). The docs don't have to listen to the patients tell them they are still hurting. We tell them, but our reasoning doesn't match up with their protocol. I think they're so paranoid about people becoming addicted that they aren't really paying attention to the difficulties we and the patients are facing. Maybe if we get enough patient complaints . . .

[suebird3]

One resident stands out in particular. Had end stage liver failure, d/t using Tylenol secondary to a back injury. Lord, she was in pain, and we had to really watch it cuz of the disease progression. I will never forget the whole situation.