[msnursekim]

I NEED SOME INPUT HERE...I'M GETTING TEASED AT WORK AND CALLED THE"TYLENOL QUEEN" BECAUSE I GIVE TYLENOL OR PAIN MED ORDERED TO MY DEMENTED PATIENTS THAT CAN'T ASK FOR THEIR PRN'S OR DON'T REMEMBER THEY HAVE PRN'S TO TAKE. I DON'T GIVE THEM JUST BECAUSE...I USE BODY LANGUAGE AS ASSESSMENT TOOL OR ASK "HOW ARE YOU FEELING TONIGHT" IF THEY CAN TALK AND GO WITH WHAT THEY TELL ME. IF THEY SAY, "OH, THIS WEATHER IS MAKING ME ACHE ALL OVER" OR SOMETHING SIMILAR I WILL ASK DO YOU NEED SOME TYLENOL OR SOMETHING TO HELP RELIEVE YOU? NINE TIMES OUT OF TEN, THEIR RESPONSE IS YES. MY CO-WORKERS OBJECT BECAUSE THEY SAY, WELL THEY WILL ALWAYS SAY YES. I DON'T AGREE. I DON'T FEEL MY CO-WORKERS ARE LISTENING OR OBSERVING WHAT THEIR PTS NEEDS ARE...DON'T HAVE TIME ETC. ANOTHER REASON FOR THEIR OBJECTIONS IS AT OUR FACILITY, TYLENOL HAS TO BE SIGNED OUT SIMILAR TO A NARC AND IT "TAKES TO MUCH TIME OR TROUBLE" FOR THEM TO DO SO UNLESS THEY ARE SPECIFICALLY ASKED FOR A PRN. AM I WRONG IN TRYING TO HELP RELIEVE DEMENTED PERSONS ACHES AND PAINS ESPECIALLY WITH A DX OF ARTHRITIS IF THEY CAN'T ASK FOR IT?

[scrmblr]

I would enjoy the title. Don't worry about what your co-workers say. Give your pt's the best care you can.

(ps...all cap's makes me feel like you are yelling at me:lol)

[mamason]

demented pt's feel pain too. you are right to read their body language and such. i believe you are trying to give your pt's the best care possible. don't worry what other nurses think. unless there's a problem that contraindicates pain meds such as loc, blood pressure, respirations, etc.

[Cameron67]

msnursekim enjoy the title that is what a nurse does...assess the patient for a need and handle that need. Residents with dementia for the most part are unable to state they are having pain, it shows up in behaviors, such as acting out or maybe just as not wanting to eat. If you give a pain med and it doesn't seem to work then we assess for more pain med or is there something else going on...such as a UTI or some other infection. Enjoy the title you deserve it because you are doing your job!

[michelle126]

Forget about you cows. What you are doing is assessing your residents for pain. Res who are not able to communicate verbally show the nonverbal signs. That is why we have pain assessment charts for demented or nonverbal res.
Pain assessment is such a biggie now with the state. Heck...pain is the 5th vital sign now, huh. Doesn't it tie in with the quality of life f tag? I'll bet you might notice less behaviors, better sleeping and eating and better overal functioning of those residents who are being assessed and treated for thier pain.

Side note....all of my demeted pts with UTIs get Tylenol prn. Having just gotten over some bad ones myself...I feel so much for them. No wonder you see and increase in behaviors with UTIs.

BTW...what type of narc like procedures do you have when sighning out tylenol? We chart the same for all pain meds...mark it off on the mar, place a note on the back of the sheet (why, when, initals and results) and also mark them off on our pain assessment flow sheets in the MAR. Only difference is the narcs are under double lock. Just wondering.

[earle58]

one of my biggest pet peeves is when nurses write "denies pain".
my experience with dementia pts, is often, their agitation is symptomatic of pain or some other etiology.
also i find that most cannot answer accurately, when asked if they're in pain, are hungry/thirsty....it truly takes keen assessment.
most elderly have a dx of djd/oa/ra.
the dx alone should be indicative of the potential and reality of their pain.
when i routinely give tylenol and see a mental status change from agitated to pleasant and even happy, that is confirmation enough for me.
when i can safely identify this pattern, then i get a scheduled order from the docs.
of course dementia pts have pain!
just as 95% of our elderly do.
thankfully, tylenol usually does the trick.
but it is our duty, to keep our pts free of pain, whether it is physical, emotional/mental or spiritual.
why is that such a hard concept for some to understand?

leslie

[msnursekim]

First of all, sorry for the caps, just easier for me to type without typos. We have to sign out tylenol just as if it was a darvocet, tyl #3, etc... because of our pharmacist. She thought it was a good idea to track use and yes they are locked up with narcs. Her quote, tylenol is for pts, not employees! She had aproblem in the past with pilfering of stock tylenol.Thanks to all of you for your validation...made me feel better. I was beginning to doubt myself,but as you have stated, dementia pts do have pain and a quiet restful night for all of us is the results of giving them their prns. Thanks again!

[RGN1]

Good on you is all I can add to this! Be proud of your new title - perhaps you can get a badge made up with that on it

[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.

[txspadequeen921]

If the patient say's they are in pain then they are. Period. It is not my job to question or deny them pain medication within reason. I dont care what anyone I work with says , if they accuse me of stealing drugs they need to be ready to prove it. I personally have a issue with nurses that refuse to take up for the resident for fear of what others think. I am very anal about making every effort to keep my patients out of pain and I would be disappointed if I was in pain and my nurse fumbled around about it.