[Spider Cat]

I am a new grad and have been working for only a few months. The biggest question I have on the floor that I haven't been able to get a good answer on is administering pain meds. I had two pts last night - one with Dilaudid and demerol - the other with dilaudid and darvocet ordered. I thought if you gave Demorol for instance you had to wait for the time limit prescribed (q3h or whatever) to be up before giving something else unless it was specifically ordered for breakthrough pain. Some people have told me this because they are both narcotics, others say to wait for an hour or two before giving something else (if the first thing isn't working for the pt). As far as tylenol and percocet and lortab not being given together I can see the rationale for that but not the previous issue. Also have been told Toradol can be given anytime during administration time of any other pain med. I don't want to over medicate anyone but then on the other hand I want them to have the pain relief they need. The above questions concern someone not on a PCA or epidural. Not much in nursing seems to have a black and white answer to it! I'm so confused!!!!! Another question is - could someone rate some of the common pain meds as far as most effective to least effective.

[Pattiecake]

Spidercat, it would be easier to answer if you could also mention the actual MD order/doses, the patient's condition, the pain scale, just a little more clinical info

[RNPATL]

There are so many factors to consider when giving pain medication. Giving a blanket answer to this question would be tough. I would recommend that you reference an experienced nurse on a case by case basis and get his/her feedback. This has always been helpful to me. Even as an experienced nurse, I often find myself asking for the advice of another nurse - "just to be sure." There is certainly nothing wrong with that and in fact, it is all about patient safety. Some nurses are afraid to ask these kinds of questions .... I appluad nurses that ask each other questions. Good luck.

[Spider Cat]

I agree - getting the advice of an experienced nurse is so very helpful. It's just hard when they all have a different answer for everything!

[sxrn]

Originally Posted by Spider Cat

I am a new grad and have been working for only a few months. The biggest question I have on the floor that I haven't been able to get a good answer on is administering pain meds. I had two pts last night - one with Dilaudid and demerol - the other with dilaudid and darvocet ordered. I thought if you gave Demorol for instance you had to wait for the time limit prescribed (q3h or whatever) to be up before giving something else unless it was specifically ordered for breakthrough pain. Some people have told me this because they are both narcotics, others say to wait for an hour or two before giving something else (if the first thing isn't working for the pt). As far as tylenol and percocet and lortab not being given together I can see the rationale for that but not the previous issue. Also have been told Toradol can be given anytime during administration time of any other pain med. I don't want to over medicate anyone but then on the other hand I want them to have the pain relief they need. The above questions concern someone not on a PCA or epidural. Not much in nursing seems to have a black and white answer to it! I'm so confused!!!!! Another question is - could someone rate some of the common pain meds as far as most effective to least effective.

personally, i think dilaudid, toradol are the best pain meds. zofran is the nicest anitemetic, phenergan is good too but must be careful d/t the sedating effects. po pain meds: i find that people like lortab/vicodin.

[barefootlady]

I would love to give you some input on pain med administration but the question is a little to fuzzy for me to come up with a clear answer. But, if a patient is consistantly c/o pain and needs break through meds after 2 hours, has the doctor been called and advised of patients complaints? Also has drug abuse been ruled out, someone who has a long history of drug abuse will need a different approach to his pain meds. Here we have strict rules on toradol administration. So I never heard of giving it anytime with other meds. I hope this helps. While asking a more experienced nurse is a good idea, get the input from pharmacy too. Sometimes they can come up with a better combination or schedule that we as nurses and even doctors overlook.