How would you interpret this order for pain medication?

leslie :-D · Dec 22, 2010

i read it as being able to give the mso4 and lortab, independent of ea other.

it's certainly not unreasonable order, but would necessitate nsg judgment as to which to give.

since mso4 is for severe pain, you'd give it accordingly.

rating pain as a 4, is lortab-appropriate.

lesie

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Dec 22, 2010

The order is for both meds, and has leeway for nursing judgement.

Without knowing something about the patient and the reason for the pain meds, it's hard to say exactly what's the best move. One Lortab for sure, if the patient is alert, not frail, has a history of taking narcotics for pain meds, I might give him 2. It takes more pain meds to GET someone pain free than to KEEP him pain free. With what you've given I see no reason to call the doctor. IMHO, and of course your mileage may vary.

kayern · Dec 22, 2010

First of all, the order for Lortab 1-2 tabs every4 hours prn isn't acceptable. We would need parameters, i.e., Lortab 1 tab PO Q4 hours prn for mild pain, Lortab 2 tabs PO Q4 prn for moderate pain.

Besides that, I read it as the above poster, you can give the Morphine for severe pain and for breakthrough give the lortab. I would probably only given one for a pain scale 4/10.

ErinS, BSN, RN · Dec 22, 2010

I work in hospice, so it is sometimes different, but when a pt is in severe pain we often give them their standard pain medicine (the lortab) and morphine for the breakthrough pain. Morphine is much shorter acting than lortab for most people. This is an md who has given you the tools you need to manage your patients pain within your nursing judgement.

CRNA1982 · Dec 22, 2010

Give Lortab first and use as your primary drug. Only use Morphine for breakthrough pain if Lortab cannot be given. This patient will have to eventually go home (I'm assuming) and they cannot go home until their pain is controlled with PO meds. In most circumstances, pts. cannot go home on IV morphine; but they can on Lortab. Make sense?

meandragonbrett · Dec 22, 2010

Those are two independent orders. You can give Morphine every 4 hours and you can also give lortab every 4 hours. The time frames are not inclusive for both drugs. they are separate.

GoodNP · Dec 22, 2010

I interpret them as two separate orders, independent of each other. If you medicate the patient w/ morphine, and in

In this situation with the patient c/o pain 8/10, it seems appropriate to me to give morphine for immediate pain relief AND 1-2 Lortab tabs for a more lasting effect. After that, continue ATC or PRN dosing with Lortab as the patient needs to maintain pain control. This will most often be sufficient, but you still have the option to use morphine for breakthrough pain.

RedhairedNurse, BSN, RN · Dec 22, 2010

Morphine 4mg IV q4h PRN pain
Lortab 7.5/500mg 1-2 tabs q4h PRN pain
Your patient calls out at 0800 with pain 8/10. You give Morphine 4mg IV as ordered which helps with their pain. Two hours later the patient calls out with pain rated 4/10 and wants something for it. Do you:
Give Lortab 7.5mg as the pt. has not had that since the order was written
Call the doctor and ask what they want given
Tell the pt. they have to wait as they only have pain medication ordered every 4 hours
Does this order mean to you that a patient can have pain medication every 4 hours only no matter if it is the Morphine or the Lortab?
Does this order mean to you that they can have Morphine q4h AND the Lortab q4h without regard to each other so long as the Morphine doses are 4 hr apart and the Lortab are 4 hr apart?
What do you think?

You gave the morphine at 0800, as that can be given q4h as ordered. Two hours later, the patient can have the lortab, the pt can have the lortab an hour later (at 0900) if warranted, it's nursing judgement and depends on the severity of the pain. These pain med orders are two separate orders. The morphine can be given q4h and the lortab can be given q4h as written.

The only thing is, you CAN NOT give 2 pills of the 7.5/500 q4h as that would exceed the acetaminophen limit of 4g per day. Most doctors do not pay attention to this and therefore they do not write the order correctly. If the pt needs 2 pain pills q4h on top of IVP morphine as ordered, then the pain pill order must be changed to Norco 7.5/325 which you can give 2 pills q4h.

Like the above poster said, some doctors will write parameters to give 2 pills if the pain is 'moderate' in intensity or greater than 7/10. The way this order is written, if the timing is right, the patient will be able to get pain meds every 2 hours. For example:

morphine at 0800,

1 - lortab at 1000

morphine again at 1200.

However, if the lortab order doesn't get changed, with that amount of acetaminophen, you can only give 2 pills every 6 hours. Hope this helps.

BOOYARN · Dec 22, 2010

if this is an exam question the answer is probably call the doctor.... to get some dilaudid

in REAL LIFE give each regardless of the other drug, the doctor wrote it this way so that you wouldnt bother him LOL also as long as patient vitals are stable and tolerating the meds well

and its true the lortab orders does need parameters , like the nurse said prior 1 for mild pain, 2 for moderate pain

Katie5 · Dec 22, 2010

I interpret them as two separate orders, independent of each other. If you medicate the patient w/ morphine, and in
In this situation with the patient c/o pain 8/10, it seems appropriate to me to give morphine for immediate pain relief AND 1-2 Lortab tabs for a more lasting effect. After that, continue ATC or PRN dosing with Lortab as the patient needs to maintain pain control. This will most often be sufficient, but you still have the option to use morphine for breakthrough pain.

Overkill in my opinion.Just because the two orders are independent of each other, doesn't mean we should overload the patient with them.

What about,if an hour later, patient complains of breakthrough pain, what more do you have to give them?Another morphine or Lortab?

nursynurseRN · Dec 22, 2010

I would give both alternating pain meds. morphine then lortab or vice versa depending on thier pain level. I would also try to give them the lortab for mild to mod pain and try to reduce the morphone to get them ready for discharge....