IV Dilaudid problem patients!!!!!!!!!!!

hereigoagain · Feb 27, 2009

This thread kind of ****** me off because what makes you think you know the "addict" from the truly in pain? I say this because I have BEEN THAT PATIENT that your mistakenly think is a drug seeker. I had a motorcycle wreck a couple years back with a compound tib/fib fracture external fixator, tit rod, road rash over 15 percent of my body. I had 5 surgeries over the course of a year including bone graft. I learned from my first two weeks in the hospital that dilaudid was the ONLY med to make me feel no pain. It was the only time I DID NOT HURT. Well after my fixator was off and I was in my boot I had to go back in for my bone graft (months later) my rash had healed and I was in a vader boot. Well sure enough I knew my order of 3 CC every two hours and you bet your ass I was on the call light EVERY TWO HOURS. I know it ****** my nurses off but dilaudid starts to wear off at 1:30 minutes for me. Until you have felt bone pain DO NOT JUDGE. I have never done drugs in my life but I guarantee the nurses thought I was a drug seeker because of my persistance with dilaudid. So please know that you dont know the person OR THE PAIN. It is not your call to make.

I would have never thought that you were just "drug seeking" (I don't even like this term). I did hear that pain from fractures is terrible. And not treating this kind of valid pain is just dangerous for the patient's well being. I hope that you are not feeling judged by anyone here. There is validity of using Dilaudid and there are situations when it is just used with no discretion.

I had a friend that was taking Dilaudid for a very severe pain caused by surgery on his spine. The withdrawal symptoms I saw I don't wish to anyone... I think he's off Dilaudid now, I hope that you are able to cope with your pain in the safest and healthiest way possible. I am not just talking from my head, I had a major accident and I have been through intense pain for a year, but G-d is great, I was able to keep my sanity, I am drug free and I feel much better now. I even wrote a letter to The Dalai Lama and I begged Him to pray for me, that the pain will go away, because it was killing me slowly and guess what? His secretary answered and he assured me that they will pray for me. I know that the pain will always be with me and I know that I might get re-injured, but in the same time, knowing that I survived the first one, I know I will survive the second.

Hear out the message of the post, I am glad that nurses are actually worried about how strong and dangerous Dilaudid can be. Nobody here is judging you and I appologize for the ones that took your pain for granted and denied you the help you needed. All the best and I am hoping for the same miracle of your pain getting better that happened to me.:redbeathe

hereigoagain · Feb 27, 2009

is that your scope of practice... to diagnose and then prescribe treatment? providers are faced daily with this ethical dilemma. nurses can judge and imagine that they have undertaken the hippocratic oath but that is not their role. argue your point with the providers and then follow their prescribed treatment - even if it abrades your puritan ethos.

wow...i don't really understand your post...can you elaborate? are you a doctor? i think that this thread is more like a way of nurses expressing sorrow/worry at the miseries of dilaudid that to bash doctors...maybe you should reconsider...

november17, ASN, RN · Feb 27, 2009

I get patients like this from time to time (I work M/S). I just give it to them. I honestly don't really care. You're not going to hurt them. 99% they are more than able to tolerate the dosage. If not then you should be monitoring their VS anyways and a dose of narcan can correct any problems very quickly. I've seen (young) people get 7mg of dilaudid in short periods of time and it doesn't even touch their pain. I've also seen people get 1mg and start getting toxic. You use your good judgement.

If they're conscious enough to hit their call light and ask for more, I'd assume they're probably able to handle another dose.

Again, if they ask, I give it. If they say their pain is coming up, I give it. I give it if they say their pain is a 5 out of 10. I give it if its a 10 out of 10. Doesn't matter to me...Pushing drugs is what I do. Kind of comes with the territory when you're a professional nurse.

However, when I have patient that comes in for DKA and then starts c/o leg pain and wants dilaudid that's about right when I start rolling my eyes.

ANnot4me · Feb 27, 2009

Frankly, I will give patients what is ordered, but using a nurse as a human PCA is abusive and demeaning. It is also just plain poor pain management (least) and negligent (most). Pain can be controlled better than with a 1 hour IVP med for days on end. Even more demeaning is that you are giving 4mg Dilaudid IVP q 1 hour and the paitient is considered low acquity by managment and other nurses. IMO, they should be in a step down unit on a pulse ox and 2LNP. Ridiculous...

BTW, you must be working with some real old fashioned practitioners.

medpsychRN · Feb 27, 2009

I have had some bad experiences giving Dilaudid in the past so it's not on my favorite list.

In regards to drug addicts, they can be near coma and still complain of pain and demand more meds.

Recently, when an addict was admitted to psych and on IV Dilaudid, I asked for specific parameters, e.g., respirations above 8. Even if the patients respirations were above 8

there were many times when I told her I wasn't giving her any more Dilaudid. Just because it's ordered doesn't mean I have to give it.

I cannot financially afford a lawsuit because the patient gets what she wants and then falls flat on her face because she's sedated.

Since it's highly unlikely the patient will be discharged on IV meds, the pain service needs to see ASAP and recommend a plan for a patch or for oral meds.

Drug addicts can be needy and demanding folks. If it's safe for them to get meds, they can have what's ordered. However, I have five (or more) patients to take care of and the majority of them think their problem requires immediate attention. Thus, the addicts have to get in line and when I can get to them I will.

This isn't an attempt to make anyone suffer. I can't ignore other patients. Sometimes it's okay for addicts to have an awareness of delayed gratification.

BradleyRN · Feb 27, 2009

"How many of you can say for certain, that you will be, for your entire career, 100% right when decideing who is an addict and who is in pain?" Of course, no one raised their hand.

I love this question!!!

The most important post in this thread was by Dalzac. As you see, people in pain are on narcotics. And narcotics are addictive. As a nurse, it is not your place to decide if someone is really in pain or faking pain. I dont care if they are a frequent flyer or not. If there is an order, we follow it. Some of you should have been detectives or psychics, because you can only prove to hurt people with your judgements. Can you say for certain that you can always be 100% right in knowing an addict with no pain from an addict with genuine pain or just someone in pain? If you cant, then quit whining about having to give a 3 minute push every two hours and just do it. I am always disappointed to find so many nurses who think they are the judge and jury over what someone else is going through. I once said in a thread that if i have a pain of 8, i may not be writhing around in the bed, but you certainly better bring me my Dilaudid every two hours. I have a high tolerance for pain, and I shouldnt have to put on an act to get you to believe me. I have never needed Dilaudid, but if i ever do, i pray it wont be one of you Columbo's deciding if i am telling the truth. :)

Magsulfate, BSN, RN · Feb 27, 2009

I had a patient one time who was a nurse who had lost her license r/t drug use. She was/is a frequent flyer and knew how to manipulate the doc. She was caught red-handed crushing a percocet and pushing it into her portacath. The doc was shown, he said "ah, just continue to give it to her". She then would c/o nausea and requested phenergan. She asked me "are you going to push it"? I told her that I was. I didnt understand her question at first. The other nurses had been putting it into a 25 or 50 ml bag of saline and administering it as a secondary (it would go in over a period of 15 minutes). She didnt like that. She was caught manipulating the IV pump and making it go in faster. It was more grieving to me trying to stop this situation because her antics became more desperate. Its tough handling people like this, I know. But then you have the addicts who come in and are truely in pain. It takes more pain medication to treat their pain because of the tolerance they have. So you know they are drug-abusers and they are asking for a massive amount of pain meds....its hard to distinguish between those who are in pain and those who are wanting a "high" in these situations. I blame the docs for alot of the problem of drug-abusers. They feed into it and keep giving it.
I went to the ER for stomach pain one time (it ended up being an ulcer) and they prescribed me Lortab. When I questioned WHY they were giving me Lortab, the response was "Lortab will help with ANY pain you have". All I needed was a GI coctail. Some are too eager to prescribe it, while others are the extreme opposite and wont give it to even the worst pain sufferers. Our best bet is just to administer what is ordered, if it is a problem, then try to get a PCA ordered. We need to discuss our suspicion with the doc and chart it, then leave the decision up to the doc. Im not into nursing to rehab a person who doesnt want rehab because even if successful, they will continue to abuse once discharged and what we did was in vain. I feel the frustration too, I do.

Which brings me to my question... what about the nurses that are giving out so much dilaudid, and that one nurse that decides to try it for herself??? When you've got so much dilaudid being given out on the floor like candy,, how can you know if a nurse is swindling some for herself? You can't. You've got dilaudid going everywhere, and a nurse who is high as a kite.

Magsulfate, BSN, RN · Feb 27, 2009

I have been on both ends of this spectrum and I can ultimately tell you it just reeks! I am 57. I don't work anymore because I can't physically do it. I have a rare type of rhematoid arthritis. is a lot like lupus but not lupus. Not only do my bones hurt, but so does my muscles and connective tissue. Here is where it gets hinky. I am a recovering addict, have been for 23 yrs. When all else is said and done , do I deserve any pain relief for the pain I am in? I signed a contract with my Doctor for pain medication I took oxycontin40 mg BID I was addicted to it. In 2005 I had my hip replaced twice the first one the prostesis went though the back of my femur. So I had to get another one. At the time I was addicted to oxycontin. Should I have denied all pain medication because I was addicted? How can a person be denied pain meds just because they have addictions? Don't they feel pain? Who are you to be judgemental about them? As a nurse I gave what the doctor ordered and never, ever with held anything the doctor ordered.
I don't take oxycontin any more. I have just started back on Lortab, and will probably become addicted again. I still have severe pain not from my hip but the rest of my body. And, by the way, my disease didn't come from the drugs. It came honestly, genetically. I still go to Narcotics anonymous on a regular basis. The folks in my fellowship know and understand. In our fellowship we have literature about the recovering addict and pain medication. I take the meds exactly as it is ordered nothing more. and I never get high, only relief.
If you have problems about addicts getting pain meds that is YOUR problem not their's.
I am sorry if I stepped on toes with this posting ,but that is how I feel.

You are absolutely right. An addict still needs pain relief. My mother has a condition sort of like yours, deformities of her fingers and hands, and now her feet. She is in constant pain. I know she is addicted but, what can you do? Keep giving it to her, because when she doesn't have it she wants to die because the pain is so bad. I want my mother pain free, and I know that will never happen. But when she has some relief it seems like I get my mom back.

LilyBlue · Feb 27, 2009

Frankly, I will give patients what is ordered, but using a nurse as a human PCA is abusive and demeaning. It is also just plain poor pain management (least) and negligent (most). Pain can be controlled better than with a 1 hour IVP med for days on end. Even more demeaning is that you are giving 4mg Dilaudid IVP q 1 hour and the paitient is considered low acquity by managment and other nurses. IMO, they should be in a step down unit on a pulse ox and 2LNP. Ridiculous...
BTW, you must be working with some real old fashioned practitioners.

Well, the one doctor who constantly orders this kind of thing always says that nurses are nothing but whiners and he could do a better job taking care of all 28 patients on the floor single-handedly than we do. I pray that one day before I die I get to see that sorry SOB try it.

michael79 · Feb 27, 2009

What are the seekers chief complaints? Also, if an ED has a standing order to NOT give more that 1-2mg of IV Dilaudid, what is being done to achieve pain control for those in acute pain such as those with kidney stones or pancreatitis? 1-2mg ain't gonna cut it....

RNpandoraRN · Feb 27, 2009

I give it. As previous posters have said, I'm not going to end their addiction during my mere 12-hour shift, simply by refusing it. It can be so aggravating though, to have that patient on the call light every 2-3 hours for their "pain shot." One of my favorites was a patient who let it slip that he loved Dilaudid because it gave him a rush and put him to sleep. He'd also started hallucinating but told me he enjoyed the "show" because he'd see beautiful things. He'd been getting 2mg every two hours for several days. Finally the doctor discontinued it and added Lortab every 6 hours. Now that was one disgruntled patient!! I don't think he was an addict when he came in, but he sure was one before he left!

RNperdiem, RN · Feb 27, 2009

Some settings simplify the issues of pain management.

I work in SICU. Most of our patients are trauma patients. I have no trouble believing that someone with a multiple fractures or a traumatic amputation is in pain, addict or not.