Let's say you have a new patient, one that has an acute condition that could reasonably require pain medication, and also a psychiatric disorder which has the tendency to cause anxiety and sudden mood swings.
You initially do not have the narcotic (Norco) that the MD prescribed as the pharmacy is running late, but you do have an order for acetaminophen 500-1000mg Q6H PRN and your patient insists at first that they will be fine with Tylenol.
Not knowing how they respond to Tylenol, other than that there is no allergy, you initially offer your patient 1 500mg tablet as they have insisted repeatedly that they are not in much pain and do not need anything strong. Your patient accepts it without complaint. It is 12 pm.
At 2 pm, you finally receive the narcotic. The patient states that they 'would like one of those' as their pain is back. Your order for the Norco is Q4-6H, 1-2 tablets, 7.5/325mg. Knowing that the acetaminophen you gave earlier could've been given in a 1000mg dose, let's go ahead and assume you were comfortable giving your patient 1 tablet of Norco.
In your patient's body is now 825mg of acetaminophen. 15 minutes later, you get a call from the patient. They are very agitated and accuse you of not doing your job because they are still in pain. They demand another norco tablet from you, though they did not protest earlier about the given dose.
Did you give the 2nd pill? Why / Why not? Do you give acetaminophen to your patients in between norco / percocet / ultracet doses, even though those medications contain acetaminophen? Why / why not?
Is there something you would've done differently than the nurse in the example did? If yes, what and why?
