to give pain meds or not to give meds? - page 2

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... Read More

  1. by   RGN1
    Quote from 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.
    I think that's ridiculous. Surely you sign the patient's chart each time you give the med, so they can see it all ties in? I think it comes to something when a patient has to suffer because their nurse is worried about giving them their pain meds!

    This is a criticism aimed at your facility by the way & in no way at you personally at all. I fully understand your reasoning but I just wonder how your management would feel if it was them or their relatives that were suffering?
  2. by   suebird3
    I would continue the pain meds, too; just remember the Max. dose of Tylenol (and tyl. containing products) can be 2400 mg. a day.

    I would love having you work with me!

    Suebird
  3. by   rn/writer
    Quote from suebird3
    I would continue the pain meds, too; just remember the Max. dose of Tylenol (and tyl. containing products) can be 2400 mg. a day.

    I would love having you work with me!

    Suebird
    Is the standard 4000 mg/day reduced for the elderly?

    To the OP: you are doing for your patients what I would want done for me. Unless there are contraindications, most older folks could probably benefit greatly from routine doses of Tylenol. Few people over the age of 60 don't have some arthritis and stiffness. Pain can be an unarticulated source of agitation in dementia patients. Your patients are fortunate to have someone like you looking out for them.
  4. by   MarySunshine
    I'm the exact same way. It's more difficult on my unit sometimes because I work in neuro and the physicians are always terrified of "oversedating" someone and masking real neuro changes. However, I assess pain as regularly as all my other vital signs and I treat it efficiently if it is within my ability to do so.

    If someone has a cardiac problem they are not "addicted" to their cardiac meds, so that if someone has a chronic pain problem I would not say they are "addicted" to the pain meds unless the med use itself is HURTING the patient in some way (health/family/job/relationships) or they use it inappropriately (for a high).

    I don't think that all health care professions actually realize how much pain affects a person's hemodynamics. You're not just going to have a calmer patient -- you're going to have a healthier (aka EASIER) patient if you just treat their pain!
  5. by   suebird3
    OK..was half asleep here.....sorry! Was trying to remember the max dosage and ditzed.
    I have so many rezzies who try to get 500 mg of ES Tylenol every 4 hours, PLUS other Tylenol based products, we devised a plan incorporating said products. So far.....seems to be working. That is where the 2400 comes from.
  6. by   rn/writer
    Quote from suebird3
    OK..was half asleep here.....sorry! Was trying to remember the max dosage and ditzed.
    I have so many rezzies who try to get 500 mg of ES Tylenol every 4 hours, PLUS other Tylenol based products, we devised a plan incorporating said products. So far.....seems to be working. That is where the 2400 comes from.
    2400 mg is also the max for ibuprofen.

    On our postpartum unit almost all patients start with ibuprofen for pain management. Then the vag deliveries with severe cramping, perineal trauma, and almost all c/s patients can have either Percocet or Darvocet. The problem is that some of the docs prefer that we give Darvocet which isn't as strong narcotically AND has twice the Tylenol (650 each as opposed to 325). I prefer to give 2 Percs q 4 hours (total for the day--3900 mg) which seems to give very good coverage vs. 1 Darvocet q 4 (also 3900 but far less narc analgesic). The docs don't have to listen to the patients tell them they are still hurting. We tell them, but our reasoning doesn't match up with their protocol. I think they're so paranoid about people becoming addicted that they aren't really paying attention to the difficulties we and the patients are facing. Maybe if we get enough patient complaints . . .
    Last edit by rn/writer on Sep 15, '06
  7. by   suebird3
    One resident stands out in particular. Had end stage liver failure, d/t using Tylenol secondary to a back injury. Lord, she was in pain, and we had to really watch it cuz of the disease progression. I will never forget the whole situation.
  8. by   CapeCodMermaid
    I worked in a facility once where the Alzheimer Program director tried to tell everyone that people with dementia don't feel pain like the rest of us! One old lady scrunched up her face with every step and the PD tried to tell us it was a facial tick. SO....I said give her some tylenol...hmmmm....amazing how that "tic" went away when the woman was medicated. And as for the person who said she won't medicate because someone else will think she's pocketing the meds...shame on you! Have someone give an inservice on pain and document document document. No one should have to suffer unnecessarily.
  9. by   nurseangel31_03
    Quote from 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?
    \


    I say you should always give pain med because alot of them dont know how to let us know they are in pain and that helps us to know if that may be part of there problem or if we need to look at some thing different. I have found where I work that alot of nurse wont give pain meds unless ordered regularly and so i have to do it my self or tell them to do it. It is very upsetting to me when a nurse doesnt take time to care and found out what there residents need to make there live better. If they where able to know there own needs they would still be at home.
  10. by   rambisisking
    Mother Theresa said it best:

    People are often unreasonable, illogical, and self centered;
    Forgive them anyway!

    If you are kind people may accuse you of selfish, unterior motives;
    Be kind anyway!

    If you are sucessful you will win some false friends and some true enemies;
    Be sucessful anyway!

    If you are frank and honest some people may cheat you;
    Be frank and honest anyway!

    What you spend years building someone could destroy overnight;
    Build anyway!

    If you find serenity and happiness they may be jealous;
    Be happy anyway!

    The good you do today people will often forget tomorrow;
    Do good anyway!

    Give the world the best you have and it may never be enough;
    Give the world the best you've got anyway!

    You see in the final analysis, it is between you and God;
    It was never between you and them anyway!
  11. by   grace90
    I agree with previous posts. You're doing good!
  12. by   emmalou*
    Quote from CapeCodMermaid
    I worked in a facility once where the Alzheimer Program director tried to tell everyone that people with dementia don't feel pain like the rest of us! One old lady scrunched up her face with every step and the PD tried to tell us it was a facial tick. SO....I said give her some tylenol...hmmmm....amazing how that "tic" went away when the woman was medicated. And as for the person who said she won't medicate because someone else will think she's pocketing the meds...shame on you! Have someone give an inservice on pain and document document document. No one should have to suffer unnecessarily.
    Oh my god, that is absolutely terrible - dementia patients (or otherwise confused or neurologically impaired patients) are the most vulnerable when it comes to pain or discomfort because they can't tell us they're in pain!

    Observing and assessing someone's non-verbal communication in terms of pain is a necessary part of the role of nursing, this is something I have always done instinctively.

    Sometimes the lack of education in some of my managers and/or peers has both appalled and concerned me. Some definite education is needed for those nurses who won't administer PRN meds to people who cannot communicate verbally.
  13. by   CapeCodMermaid
    On the doses of Tylenol-our pharmacy recommends no more than 4000mg/24 hours....that's fine for US, but if you read the studies, elderly people should get no more than 3000mg/day...and some nurses are always surprised at how many meds have Tylenol in them.
    PS. Darvocette and Darvon are on the Beer's list and should never be used in the elderly population.

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