to give pain meds or not to give meds? - page 3

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   dano3
    :wink2: remember we are the eyes & ears for our patients. just treat your patients like you would your family, you spend more time with them than your own.if their in pain medicate.most are 80-100 years old i doubt they will get addicted. make them comfortable
  2. by   GPatty
    I also give my pain meds. Especially in the AM. When I get there at 5:30a, and I see my patients walking bent over, obviously in pain, or another, who tends to get more agitated when her leg hurts...yea, they get their PRN's when I am there.
    It's unfortunate that I only work two days a week because of school, and the other nurse that takesover for me, says... "State's gonna look at this real close cause of all the PRN's you give."
    I just know when they are in pain, and yes, I do ask, or am able ot tell by their action! When my elderly folks wake up in the morning, athritits or any other thing hurts, they are getting what they need. Keep up your good work!
  3. by   mrsalby
    I am glad to see that you are being attentive to your patients and really using "all" your assessment skills and not just your ears.

    A quick story....my Grandma is in a LTC in another state. I go to visit as often as I can (keep in mind I am in NM and she is in FL). She had fallen and broken her hip. COme to find out, when we got there, her toenails were literally curled around and under her toe. the podiatrist had not attended to her although when we would call and check on her the nurse would say "oh in the chart, it is noted that Dr. so and so was here last week blah blah blah." Well, we really feel that part of her fall was due to the condition of her feet.

    My grandma was what they call a "walkie talkie." A&O x 3, helped other patients find their rooms etc. After her fall, she would not come out of it and would just sit in her WC all day real still. PT stopped attending to her and she began to diminish in numerous areas. Imagine my shock when we went home to visit in June and here is my walkie talkie Grandma who raised me almost an invalid. Now this may be bad, but of course thinking I am the super nursing student I am:wink2: (jk), I asked to see her chart and MAR etc. come to find out she had fractured her hip in May and since 4 days after she returned from the hospital (no sx required) she had recieved NO pain meds. Even with notes from physical therapy saying she noted pain, grimacing, pt states etc etc. One of the first things I remember learning was how elderly can react to pain and G'ma had shut down! I was furious.

    We were in Fl for 30 days and by the time I got off my soap box with the nursing director and seeing grandman everyday and PT starting again, she was walkie talkie again although not as strong as she was before. Very disappointing.

    sorry so long, But kudos to you and know families appreciate your diligence! I wish your were taking care of my Gma.
    Mrsalby
  4. by   banditrn
    Quote from mrsalby
    I am glad to see that you are being attentive to your patients and really using "all" your assessment skills and not just your ears.

    A quick story....my Grandma is in a LTC in another state. I go to visit as often as I can (keep in mind I am in NM and she is in FL). She had fallen and broken her hip. COme to find out, when we got there, her toenails were literally curled around and under her toe. the podiatrist had not attended to her although when we would call and check on her the nurse would say "oh in the chart, it is noted that Dr. so and so was here last week blah blah blah." Well, we really feel that part of her fall was due to the condition of her feet.

    My grandma was what they call a "walkie talkie." A&O x 3, helped other patients find their rooms etc. After her fall, she would not come out of it and would just sit in her WC all day real still. PT stopped attending to her and she began to diminish in numerous areas. Imagine my shock when we went home to visit in June and here is my walkie talkie Grandma who raised me almost an invalid. Now this may be bad, but of course thinking I am the super nursing student I am:wink2: (jk), I asked to see her chart and MAR etc. come to find out she had fractured her hip in May and since 4 days after she returned from the hospital (no sx required) she had recieved NO pain meds. Even with notes from physical therapy saying she noted pain, grimacing, pt states etc etc. One of the first things I remember learning was how elderly can react to pain and G'ma had shut down! I was furious.

    We were in Fl for 30 days and by the time I got off my soap box with the nursing director and seeing grandman everyday and PT starting again, she was walkie talkie again although not as strong as she was before. Very disappointing.

    sorry so long, But kudos to you and know families appreciate your diligence! I wish your were taking care of my Gma.
    Mrsalby
    Kudos to you!! I'd be more than a little furious at the bunch of them. Unfortunately, I see this sort of thing a lot - because the resident is quiet and doesn't complain, they tend to ignore them.

    And sometimes other things will help besides medicine - cold packs, massage, etc.
  5. by   hospitalstaph
    Quote from cotjockey
    I have the same sort of reputation...only my coworkers feel that I am too generous with narcotics. We have a resident with a long history of drug and alcohol addiction. He also has a history of several MVAs, arthritis, falls, and a work related back strain. He has taken percocet on a routine basis for years. Now, he complains of pain on a regular basis...he says no matter what we give him, he is never pain free. So, I routinely give him the dilaudid and percodan he has ordered...he can have them each every 6 hours, so unless he is asleep, I give him something every 3 hours. Usually, he asks for his meds, so it's not like I am just giving them without assessing or anything. I honestly think he is in pain...I also think he is an addict. I worked with a physiatrist for a while and I agree with his belief that addiction is a choice...I shouldn't encourage his addiction, but if he says he needs the meds, then he needs the meds. A lot of the other nurses will tell him he still has an hour before his next dose even if it is time or who will give him an ativan instead of dilaudid. We also have nurses who will make him go for long periods without narcotics. He has a habit of staying awake for the greater part of three or four days and then crashing for 24 hours straight...it is something he has always done. When he is on his 24 hour crash, I will wake him up at least once to take either the dilaudid or percodan...otherwise, he has been known to go up to 36 hours without anything...then we have a hard time playing catch-up with his pain (and his addiction).

    I have no problem giving pain meds to other residents on a routine basis as well. A lot of times, even the residents who are not cognitively impaired either don't ask for pain meds, don't want to become addicted, don't want to make extra work for nurses, or whatever. It is our job to look for the cues that they are in pain and assess and medicate appropriately. I don't think it is my place to decide that they are taking too much of something or that they don't need something (unless there are definite signs that they are). Simply because I don't think they are in pain does not mean that they aren't.
    EXACTLY! I am so tired of seeing nurses avoid patients that are asking for pain meds b/c the nurse thinks that the pt is an addict. So what if they are an addict? Addicts have pain too and if the medication is ordered then it is not the nurses job to detox someone. You sound like an awsome nurse

    T
  6. by   vloho
    I like the key words HE HAS ORDERED. If the Dr. didn't think the PT needed them he wouldn't have ordered them .
  7. by   nurseJLoo
    If grandmas axox3 and a walkie talkie why dont you take her home?
  8. by   carolbear
    The docs I work with are almost always happy to write for pain meds to be given routinely. That way you can be assured the resident is getting something for pain, especially if they are demented. Just be careful about being the only one who passes PRN narcs. If you are the only nurse who cares enough, and I'm one of those too, to be concerned about pain in demented patients, speak with someone in management about what you are observing and what other nurses say to you. To be the only person who passes narcs prn on a unit, you could be placing yourself under the microscope for possible diversion. As a manager, if we have med problems with a nurse, or people are saying "Nurse So-and-So" is the only one who gives narcs, etc, management does look at the MAR's. Please protect yourself and the patients. Good job for what you are doing for these poor people, just get everyone on the same page.
  9. by   Nurset1981
    I am the same way and had the same doubts you all have shared, until I was doing a med pass in front of a DPH nurse(we were in survey and I alays got stuck doing it lol) and I had this patient that I knew very well, ETOH, DM, HTN, Neuropathy and a recent partial foot amp. I poured his 5PM meds and signed out two Percocets for him because I knew his schedule and when he would start to hurt. I went down gave him his meds and left the room. The DPH nurse took me aside and actually commended me for anticipating my patients needs. Pain mngt. has been a huge part of thier focus during recent surveys. I was shocked she said that to me. Usually they rip you a new one. I always assess my pts for pain regardless of thier mental status. All of our pts come in with a standing APAP order as well as MOM, colace and usually trazadone. Side note..I can't believe they make you sign out tylenol. What a joke. You work your butt of the least they can do is give you a couple tylenol. Its not like its costs an arm and a leg.
  10. by   mrsalby
    [quote=nurseJLoo}If grandmas axox3 and a walkie talkie why dont you take her home?

    Simple question to ask, I suppose, when you are not involved.

    My father her POA and won't allow it. Also, for "me" to take her home would include a 1500 mile trip and isolate her from the friends and extended family that are local to visit her. Also, she is a heart patient and has dementia. Before you ask about these friends and family taking her home...no one is able to, or cannot afford it or simply doesn't want to. Family dynamics are different everywhere. Besides, importantly, she likes where she is and doesn't want to come to come to NM. I believe her wishes are important. She is able to leave and visit and spend the night which she enjoys from time to time.
  11. by   banditrn
    Quote from 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.
    Capecod - I've never heard of the 'Beer's list'. Is this something just for LTC?
    I know that at the hospital where I worked, the last couple of years they were trying seriously to get Darvocette off the formulary - some of the doc's were really unhappy with them.
    The last 3 years I worked in Ambulatory surgery, post op, and we had one urologist who would routinely order 1 Darvocet - just 1, mind you - post op!! Hardly ever was effective, and I'd call him to get something else.

    Had an incident at the LTCF where I now work. Keep in mind, we're not supposed to "bother" the docs at nite.

    I came in for my nite shift, and we had a new patient admitted - a LOL with cancer and gangrenous toes. I found out during report that she was in a LOT of pain, so I asked the evening nurse if it was time to give her pain meds. The nurse said that she didn't have anything ordered. ??!! WTH!! She stated that the plan was to call the office ON MONDAY to get something!!

    I'm sorry, but I found that to be totally unacceptable. I went to assess the lady, then I called the doc at home, woke him up, and got an order for Vicodin. She was actually able to sleep for a few hours, and stated that she 'felt less like crying'.

    Now, I don't feel like every situation calls for narcs, or even meds. One LOL will complain of her knees hurting, and I've found that if I take a couple of minutes to rub lotion on her knees, she gets relief and can go to sleep.
  12. by   CapeCodMermaid
    Some doctor named Beers must have had lots of time on his hands one day so he studied many drugs. The ones that are BAD to use in the elderly population were put on a list which he named after himself. Old people are old people no matter where and some drugs are just not good for them. Darvon and Darvocette have metabolites that really affect livers...valium is on the list, Benadryl...it's very extensive. You can do a google search to get a copy. As for not calling docs for pain meds....yikes!!! Call 'em and if they give you a hard time, let your medical director AND administrator AND the DNS know.
  13. by   DusktilDawn
    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?
    Your not wrong at all. There are times when dementia patients ARE agitated because they are uncomfortable or are in pain. These are the type of patients that may not be able to verbalize their discomfort or pain. I think it's wonderful that you take the time to assess and to ensure that these people are comfortable and not suffering pain needlessly. I'm willing to bet that you have an easier time settling these patients than your co-workers.

    I once had a dementia pt that was extremely agitated, he was practically on the ceiling. The report I had received was that this pt had received 2 units of PCs with lasix in between, no mention of him being changed (he was incontinent). First thing I assessed was his bladder, which was distended. Amazing how fast this patient calmed down once he was catheterized and all that pressure in his bladder was gone. It's so important for nurses to be able to assess the needs of patients that are unable to articulate them for themselves. Too much bother to sign out Tylenol???? Shame on your co-workers.

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