to give pain meds or not to give meds?

  1. 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?
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  2. 44 Comments

  3. by   scrmblr
    I would enjoy the title. Don't worry about what your co-workers say. Give your pt's the best care you can.

    (ps...all cap's makes me feel like you are yelling at me:lol)
  4. by   mamason
    demented pt's feel pain too. you are right to read their body language and such. i believe you are trying to give your pt's the best care possible. don't worry what other nurses think. unless there's a problem that contraindicates pain meds such as loc, blood pressure, respirations, etc.
  5. by   nursedawn67
    msnursekim enjoy the title that is what a nurse does...assess the patient for a need and handle that need. Residents with dementia for the most part are unable to state they are having pain, it shows up in behaviors, such as acting out or maybe just as not wanting to eat. If you give a pain med and it doesn't seem to work then we assess for more pain med or is there something else going on...such as a UTI or some other infection. Enjoy the title you deserve it because you are doing your job!
  6. by   CoffeeRTC
    Forget about you cows. What you are doing is assessing your residents for pain. Res who are not able to communicate verbally show the nonverbal signs. That is why we have pain assessment charts for demented or nonverbal res.
    Pain assessment is such a biggie now with the state. Heck...pain is the 5th vital sign now, huh. Doesn't it tie in with the quality of life f tag? I'll bet you might notice less behaviors, better sleeping and eating and better overal functioning of those residents who are being assessed and treated for thier pain.

    Side note....all of my demeted pts with UTIs get Tylenol prn. Having just gotten over some bad ones myself...I feel so much for them. No wonder you see and increase in behaviors with UTIs.

    BTW...what type of narc like procedures do you have when sighning out tylenol? We chart the same for all pain meds...mark it off on the mar, place a note on the back of the sheet (why, when, initals and results) and also mark them off on our pain assessment flow sheets in the MAR. Only difference is the narcs are under double lock. Just wondering.
  7. by   leslie :-D
    one of my biggest pet peeves is when nurses write "denies pain".
    my experience with dementia pts, is often, their agitation is symptomatic of pain or some other etiology.
    also i find that most cannot answer accurately, when asked if they're in pain, are hungry/thirsty....it truly takes keen assessment.
    most elderly have a dx of djd/oa/ra.
    the dx alone should be indicative of the potential and reality of their pain.
    when i routinely give tylenol and see a mental status change from agitated to pleasant and even happy, that is confirmation enough for me.
    when i can safely identify this pattern, then i get a scheduled order from the docs.
    of course dementia pts have pain!
    just as 95% of our elderly do.
    thankfully, tylenol usually does the trick.
    but it is our duty, to keep our pts free of pain, whether it is physical, emotional/mental or spiritual.
    why is that such a hard concept for some to understand?

    leslie
  8. by   msnursekim
    First of all, sorry for the caps, just easier for me to type without typos. We have to sign out tylenol just as if it was a darvocet, tyl #3, etc... because of our pharmacist. She thought it was a good idea to track use and yes they are locked up with narcs. Her quote, tylenol is for pts, not employees! She had aproblem in the past with pilfering of stock tylenol.Thanks to all of you for your validation...made me feel better. I was beginning to doubt myself,but as you have stated, dementia pts do have pain and a quiet restful night for all of us is the results of giving them their prns. Thanks again!
    Last edit by msnursekim on Sep 13, '06
  9. by   RGN1
    Good on you is all I can add to this! Be proud of your new title - perhaps you can get a badge made up with that on it :chuckle
  10. by   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.
  11. by   txspadequeenRN
    If the patient say's they are in pain then they are. Period. It is not my job to question or deny them pain medication within reason. I dont care what anyone I work with says , if they accuse me of stealing drugs they need to be ready to prove it. I personally have a issue with nurses that refuse to take up for the resident for fear of what others think. I am very anal about making every effort to keep my patients out of pain and I would be disappointed if I was in pain and my nurse fumbled around about it.
  12. by   flashpoint
    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.
  13. by   cookie102
    how wonderful it is that someone takes the time to assess/address ALL pt needs, if anyone of us has dementia, won't it be great to know there are nurses out there that really will take care of us. thanks!!!
  14. by   Patti 2nd gen RN
    Don't worry--you will be called much worse things than someone who is extra concerned about something. But be careful you are not masking a temp, and watch Liver functions. We have a psych CRNP who writes Tylenol orders Q 6 hrs standing--I hate that--because why wake someone with no s/s of pain? Follow your nursing judgement--it is your name and your license--MAKE a name for yourself, before they call you something worse. And if you laugh about it, and keep doing what you know is right, they will get over it. And your confidence may start themlooking at thier own practice.

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