Is following a doctor's order "too many" narcs? - page 2

by 33762FL | 3,443 Views | 13 Comments

I'm a new grad and I'm about 2 months into orientation on a med-surg unit. Sometimes I get patients with histories of painful conditions such as cancer or sickle cell anemia, with a doctor's order for a narcotic pain medication... Read More


  1. 0
    As long as you are following the order (giving Q4H or Q6H or whatever) and the patient looks okay and VS are stable, you will be fine.

    And with chronic pain, it is better to give meds around the clock versus waiting for it to become agonizing. Much harder to get it down to an acceptable level for the patient that way (harder to control) if that makes sense.
  2. 0
    Quote from BluegrassRN
    And while I'm on a pain control rant, toradol is WAY underused as a pain medication. I've seen plenty of patients c/o pain uncontrolled by a pca of dilaudid, morphine, or fentanyl get better pain control with intermittent prn iv or po narcs and scheduled toradol. Particularly pts with some sort of abscess or soft tissue pain (peritonsillar abscess comes to mind).
    last spring, i had some lesions surgically removed from my lung.
    i was on iv fentanyl, dilaudid and morphine - none of them were helping my pain.
    then the nurse offered me toradol - it took my pain from a 7 to a 0.
    that's all i wanted afterwards.
    i would do a commercial for that drug.

    bluegrass, great post btw.
    pts with cancer and sickle cell, the implications are there for strong pain mgmt.
    but you want to mimic their regimen, to what they'll be using at home, to extent possible.

    as for prn dosing, i am huge on staying ahead of pain.
    you just don't wait until the pt starts complaining.
    op, keep on doing your assessments, keeping in mind - that their pain (real or potential) is valid and warrants addressing.

    leslie
  3. 2
    Everyones pain is different. I always ask what the pain level is, then ask them if they need pain meds. If they want it, and it is due, I give it. It not my place to judge if they are in pain or not; pain is subjective, not objective. If they say 2-3 and say they want pain meds, I will some times suggest Ibuprofen and tell them that after 45 mins if it has not worked we can try a narcotic (my patients always have IBU ordered post partum unless they are already on Tordol). I usually have to talk my patients into taking pain meds because they are paranoid with breastfeeding...its easier to stay ahead of the pain than to treat it
    sharpeimom and leslie :-D like this.
  4. 2
    i am currently a patient trying to get my pain managed...

    i had a golf ball size tumor removed from my knee, muscle flap, skin graft, and 2 snb sites in my groin and lower abdomen...

    i am 11 days post op, and in a rehab facility to gain strength and safety with ambulation...

    the original order was 2 vicodin every 6 hours... which pretty much faded by hour 3... so pa wrote for 1 or 2 every 3 hours. i have only been taking 1 tab every 3 hours, and of course i have to ask for it, and the past 2 days were a mess, i would ask at the 3 hour mark, it would take them 20 min to get it to me, so now i was 20 min past, and it snowballed... now, i ask 30 minutes prior to the hour, and request a pain pill at ....... o'clock

    i do not want to become addicted, but i refuse to be in pain. over the past day and a half, i have been on top of it, and working on stretches, and today, i can bear weight on my foot!!!

    moral of the story? listen to your patient... yes there may be some who are drug seekers, but many patients just want to not be in pain, and be able to sleep
    nursel56 and sharpeimom like this.


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