Diprivan & pain mgmt after surgery

[NrsBtrfly2005]

Hi everyone,

I think I have read something about this topic on a previous thread, but am unable to find it, so I apoligize if this is a duplicate post.

I work nights and on night #1, I recovered a patient that had just had a large portion of his bowel removed due to necrotic bowel (ileostomy, jejunostomy) Well the patient comes to me from the OR intubated with NO sedation OR pain management orders. Only order is to contact intensivist. Patient starts to wake up very quickly; intensivist called, order for Morphine and Ativan; max out on doses; patient still wild and fighting vent. Re-paged intensivist and got a Diprivan order; everything MUCH better for patient. (By the way our intensivists like our patients at -1 RASS Score, not zonked, which I feel is sufficient)

I am a new nurse in the ICU, but my thought process is that although the Diprivan is a sedative, it is not a analgesic, therefore, patient still needs Morphine to help with pain..... so, I continue to give Morphine (as ordered) PRN when patient vigorously coughs during suction (or on own), gets turned/reposition, grimaces, gets restless, grabs belly, etc.

Night #2, I come in to find that the day shift RN (12 hours) did not give the patient morphine all day... only kept the diprivan gtt running... I continued my routine of PRN morphine during times described above (I only gave 4mg doses about 3 times during my 12 hours). When I gave report to the oncoming day nurse (not same nurse), she did not seem bothered that patient didn't get morphine the previous day and seemed surprised that I was concerned.

My question is do many of you see this happening in your ICU, where some nurses feel diprivan is adequate pain relief for fresh post-op patients? Am I over reacting when I feel frusterate about this? Since I am a new ICU nurse, your input is really appreciated.

NRSBTRYFLY2005

[sirI, MSN, APRN, NP]

Hi everyone,

I think I have read something about this topic on a previous thread, but am unable to find it, so I apoligize if this is a duplicate post.

I work nights and on night #1, I recovered a patient that had just had a large portion of his bowel removed due to necrotic bowel (ileostomy, jejunostomy) Well the patient comes to me from the OR intubated with NO sedation OR pain management orders. Only order is to contact intensivist. Patient starts to wake up very quickly; intensivist called, order for Morphine and Ativan; max out on doses; patient still wild and fighting vent. Re-paged intensivist and got a Diprivan order; everything MUCH better for patient. (By the way our intensivists like our patients at -1 RASS Score, not zonked, which I feel is sufficient)

I am a new nurse in the ICU, but my thought process is that although the Diprivan is a sedative, it is not a analgesic, therefore, patient still needs Morphine to help with pain..... so, I continue to give Morphine (as ordered) PRN when patient vigorously coughs during suction (or on own), gets turned/reposition, grimaces, gets restless, grabs belly, etc.

Night #2, I come in to find that the day shift RN (12 hours) did not give the patient morphine all day... only kept the diprivan gtt running... I continued my routine of PRN morphine during times described above (I only gave 4mg doses about 3 times during my 12 hours). When I gave report to the oncoming day nurse (not same nurse), she did not seem bothered that patient didn't get morphine the previous day and seemed surprised that I was concerned.

My question is do many of you see this happening in your ICU, where some nurses feel diprivan is adequate pain relief for fresh post-op patients? Am I over reacting when I feel frusterate about this? Since I am a new ICU nurse, your input is really appreciated.

NRSBTRYFLY2005

Hello, NRSBTRYFLY2005,

Here are a couple threads on this topic. Not sure it will help you, but, interesting threads.

https://allnurses.com/forums/f18/propofol-130833.html?highlight=Diprovan

https://allnurses.com/forums/f16/gi-diprivan-thread-81407.html?highlight=Diprovan

[sjrn85]

Just because a pt. is sedated doesn't mean he doesn't feel pain. I would have given the MSO4 as you did.

[pricklypear]

No way - you're not overreacting. I've even run across doctors who don't understand that Diprivan has absolutely NO analgesic properties. People seem to see a well sedated patient and assume that they can't be having pain. It says a lot about you that you are concerned with this. It is soooo frustrating when you work so hard to make a patient as comfortable as possible, only to have all that work undone by the next shift, and you realize that your patient has been miserable for the 12 hours you were gone.

Have you thought about asking your manager if you can make up some sort of educational presentation (like a poster for the break room) about this subject? Sometimes all it takes is some education to change old habits. Keep up the good work!