What do you think? (warning: vent ahead)

Nurses Relations

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Specializes in M/S, Tele, Sub (stepdown), Hospice.

Young patient. Allergies: Compazine, Reglan, Zofran, NSAIDs, Haldol

Patient "fired" me because I wouldn't push his Dilaudid 1.5mg & Benadryl 50mg (both IVP) together. I told him I would give his Benadryl 30 min. apart. He literally yelled, "they always give it to me together". When asked what he took the Benadryl for he told me for "reactions" to Dilaudid & he was gonna bleed from itching if I didn't get it to him at. the. same. time. First of all, he get's Dilaudid Q2h & Benadryl Q4. Weird how he doesn't bleed the times he gets Dilaudid without the Benadryl. He also gets Phenergan IM Q4h.

I tried explaining my reasoning but he wanted to talk to my CN. She went in....w/ Benadryl. She totally understood my reasoning but in the end he got what he wanted. He got a new nurse & was happy because she gave him everything he wanted. These patients are so frustrating. They act like the hospital gives them an excuse to act like a child throwing a tantrum when they don't get what they want. I'm not there to give him everything he asks for....if it's not safe! Sure, he may have a high tolerance but it's my license on the line & I don't want to be the exception if something bad actually happened to him!

And because these nurses are giving in to "shut him up"...it makes it worse on the next nurse!!! Ugh...

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Specializes in Med/Surge, Psych, LTC, Home Health.

If you didn't feel safe pushing the two meds together, then you didn't feel safe and that's it. You did nothing wrong. He wants another nurse, fine, you don't have to put up with him anymore. I've had patients "fire" me before and it's like.. fine then, good Riddance.

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And because these nurses are giving in to "shut him up"...it makes it worse on the next nurse!!! Ugh...

That's often the case, but sometimes the nurses are "giving in" not to shut him up, but because they disagree with your rationale for withholding. It's not always black and white.

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Specializes in M/S, Tele, Sub (stepdown), Hospice.

That's exactly what the nurse before told me...her own words, not mine.

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Specializes in Cardiology and ER Nursing.

Patients generally act like this because they are conditioned to act like this.

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Specializes in Pedi.
If you didn't feel safe pushing the two meds together, then you didn't feel safe and that's it. You did nothing wrong. He wants another nurse, fine, you don't have to put up with him anymore. I've had patients "fire" me before and it's like.. fine then, good Riddance.

One of my colleagues always says "do you notice how the patients who 'fire' nurses are the ones no one wants to take care of in the first place?"

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Specializes in Gerontology, Med surg, Home Health.

We all have to follow our own ideas about what is safe practice. I used to have to pass meds if someone called out. I always went by the book. Some of then patients would get mad at me because "the other nurses would give me all my meds together" or the other nurse 'gives me my ativan, percocet, and ambien at the same time." I'd tell them I wasn't 'the other nurse' and I would continue to practice the way I had been taught. Most of them just laughed and told me they could stand it for one night until the regular nurse came back.Do what you know is right.

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Don't know where you are or the situation but could the pharmacy provide a consult that results in black and white rules for the nurses? Staff splitting is a time honored form of manipulation. Sounds like he is good at it. I agree with ScottE. We condition patients. Remember random reinforcement?

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Specializes in Med Surg - Renal.

I don't know what it is about these patients but they sure do resemble each other.

What is the reason for the 30 minutes between Dilaudid and Benadryl?

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If you didn't feel safe pushing the two meds together, then you didn't feel safe and that's it.
The OP never said anything about not feeling safe. In fact, she never gave her rationale for pushing the Benedryl 30m after the Dilaudid. Are there factual reasons for giving the two meds separately [e.g. the patient snows out when the two are pushed together or she has concerns about it affecting his respiration], OP?
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this is what medscape (partially) states about hydromorphone.

"diphenhydramine will increase the level or effect of hydromorphone by affectic hepatic enzyme CYP2D6 metabolism. Significant - Monitor Closely.

diphenhydramine and hydromorphone both increase sedation. Significant - Monitor Closely."

http://reference.medscape.com/drug/dilaudid-hydromorphone-343313#3

only op can answer why she gave 30 minutes apart, but if it was r/t above, it was a prudent decision.:twocents:

leslie

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Specializes in psych, addictions, hospice, education.

I agree with Leslie and also am thinking that the patient knows he gets an intense allergic reaction from Dilaudid (itches til he bleeds, from scratching I guess). He also knows Benadryl prevents it, it seems. If he doesn't know your rationale, he's just loudly and rudely fighting for his rights.

He wouldn't itch til bleeding on the times in-between doses of Benadryl because it would still be within its effective time frame.

He definitely could have been nicer.

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