Tylenol Versus Vicodin

txspadequeenRN, BSN, RN · Nov 21, 2007

how old is this patient and where is the pain? did the patient have recent surgery or have a diagnosis that would make you think they would have pain? is there some reason this tylenol is in supp form, besides this is only 650mg? i personally only give tylenol when i am dealing with a headache. i think it is a useless drug anyway . i don't think tylenol is ever appropriate for moderate level of pain. when i have a patient that has a order for both and because and because i know my patients pain real well you will never catch me giving tylenol. one reason it is worthless the other is if it don't work and i have to come back and give the vicodin then i am working toward a max dose on acetaminophen. another thing is transferring the patient back into bed then out again only increases the pain. if you feel the vicodin is to much then see about a order for ultram or something like that...

if a patient has a pain. which one is the best medicine? let say.. tylenol (suppository) if pain is moderate. give vicodin p.o. if severe. that's very easy to follow for prn orders.
here's my story:
the cna came up to me and stated that the patient has pain. the patient is unable to rate the pain, but looking at the patient facial expression. it's moderate. i wanted to give tylenol for pain. but the patient needs to be lying in bed in order for me to administer the tylenol (suppository). i tell the cna that the patient needs to be in bed. well, the cna got stress out because the cna just got her up. i told the cna that i can only give the pain medication thru anal. the cna argued that why i can't give it thru the mouth instead. i told the cna, the order is suppository.
geez. i'm such a noob. =d
i should have asked the cna if the patient is in bed. then she could have waited for me to administer the medication before the cna get the patient up.
well, the patient did get the suppository. the patient has to be back on bed in order for me to give it, but the cna got really upset. i don't like people getting upset. =( also, it's not fair for the cna and the patient to get all the trouble of transferring. gawd. what a bad nurse i am.
well, the good outcome about this...is that....i learned something new. the bad part is...err..well, the good part is that i will remember this next time. when a cna stated that the patient is in pain, i will just let the cna know the next time that cna will leave the patient on bed. because the patient need rest anyways.
why didn't i just give vicodin instead?
what do you guys will do in this situation?

ari3sdog · Nov 21, 2007

how old is this patient and where is the pain? did the patient have recent surgery or have a diagnosis that would make you think they would have pain? is there some reason this tylenol is in supp form, besides this is only 650mg? i personally only give tylenol when i am dealing with a headache. i think it is a useless drug anyway . i don't think tylenol is ever appropriate for moderate level of pain. when i have a patient that has a order for both and because and because i know my patients pain real well you will never catch me giving tylenol. one reason it is worthless the other is if it don't work and i have to come back and give the vicodin then i am working toward a max dose on acetaminophen. another thing is transferring the patient back into bed then out again only increases the pain. if you feel the vicodin is to much then see about a order for ultram or something like that...

thanks for your advice.

the patient didn't have post-op surgery. just body pain due to immobility. i should have given the vicodin instead, but the patient seems drowsy and tired. the vicodin might worsen the drowsiness. i was just following the prn orders. moderate pain = tylenol...severe pain = vicodin. since i assess the pain for moderate, then i should give tylenol. but i was thinking that i should have given the vicodin so that the medication will prevent the pain from rising. anyways, the patient is alive and well.

maybe the next time what i will do is...

1. look at the previous pain medication that they usually offer

2. ask other nurses what they usually give to this patient

i should have been more resourceful. sigh.

kcalohagirl · Nov 21, 2007

Since the patient could obviously swallow, since there was an order for PO vicodin, I might have called the doc and asked why in the world the order for tylenol was only as a suppository, and could I please have an order for PO. (That is if I had really wanted to give tylenol. I probably would have gone with the vicodin, myself.)

Most people hate getting suppositories worse than they hate pain. I don't blame them.

Of course, I work at a teaching hospital, and residents do silly things like write for PR instead of PO on a fairly regular basis.

ari3sdog · Nov 21, 2007

Since the patient could obviously swallow, since there was an order for PO vicodin, I might have called the doc and asked why in the world the order for tylenol was only as a suppository, and could I please have an order for PO. (That is if I had really wanted to give tylenol. I probably would have gone with the vicodin, myself.)
Most people hate getting suppositories worse than they hate pain. I don't blame them.
Of course, I work at a teaching hospital, and residents do silly things like write for PR instead of PO on a fairly regular basis.

Hmmm...good point. I have to check that out tomorrow. Thanks for the replies

Home Health Columnist / Guide · Nov 21, 2007

Since the patient could obviously swallow, since there was an order for PO vicodin, I might have called the doc and asked why in the world the order for tylenol was only as a suppository, and could I please have an order for PO. (That is if I had really wanted to give tylenol. I probably would have gone with the vicodin, myself.)
Most people hate getting suppositories worse than they hate pain. I don't blame them.
Of course, I work at a teaching hospital, and residents do silly things like write for PR instead of PO on a fairly regular basis.

:yeahthat:

Kudos to thinking about this problem. If they are up and appearing to be in in moderate pain, I'd give the po med over suppository as would kick in sooner instead of having to physically move patient thereby exacerbating pain, disrobe to insert suppository, awaiting med to melt to absorb rectally.

Some patient care activity and decisions on pain management we only learn though experience of our patients. Please look into oral route for med if no swallowing issues.... wonder if P "R" was actually poorly written P "O".

ari3sdog · Nov 21, 2007

:yeahthat:
Kudos to thinking about this problem. If they are up and appearing to be in in moderate pain, I'd give the po med over suppository as would kick in sooner instead of having to physically move patient thereby exacerbating pain, disrobe to insert suppository, awaiting med to melt to absorb rectally.
Some patient care activity and decisions on pain management we only learn though experience of our patients. Please look into oral route for med if no swallowing issues.... wonder if P "R" was actually poorly written P "O".

The patient is on pureed diet. So all Meds are crushed. I'm thinking that the Tylenol Suppository was old order. And the Vicodin was just recent order.

Anyways, thanks for the reply. I'm working at 7am today and I'm still awake because this really getting me interested reading all the replies =D

Home Health Columnist / Guide · Nov 21, 2007

Since patient on pureed diet, thinking liquid pain meds better for patient. Inquire about Tylenol liquid and Vicodan equivalent in liquid form---consult facility pharmacist for best advice. Your patient will thank you and you are meeting intent of "patient centered" pain management goals.

Time for be for me too!

**SKM-NURSIEPOOH, BSN, RN** · Nov 21, 2007

also review your facility's pain scale policy for prns (narcotics vs non-narcotics). there really need to be well specified guidelines/orders that your facility has in place. you can also check your drug guide book in terms of usage between the two types of meds (narcs & non-narcs). for example...in the recovery room i work in have the following standard orders for pain:

pain scale 1-3 (mild), tylenol po (when stable/awake enough) or toradol (super motrin in iv form)
pain scale 4-6 (moderate), morphine iv, vicodin/vicoprofen po (when stable/awake enough)
pain scale 7-10 (severe), fentanyl iv 1st, diluadid iv 2nd, ms contin po (when stable/awake enough)

see what i mean? of course your facility may have slightly different orders/policy ~ but whatever they are, do review them again.

now about having the cna return the patient back to bed is another thing entirely. firstly, even if you felt correct & required the patient to return to the bed, why on earth couldn't you do so yourself? why would you ask the staff to transfer the patient when you're perfectly capable in transferring them? i definitely understand the staff's frustration there. secondly, just think about how the patient must feel & see or anticipate how re-transferring them will make the patient feel.

be that as it may, others here have given you some good sound advice as far as giving the narcotic first as that would have been more advantageous to the patient for both comfort & practicality.

cheers :cheers: ,

moe

**canoehead, BSN, RN** · Nov 21, 2007

Why not just have the CNA help you stand the pt, pull down their pants momentarily and pop it in? A lot less effort- same result.

Hellllllo Nurse, BSN, RN · Nov 21, 2007

I agree, Canoe. I'm sure many of us have given a supp to a pt while they are in a w/c, as well. it's not hard- as long as they can lean forward and rest their upper body on a table.

Also, many facilities have standing orders, which almost always include prn APAP, in any form needed.

Tweety, BSN, RN · Nov 21, 2007

Great advice so far!

I would have tried to give the tylenol while the patient was up. For general aches and pains mild to moderate Tylenol should be o.k. especially for someone already drowsy. So trust your instincts here. But for moderate, I would have went with the Vicodin. For many bedridden and elderly patients with aches and pains of bedrest and old age, Tylenol doesn't cut it.

Definately try to get that supp order changed for future use.