Pain meds and low BP? - page 2

I had a pt who had scheduled 20mg oxycontin q8, along with PRN narcs q6 and q4. Her normal blood pressure ran low 100s. For a few days before I had her she was mid 90s. I work night shift and the... Read More

  1. by   canned_bread
    It's tricky, because if something happened and you DIDN'T give it (such as patient complaint), you aer in trouble. If you did give it, and something happened, trouble there too! I would document, document, document as well as inform the nurses around me and give it. Then I have covered my butt, because I was TOLD to give it!! I would also inform the doctors about any drop, and also chart the BP frequently, especially prior to dose and perhaps 30mins after to see any change.
  2. by   corky1272RN
    The nurse has to rely on her/his critical thinking and assessment skills. You cannot be forced to give narcs if you think it is inappropriate. Go to your charge nurse if the pt starts hollering that she isn't getting it. If the pt is asleep when it is time for a scheduled narc, chart that and reassess later. Even if the pt isn't falling asleep/drooling when it is time for a scheduled or PRN narc, I don't give more than 1 or 2 at a time (depending on the meds/situation), even if they take it all at home at the same time. I just explain that it is different in the hospital and I have to make sure that it is safe. That is my job. Some understand, some get very angry.

    I have had times where I wouldn't give certain meds at the same time. The pt became very angry, I explained the situation to my charge nurse, he agreed with me. But even if he didn't agree, he would either support me or give them himself. BUT if he decides to give the meds, he will take over the pt. Noone better demand that you give meds to a pt, because it is your license it anything goes wrong. I try to know beforehand if there will be an "overlapping" of meds. I will talk to the pt and let that person pick which ones are given & omitted. One time the house supervisor even got involved, she disagreed with my decision but still backed me.

    Suggestions that it is ok to give a bunch of narcs together just because the person takes it at home that way is a flawed way to think. You must keep in mind that the pt is getting other meds in the hospital that aren't taken at home that could increase (or decrease) the efficacy of the meds. Plus the person's current medical condition can change their tolerance.

    As for the BP, don't look at the #, look at the pt (and trend). You have to keep in mind what is the pt's normal, that is part of the critical thinking.