Dont feel bad- it does happen. If I have doubts, I ask the pt- have you ever taken this ______ before, or this combo? If no,maybe I'd stagger the med- give pain med 1st and see how they do. But I also have seen others that get rediculous amts( example- 10mg ambien, 2 mgvalium, and tylenol #3's) all in one sitting, and 87 (eek!~) yrs old- and he does just fine( he had a hx of fibro/pain and these were his home meds) I also remember having a pt that was sooo tolerant- she finally got the doc to write for 4 MG!!! IV dilaudid Q2 hours!! but let me tell you, i was on pins and needles with that one. Thing was , she WAS very sedated, and the only thing keeping me from calling on her was the fact she responded to voice, rr 10-12, and she would ask for more when I assessed her, falling right back to sleep.o2 sats ok too.
People respond different. I remember a cath lab pt being brought up to me , the rn telling me "we had to reverse them" they only got 2 versed and 50 fentanyl- not unusually doses, but for that person, it was too much. Dont feel bad.
It is so hard nowadays for pain control, as the PG scores also ask" was your pain adequately controlled" . Because so many people nowadays want to BE SNOWED to oblivion, some docs DO order the stuff, leaving us nervous wrecks, as since we give the drug, its now our responsibility, but if we don't, they say they got crappy care.