Dilaudid question - Personal Opinion

MayLady · Apr 7, 2009

I guess I should have made myself more clear. I have no problem medicating people for pain, nausea, or itching as some of you seem to be insinuating. I pride myself in appropriately medicating people as well as responsibly medicating people. I am simply talking about the people who are lying comfortably in bed saying "I'm itching so bad" but hasn't so much as scratched. Or they say "I'm really nauseated" but are scarfing down a cheeseburger. To me, it seems that most pts on Dilaudid seem to want the additional med with it. I have had a sickle cell pt tell me once that it made her "more high" when she had the Benadryl/Phenergan with it. Please don't make assumptions that I'm judging, b/c I medicate them if they need it. I'm just asking if there's a trend elsewhere like we see it here in my hospital (discussed with other RN's on my unit).

azhiker96, BSN, RN · Apr 12, 2009

I've found the patient matters more than the drug. If you have a patient on scheduled doses of dilaudid they are probably already an addict. The diluadid didn't make them that way.

In my area, PACU, I give lots of morphine, demerol, dilaudid, and fentanyl. I've only had one patient who demanded, no....screamed is more accurate, for benadryl. When she woke up she screamed "Give me Dilaudid, 6mg, NOW!" I looked at my orders for morphine 2mg IV q5min max10mg and concluded I had a huge disconnect. So I checked the MAR from the floor. Guess what I found, pt was on dilaudid 6mg IV q4h and last dose was 4 hours ago. Well, well, well. I served up 6mg dilaudid. She then requested (screamed) for benadryl. Checked the MAR and found benadryl 25mg IV q4h prn. Hmmm, I gave her the benadryl. That combination eased her pain so that we could then work on other issues.

Of course she's an addict. Can I cure her in PACU? Nope. She'll need to go to rehab for that. That's not our mission and we don't have the time to dry folks anyway. My job is to keep her breathing, get her awake and stable, and hopefully control pain and other symptoms.

Penelope_Pitstop, BSN, RN · Apr 17, 2009

Really? I've never heard of such a thing. Was your patient a horse?

I can top 16 mg/3 hours. I had a patient receiving 6 mg IV every hour. She was also receiving Benadryl and Phenergen.

TuTonka · Apr 17, 2009

Yes May lady these people are everywhere but pain is subjective if you doubt thier pain scale rate defining it is the best you can do in an effort to educate pts.. However, you will always have pts talking and laughing on the phone and tell you their pain is 10/10. If their v/s are good, their resp good , their LOC good and your orders call for it at the right time you have no recourse except bringing it to the attention of your charge nurse and or the pts MD.

Teacher First · Apr 18, 2009

Pain is subjective. I, too, am one of the people who have a "different" way of handling pain for myself. First off, I don't like the effects of morphine or demerol, and Toradol works much better for me. That being said, each person responds differently to different meds. I have had several major surgeries, and I have experiece with self-hypnosis so that I seem to be able to use it and compartmentalize the pain. I still feel the pain, but I am able to dissociate my pain and respond in a sane manner. I don't whine or scream, I just calmly tell the nurse that I have pain 10/10....no need for histrionics. So for some of you that seem to need to see the patient writhing before believing their complaint, keep in mind what some others have said here....pain is whatever the patient says it is, and medicated them accordingly or discuss your concerns with the prescribing provider. I agree with azhiker....we can't rehabilitate patient's with addictions in the short time most of us have with them, but only pass on the observations that we make.

star77, MSN, RN · Apr 18, 2009

"Pain is whatever the person says it is, existing where ever the person says it does." (McCaffery, 1968).

And last time I checked, there are genetic variations in metabolism of drugs. Our job is to treat the patient and his/her pain. Addiction treatment, if that's what's going on, is secondary. Not for us to judge.

We can ask for an addiction assessment and a pain contract, but if someone says they have pain, then as far as I'm concerned, they have pain.

allnurses Guide · Apr 19, 2009

"Pain is whatever the person says it is, existing where ever the person says it does." (McCaffery, 1968).
And last time I checked, there are genetic variations in metabolism of drugs. Our job is to treat the patient and his/her pain. Addiction treatment, if that's what's going on, is secondary. Not for us to judge.
We can ask for an addiction assessment and a pain contract, but if someone says they have pain, then as far as I'm concerned, they have pain.

Let me add one little caveat to that just because a patient says they are in pain doesn't mean they need narcotics. There are a lot of ways to treat pain that do not involve pain, and the long term use of narcotics has shown to make pain worse not better. http://www.medscape.com/viewarticle/562216_4

allnurses Guide · Apr 20, 2009

Let me add one little caveat to that just because a patient says they are in pain doesn't mean they need narcotics. There are a lot of ways to treat pain that do not involve pain, and the long term use of narcotics has shown to make pain worse not better. http://www.medscape.com/viewarticle/562216_4

"that does not involve narcotics" that is...... sorry for the typo. I really miss the old edit feature.

star77, MSN, RN · Apr 20, 2009

Long term use, yes, but I'm talking about immediate short term. For the long term, we can make pain contracts, but in the short term, we should treat the pain.

LovingNurse, BSN, RN · Apr 20, 2009

Let me add one little caveat to that just because a patient says they are in pain doesn't mean they need narcotics. There are a lot of ways to treat pain that do not involve pain, and the long term use of narcotics has shown to make pain worse not better.

I agree, there are other ways to treat pain and those should be offered... and also agree that long term use of narcotics can cause problems, but neither justifies withholding pain medication if the physician says it is allowed.

mama_d, BSN, RN · Apr 20, 2009

Personally, I think that dilaudid is overused and misused. There are certainly times when it is appropriate and it works well, but I think that some physicians and nurses go straight for the heavy hitter instead of taking the time to try and customize the pain management regime to the patient. My philosophy is pretty much to get the pain dosed initially with the IV meds, then dose with PO meds (when available and appropriate to diagnosis) for follow up and see if it works. If it doesn't, I've got the dilaudid to fall back on. It seems like PO meds tend to hold out for longer for pain control in most patients.

As far as judging pain levels, I have to say from my own pain experiences that it's entirely possible to be in a great deal of pain and not really show any symptoms of it, especially when talking about chronic issues. It's amazing the amount of pain that one can get used to! After I had my hysto, I spent a few weeks feeling almost empty in my abdomen b/c the pain was no longer there; I didn't realize until it was gone just exactly how bad it had been, I had been living with it for so long.

And as far as the attraction of IV benadryl, when my sister got it in the ED once, she said she felt as high as if she had just guzzled a bottle of vodka. She couldn't even walk straight.

krisssy · Apr 20, 2009

I had an experience as a patient that this post makes me think of. I had an intestinal obstruction requiring surgery. I had been in the ER all day receiving morphine IV for pain. When they transferred me to a floor, they stopped the pain medication, and I was certainly a 10 in pain. I asked the nurse for my pain medication. Her answer was that there was no order. I told her that I had been receiving morphine all day, and her answer was, "Charts don't lie, and there is nothing on your chart saying you were receiving any pain medication." She left me screaming in pain. My husband came a few minutes later, and I told him. Well, he started screaming so loud that my surgeon was called, and of course he verified my pain medication to be given immediately. This same nurse angrily gave me a shot which left me black and blue for months. I went to surgery, requested to be on a different floor after ICU, and we went to the director of nurses and had the nurse reported. The director of nursing came to me to personally apologize.

The lesson from this is to listen to your patient and look at them. If the chart doesn't match what they are telling you, for God's sake check it out-call the Dr. Never leave a patient crying in pain.

Like other's have said, it is not our job to decide who needs pain medication and who does not. As far as addiction, it is certainly not our job to withold an addicts pain medication. An addict is a sick person with a disease. They deserve to be treated with the same care as we would give any other patient. Who are we to discriminate between diseases? We need to follow the doctor's orders and hope that our patient with the disease of addiction will get the help he needs in a hospital or rehab that treats this disease. We are certainly NOT going to cure an addict by witholding his pain medication. We may even cause his death. Krisssy