Quote from empatheticRN
Example 1 (These are the available meds that a patient has)
Dilaudid 0.5 mg IV for pain 4-6
Dilaudid 4mg P.O (pain >6)
Phenergan 6.25 mg IV
Zanaflex (muscle relaxant)
She states her pain is 9/10. I brought in the P.O dilaudid but she refused. I told her that it wasn't time yet (she had to wait another 30 minutes). I finally gave her the IV dilaudid. Less than an hour, she said she was nauseous and wants her phenergan. In no time, she is anxious and wants xanax plus Zanaflex. I know pain is what the patient says, but who is in pain wants to wait 30 minutes when something else is available. Is it safe to give all these meds pretty much at the same time? The Doctor wrote it this way. How do you guys deal with this situation?
Example 2 (Patient has Chronic Inflammatory Demyelinating Polyneuropathy which is similar to MS and her joints get painful and swollen)
Percocet 10/325 PRN
MScontin (rscheduled dose)
Lyrica (scheduled dose)
I gave her the MScontin with her Lyrica along with her nighttime meds. 2hrs later, she wants the Percocet which she was due for and 30 minutes after she said she wants ambient because she couldn't sleep.
Example 2 doesn't bother me much but example 1 seems like she is trying to get high. I know the doctor ordered her medications that way. But is it even safe to get that many of these types of meds? The nurse that had her 2 nights later said at one time, she went into the room after she had called for her meds and she was so drowsy. She pretended to draw up the meds but instead with saline and she didn't even know the difference and continued to sleep like a baby.
Please guys how do you deal with drug seekers. If the doctor orders it , do you just happily give it? Please help me because I don't want to be contributing to someone's addiction.
There is no dosage on the Xanax of Zanaflex. However, I would like to point out that the bioavailability of PO dilaudid is not very much and can vary greatly. That's how you have sickle cell patients on prescriptions for like 8-12 mg PO dilaudid every 4-6 hrs and you don't even see them with the signs of being high and wonder how they are breathing. It's really not a good pain management medication at all in pill form. The patient would have been better off with like 10mg oxycodone over the 4mg dilaudid pill. I mean honestly 0.5mg Dilaudid IV isn't that much either, especially if the patient is on chronic pain meds. 6.25 mg of Phenergan also is not that much and given together they can potentiate each other and be very effective and last longer. If a patient is on long term medication they can build a tolerance and require more to be effective then what someone naive may need. It's all very individual.
So had it been me, and I am hurting pretty dang bad and I know this 4mg PO dilaudid pill is going to do nothing for my pain, not to mention it will take about 20 mins to even start working, then yes I would be willing to breathe it out and wait that 30 mins for the medication I know will work quick. Personally if it were me I would rather have the phenergan and then some percocet or something once the phenergan kicks in (if nausea is an issue) since PO medication will last longer and you will obtain better pain control.
In case number 1 how is it you know she is trying to get high and that she isn't in genuine pain or anxious or having any of these ailments. See this is the problem with our profession and with the stuff going on. It's so easy to judge and decide someone is drug seeking and make statements that we don't want to contribute to their addiction. But unless you're an addiction specialist and evaluating this patient, how do you determine they are an addict? What kind of training do you have to determine this? Sure some situations might seem more obvious and easy to draw a line in the sand.
But consider for just a moment that maybe the patient does have a tolerance, maybe the patient does have genuine ailments and pain. How are you advocating for them and doing best for them by you making a moral decision based off your own beliefs that they are drug seeking and wanting to get high and you're not going to contribute to it?
It's a very slipper slope.
So often we also tell patients "Don't wait until the pain is severe to call out, it's easier to stay on top of pain then to chase it" but then patient calls out saying the pain is coming back and we determine they want to get high and they aren't withering in pain yet so they are fine.