Pain meds

[ajw49886]

A friend of mine emailed me to ask a question. Her husband is in the hospital with pancreatitis. His pain meds make him nauseous so he is ordered zofran every four hours and dilaudid every two hours. She says that he rang for the nurse and asked for both. She brought the zofran and said she would be back with the pain meds. She never came back and he rang every 15 mins four an hour. After an hour and 15 mins she came back and said she was giving the zofran time to kick in and the charge nurse agreed. She asked if this is the norm. Admittedly I have been in a specialty for some time but I can't off the top of my head think why this is necessary. Any ideas?

[lmccrn62, MSN, RN]

Why doesn't he have a PCA for his pain meds?

[caliotter3]

I'm still waiting for the pain med promised to me the last time I was hospitalized. That has happened to me more than once. For the life of me, I don't understand why the caregiver can't just be upfront with the patient when someone decides to change a decision. She said she was waiting for the antiemetic to kick in, (more explanation than I got), but I don't see that the two need to depend upon each other, but that is just my opinion.

[SoldierNurse22, BSN, RN]

It doesn't typically take an IV push med an hour to "settle in" and work. Give it 15-30 minutes and you should be ready to go. Instead of making a questionable timeline for med administration, suggest to your friend and her husband that he make a plan with the nurse so that he knows a roundabout time to expect her to return with his pain med after she gives him the antiemetic. Of course, as is the nature of floor nursing, the nurse may not be there exactly on time--but that way if she's 20 minutes late, the patient knows to call and ask for his med instead of having to wonder if something's wrong.

Just let your friend know that once her husband is feeling nauseated, Zofran won't do jack skippy. It prevents nausea, but it isn't very effective at treating it.

[MunoRN, RN]

IV zofran has an onset of action of just 5 minutes, it peaks in 15 minutes, so no, there's no good reason to wait an hour to give the dilaudid.

[ajw49886]

Honestly since I work in endoscopy now we see pancreatitis patients all the time and even when I had them on the floor they never had PCAS.

[cjcsoon2bnp, MSN, RN, NP]

I haven't done Med/Surg. in a while but this is what I would have done (with the limited amount of information that we have about the situation)

If the patient reported being nauseous and in pain I would ask the patient to rate the pain on a 1 - 10 scale and the same for the nausea. I would talk with the patient and discuss my plan to try to get the nausea under better control before I give the Dilaudid because it is likely to make the nausea worse and if he vomits it will make the pain significantly worse as well. I would administer the Zofran, encourage him to rest and then tell him that I would be back to reassess his nausea in 15 - 20 minutes and with the plan to give him the Dilaudid at that time. I would tell him if for any reason I was caught up in another room or he could not wait then please use the call light to call for me. If after the 15 - 20 minutes the nausea was significant and not showing any improvement I would talk with the patient and see where is pain was at and see if he wanted to give the Zofran another 10 - 15 minutes to reach its full effect. If the pain was getting significantly worse or intolerable and the patient could not wait any longer, I would administer the Dilaudid and monitor him closely to see if if his nausea improved or if he needed another antiemetic. In my opinion, if you can keep the nausea under reasonable control it will make managing the pain a lot easier and your likely to improve the patient's ability to function whether this is an acute or chronic state of being.

!Chris