Managing pain question- best advice - page 3

by compassionRN

12,757 Views | 23 Comments

:nurse: My situation is this.... I recently medicated a pt with IVP Dilaudid 2mg (as ordered) for a pain scale of 10/10, at the same time I also gave 2 Percocet 5/325. The pt had an ACDF two days prior and was having... Read More


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    Other than being not narcotic naive, what other co-morbidities does he have? I have had people in sickle cell crisis have 8-12 mg (per hour-2 hours) of Dilaudid ordered while they were munching cookies and talking on the phone. This is while they say it is 10/10. Before the meperidine back off, these same people would get 100-150 mg an hour.

    Is your patient an addict? Is the doctor aware? Doing the oral plus the IV I'd really worry about the APAP excess if you are giving it around the clock.
    wooh likes this.
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    I've had good success with around-the-clock medication for pain. Such as, staying on top of those 2 Percocet Q4H. I used to give EVERYbody Dilaudid, and ended up with a lot of nauseous, puking, hypotensive patients... but now my rule of thumb is Dilaudid for pain greater than 7, so I will medicate my patients with a PO med ASAP after surgery to get a baseline, reassess them, and if their pain is not relieved, medicate with Dilaudid. Of course there are always exceptions, and each patient is a unique individual!
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    Quote from suanna
    With appropriate assessment your patient was in no danger and most likely grateful for your pain management.
    100% agree with suanna's post.

    I think nurses tend to overly fear oversedating patients. Especially if the patient isn't opiate naive. Patients shouldn't suffer because a nurse is too nervous to give adequate medication to relieve pain.
    I'd have done exactly what you did with the exact same rationale.
    Last edit by wooh on Mar 25, '12
    workingmama77 likes this.
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    Quote from Perpetual Student
    FWIW, our hospital does have range orders that read something like "Percocet 5/325 1-2 tablets every 4 hours PRN pain" and we passed our recent JoCo survey easily.
    Agree, what you cannot have is two ranges in the same order. So that order is good. "Percocet 5/325 1-2 tablets every 4-6 hours PRN pain" is not.


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