Conflict with fellow nurse regarding Dilaudid administration, please help! - page 3

Hi everyone, I’m a first year nurse and I have a question about Dilaudid administration. Is it necessary to hold Dilaudid pain medication for an 84 year old patient with low blood pressure? Another... Read More

  1. by   Kooky Korky
    Quote from traumanightsRN
    I'm on the same page as loriangel14. Sounds like the patient needs a PCA and I would recommend fentanyl first because of his age. Then if that doesn't work change it to dilaudid. Secondly, I would absolutely give the dilaudid; it's only 0.5mg which is just a whiff and worst case scenario his SBP drops to mid 80s, not going to harm the patient because it's not going to stay there for long. The patient's nurse is being straight up lazy and in my opinion acting unethically. If a patient says they are having pain you MUST treat the pain. You cannot hold pain medicine for any reason, even if the patient is hypotensive. Since a lot of times providers don't order pain meds that adequately treat pain, in my hospital (don't know if you have it where you work) you can get a Geriatrics consult and a Palliative consult (for pain). Both consults will evaluate the patient and then give recs for how to best treat his pain. They are the experts.

    And just a note, I would not ask a provider if it was ok to give pain meds if a patient is hypotensive. Where I work we don't need to go to the provider for every little thing; the nurses are very autonomous and are encouraged to use their brain. Treat the pain.
    You likely can't get those consults in the middle of the night, which is when this situation took place.

    You can't hold treatment of pain for ANY reason? Doesn't sound right. You might need to get a different treatment going in place of the one currently ordered, but to say you can never withhold pain treatment doesn't sound right.

    Asking the doctor if it's ok to give pain meds if a pt is hypotensive might be necessary if the nurse involved doesn't have the knowledge and experience to deal with the situation on her own. The patient's nurse did act autonomously, just autonomously incorrectly.