Dilaudid question - Personal Opinion

Nurses Medications

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How do you feel about giving IV Dilaudid (or Dila-la as we call it :chuckle )? B/c in my practice, I see a lot of people turning into addicts when they receive it. They also always want Benadryl and Phenergan given with it...hmm..wonder why... :banghead: I personally hate giving it and I hate that the pts think they are pulling one over on me saying "I have itching/nausea/etc too and push it fast". Ugh. I push slow and educate every time I give it.

Specializes in Anesthesia.
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.

Let me repharase....my statement....yes you can/should give narcotics, but NSAIDs, TCAs, SSRNIs, Tylenolol, gabepentin, lyrica are additional medications (or simply adding a regional block/pain ball/peripheral pain catheters etc.) that should be started immediately for patients that will probably have long term pain to reduce the need for narcotics and limit the adverse effects as much as possible should also be started. Our military casualties/trauma patients even with injuries that aren't very serious are started on multiple modal therapies to prevent long term pain/narcotic complications. These guys are usually started on these therapies with the 1st couple of days after injury. This is no reason not to do this for bigger surgeries, and certainly probably should be done for any patient with any kind of chronic pain.

Here is one article that may explain what I am trying to say a little better. http://www.ejbjs.org/cgi/reprint/89/6/1343

This is nice ppt overview also....http://tier1group.com/rmu/rmu_cache/project_14/ASA%20Viscusi%20C3.1224724626210_66.ppt#346,4,Suboptimal Management of Post-operative Pain

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As a patient for years I had gout that was out of control Unfortunately at times it became so bad that it was necessary to go to th local ER. I never once requested a shot for pain unless it was toradol to knock down the inflamation. Some drs did require me to recieve a shor of narcotic for pain. It was usually morpine not demoral or Dillaudid. I tried requesting it with out the phenygrin but was turned dowwwn saying it was reuired to insure there was no reacion like vomiting. It was nealy alway in the muscle not a vein and the plunged it in pretty quick. I used to hate the toradol as it fely like corn syrup going in.

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I have been suffering from chronic severe pain from Interstitial Cystitis. I have tried Torodol, Lyrica, Elavil, NSAIDs etc. for the last 9 months. Nothing has worked, and I have been debilitated for 9 months. I have finally been put on Oxycontin 10mg. every 12 hours, and my pain is gone. I am afraid of addiction, BUT I do NOT believe in suffering either. If I have to be detoxed when I go into remission if I do, I will do what I have to do. Meanwhile, I am able to enjoy my life again after 9 months of severe pain and suffering. It does not alter my mood at all. Krisssy

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In my last clinical, there was a patient who had Sickle Cell Disease and one of his medications was Diluadid for pain. The nurse said he was just drug wanting and the doctor made an order to give NS instead of the Diluadid. Our nursing instructor was informed of this by the student and she told us it was an unethical thing to do but we as students should pick our battles wisely as we have another whole year at this institution for clinicals. I know Sickle Cell Disease involves a lot of pain and the doctor should never have wrote that order. HOWEVER, after giving him his 'Dilaudid' the patient rated his pain on a scale of 5, which he previously rated as a 10 before the med.

What do you think about this?

:redpinkhe Sarah Hay, SN

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Sing with me now.....You aint seen nothing yet....OHHHH Baby you aint seen nothing yet.

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In my last clinical, there was a patient who had Sickle Cell Disease and one of his medications was Diluadid for pain. The nurse said he was just drug wanting and the doctor made an order to give NS instead of the Diluadid. Our nursing instructor was informed of this by the student and she told us it was an unethical thing to do but we as students should pick our battles wisely as we have another whole year at this institution for clinicals. I know Sickle Cell Disease involves a lot of pain and the doctor should never have wrote that order. HOWEVER, after giving him his 'Dilaudid' the patient rated his pain on a scale of 5, which he previously rated as a 10 before the med.

What do you think about this?

:redpinkhe Sarah Hay, SN

I am a nurse, and I have been a patient. Once a nurse refused to give me pain meds for an intestinal obstruction. She was dismissed by me as my nurse and reported to the Director of Nursing. Of course my doctor ignored her. BUT, if he didn't, he would be gone too. Patients need family and friends to be advocates for them if they are too ill to advocate for themselves. There are enough doctors and nurses out there who have the empathy to help a person with pain as well as with their medical and/or surgical needs. As a nurse, I am always an advocate for my patient. If he or she says they are in pain, they are in pain- period. I follow the doctor's orders for pain medication and tell the Dr. if the patient is not responding to the pain meds and is suffering. I would never ignore a patient's cry for help. Even if the patient was an addict and crying for the pain of withdrawal, he or she still deserves medical help for his disease too-the disease of addiction. As a student, not every nurse or Dr. is going to be one you can learn from. I remember a nurse telling me that it wasn't necessary to wear gloves when bathing apatient with an infection. I insisted on wearing my gloves. A few hours later, they discovered she had MRSA! I would suggest that you go to your instructor, as you described, if you feel a nurse is being uncaring or unprofessional. A good instructor will know how to handle it. Krisssy RN

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Specializes in Med_Surg, Renal, intermediate care.

I hate to give dialudid, because several times we had to either rapid response, or Narcan patients. This has happen after giving 2mg IV.

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Specializes in Medsurg/ICU, Mental Health, Home Health.
I hate to give dialudid, because several times we had to either rapid response, or Narcan patients. This has happen after giving 2mg IV.

Dang, after 2 mg most of my patients are wide awake, alert and oriented, and able to ambulate with steady gaits.

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Specializes in Med/Surg, Oncology, Tele, ICU.

i just push it very slow.

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I just came home from the hospital - was receiving dilaudid for my pain -I had a very BAD reaction to reclast infusion - long story - ended up admitted due to severe vomiting/diarreah/incontinence for days, along w/104 fever, and diffuse pain -Now, let me interject this - I take on a REGULAR basis, steroids,(Lupus) Gabapentin(seizure dx), fentanyl patch,(duh), atenolol (arrythmia) and a few others. Needless to say, was unable to keep anything down/in. My MD had me admitted to re-hydrate and help me recover from severe withdrawals of all meds(HORRIBLE FEELING). While there, most of the nursing staff was great - I only had one nurse who seemed to feel my "pain" was not a big deal... but that was only one of many. my que is this - when one nurse gave me the dilaudid, she gave it IV push- quickly - and the last three or four doses, I would get chest pain and SOB- what caused this? I know I should've said something, but the pain relief was just too important to me at that point...I was afraid if I complained, well you know - it would be stopped and the pain REALLY was INTENSE.... thanks. I tried looking it up but can only find info regarding the SOB... MInd you, I am literally only home a few hrs... And NEVER again will I do reclast!!!! I literally wanted to die!!!!

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