freaking out!!!!! please help me fast!

[glamgalRN]

I'm a brand new nurse and am on orientation. My patient was in pain today so they ordered 2 mg of dilaudid IV push q6 hours. I was told in report that her pain was relieved from that dosage.

So later in the day she went down to the OR to have a procedure done and came back complaining of severe, severe pain. I gave her 2 mg of dilaudid and she still rated the pain 10/10. I talked to the docs and we got her dosage increased.

As a new nurse I'm sooo nervous about making a mistake. On my ride home I thought "ohmygod, what happens if I gave her demerol instead?" I know that I checked it a million times and my preceptor checked it with me also, but I can't help but worry. It's so easy to mess up.

Just to calm my nerves, I was wondering if demerol even comes in 2 mg vials? I just want to sleep well tonight. Like I said before, I just thought it was strange that I gave her the demerol and her pain didn't decrease at all. But I always check and recheck my meds.

I hope I don't sound too pushy, but if you can answer fast I would really appreciate it. Thank you.

[NoviceToExpert]

I'm a brand new nurse and am on orientation. My patient was in pain today so they ordered 2 mg of dilaudid IV push q6 hours. I was told in report that her pain was relieved from that dosage.

So later in the day she went down to the OR to have a procedure done and came back complaining of severe, severe pain. I gave her 2 mg of dilaudid and she still rated the pain 10/10. I talked to the docs and we got her dosage increased.

As a new nurse I'm sooo nervous about making a mistake. On my ride home I thought "ohmygod, what happens if I gave her demerol instead?" I know that I checked it a million times and my preceptor checked it with me also, but I can't help but worry. It's so easy to mess up.

Just to calm my nerves, I was wondering if demerol even comes in 2 mg vials? I just want to sleep well tonight. Like I said before, I just thought it was strange that I gave her the demerol and her pain didn't decrease at all. But I always check and recheck my meds.

I hope I don't sound too pushy, but if you can answer fast I would really appreciate it. Thank you.

Don't forget that when your patient's pain was well managed on the dosage prescribed it was preoperative management, as least that is how your post reads. You don't mention what type of surgery your patient had. Depending on the surgery, the preoperative dose might not manage her pain nearly enough, so don't worry about the higher dose needed.

In the future, since you are concerned about making a mistake regarding possibly confused medications, use your safety nets such as scanning barcodes on drugs and bracelets and running through the usual checks... the five rights... etc... right patient, right medication, right dosage, right time, right route...but don't forget the other "r"s that include the right technique (such as differences in types of injections, duration of IV pushes, etc.), the right documentation, and the right to refuse (on the patient's part).

Your anxiety is normal just starting out... and will be there whenever you get to peak dosages, and also you will have difficulty giving dosages over normal parameters prescribed by physicians... have a nurse double check with you whenever you are unsure... hold up the syringe to your computer screen or original order...check the spelling...refer to dosage recommendations in drug guides and question anything outside of those dosages... and also, just as importantly, do not hold back pain meds because of your discomfort if they are accurately prescribed and indicated... give them within the ordered time frames and parameters... and stay ahead of the pain... or it may be hard to catch up...

Your discomfort is something all of us went through...you will get more comfortable the more you encounter these things...don't talk while you are giving narcotics... either at the drug dispense cabinet or cart or at the bedside... do not get distracted... complete the task by really going through your rights... and keep focused... you'll be okay. Don't forget to reassess pain 20 minutes or so after the med administration and document such. Keep on pain assessments every four hours at least regardless of the med schedule and document such as well. Make sure your reassessment isn't just "How's your pain"... remember to evaluate physiologic response... potential reactions... decreased respirations, differences in BP or HR...Document waste immediately, because otherwise you may forget... and really have a nurse watch the waste instead of saying "I trust you"... you want your reputation to never be questioned... and don't witness wastes unless you have really seen them...

The more nervous you are in the beginning, the better you will be later... it is an indication of your safety concern... be grateful for it...

Pass on in report changes in pain control and new dosages and responses... keep everyone up to date...

Also watch for cumulative effects of medications, especially in the elderly or those that have decreased metabolic functions... have Narcan available if giving narcotics...

You'll be okay... stay scared... it's serious business... and you'll do fine!