"I'm NOT going to support his habit...." LONG

[tencat]

I've had two patients who are well-known drug addicts (UA's done and they tested positive for every drug on the panel) who had large abscesses drained from their arms. Abscesses were due to IV drug use. Both patients required QID wet to dry dressing changes. I've done QID changes on 'non-addicts' and always in the orders I've had PRN morphine to give prior to the change. But not with the addicts. Both addicts only had 1 PRN 7.5 mg Lortab ordered q 3-4 hours for pain. Now, I'm really new to nursing (I've only been one since September), so maybe I am not fully understanding what's happening. But I do know those wet to dry changes are PAINFUL, even with the morphine. It seems to me that it's downright cruel to expect a heroin addict to deal with these dressing changes with only one lortab q 3-4 hours. Am I wrong? I suppose the rationale could be that it's impossible to give them enough morphine to ease the pain without killing them with an overdose. But when I talked to my nurse manager about the latest patient, she said that she would not, under any circumstances, support his drug habit by ordering morphine for dressing changes. The physician feels the same way. I guess I need some validation that I'm not wrong, or at least some advice on how to emotionally deal with these dressing changes. I'm really distressed by the pleas I get from them for something to help with the pain, and me being powerless to do anything other than pre-medicate with one lortab. Any words of wisdom? Thanks!

[augigi, CNS]

Maybe you can contact the companies who manufacture the wound care supplies you want to use, and ask them to come and do a presentation/supply literature about their products?

Otherwise, suggest something for your inservice meetings that you can present based on evidence? Print out some copies of the relevant literature and put them on the notice board?

[leslie :-D]

Print out some copies of the relevant literature and put them on the notice board?

i agree with this.

search the WHO, NIH websites and see what applicable data you can give them to read.

leslie

[CHATSDALE]

listen and learn..h202 use to be done for cleansing of deep wounds and decub but now is considered dangerous, as previously noted. but sometimes mds and nurses don't keep up with important changes

i don't know what choices you have with the doc and nurse mgr in one side..no one like to be corrected exp by a newbie so be tactful and diplomatic, it doesn't accomplish anything to win the battle and lose the war

i hope that you can find choices that are good for your pt and for the furtherance of your career

[zacarias, ASN, RN]

I always thought H202 was ok for minor wounds initially and not to use it again. I wouldn't use it for deep wounds. Is the research now saying NEVER to use it?

[augigi, CNS]

I just posted a bunch of references if you want to check them out.

[UKRNinUSA, RN]

I always thought H202 was ok for minor wounds initially and not to use it again. I wouldn't use it for deep wounds. Is the research now saying NEVER to use it?

Yes. The Emergency Nurses Association recommends only normal saline to clean acute wounds. Not peroxide, not betadine. If you don't have any at home (and who does?) regular faucet water is ok.