increased confusion with pain med

[Ms.RN]

i have a lady who is taking vicodin for pain. i've noticed that after taking vicodin, she becomes more confused, more crying, unable to remember where she is, but still complaining of sever pain. her daughter came to visit her and told me that she also noticed that she becomes more confused after taking this pain medicine. so what is the best way to deal with this? change to different pain medicine or decrease the frequency of pain medicine? at first doc increased the frequency of vicodin due to patient still complaining of severe pain then after telling him about increased confusion, he increased the number of tablets from one to two tablets. so i'm not sure which way is the best way to deal with this?

[Virgo_RN, BSN, RN]

Try a different pain med.

[Bug Out, BSN]

Give her the MDs phone number and tell her to call the number everytime she has pain.

[classicdame, MSN, EdD]

there are other analgesics. MD needs to be involved in prescribing another type

Don't forget - this is the situation where a patient could get hurt (fall, etc) and then YOU will be in the hot seat because you had identified a potential problem.

[BigBee48]

sometimes plain old Acetaminophen works. Especially with the elderly. I cared for a patient similar, she was always confused, crying out, c/o leg pain. After

a battery of tests to rule other causes out, we tried vicodin. Had the same

problem, then seitched to Acetaminophen, it worked very well. It may only work for a short time, also we used Benedryl, it didn't knock them out but calmed, and they stopped crying out. It seems the vicodin is not appropriate

in the elderly. Good Luck!!!

[DogWmn]

You didn't say what the pain med is for??? Is a cronic condition, if so what???

[fiveofpeep]

whats going on with her other organ systems too? for example, my step dad has metastatic liver cancer and we control his pain but then his liver metabolizes the meds poorly and gets confused and the next thing we know he is attacking a beaver (the ceiling fan) with a picture frame. its kinda a catch 22 and more history about the pt would help. in any case, if the pain meds arent working you should advocate for an option that does.

[Ms.RN]

you didn't say what the pain med is for??? is a cronic condition, if so what???

patient had a recent fracture.

[Super_RN, BSN, RN]

Definitely needs to try a different pain med.

[Lacourty]

It is expected that the patient have some pain- they had a recent fracture. It definitely sounds like the patient may benefit from a different medication. Is the increased dose appropriate for the patient's body habitus/weight?

[thehipcrip]

sometimes plain old Acetaminophen works. Especially with the elderly. I cared for a patient similar, she was always confused, crying out, c/o leg pain. After

a battery of tests to rule other causes out, we tried vicodin. Had the same

problem, then seitched to Acetaminophen, it worked very well. It may only work for a short time, also we used Benedryl, it didn't knock them out but calmed, and they stopped crying out. It seems the vicodin is not appropriate

in the elderly. Good Luck!!!

Since acetaminophen is one of the two ingredients in Vicodin, you didn't really switch her to anything as much as you substituted benedryl for the hydrocodone.

[tewdles, RN]

You should recommend trying another analgesic to the doc. Review your patient's history and current med profile. Think about what type of pain you are treating and make a couple of suggestions to the doc. Most docs appreciate a nurse who takes initiative in advocating for their patient and it will boost your confidence.