to give pain meds or not to give meds?

banditrn · Oct 2, 2006

On the doses of Tylenol-our pharmacy recommends no more than 4000mg/24 hours....that's fine for US, but if you read the studies, elderly people should get no more than 3000mg/day...and some nurses are always surprised at how many meds have Tylenol in them.
PS. Darvocette and Darvon are on the Beer's list and should never be used in the elderly population.

Capecod - I've never heard of the 'Beer's list'. Is this something just for LTC?

I know that at the hospital where I worked, the last couple of years they were trying seriously to get Darvocette off the formulary - some of the doc's were really unhappy with them.

The last 3 years I worked in Ambulatory surgery, post op, and we had one urologist who would routinely order 1 Darvocet - just 1, mind you - post op!! Hardly ever was effective, and I'd call him to get something else.

Had an incident at the LTCF where I now work. Keep in mind, we're not supposed to "bother" the docs at nite.

I came in for my nite shift, and we had a new patient admitted - a LOL with cancer and gangrenous toes. I found out during report that she was in a LOT of pain, so I asked the evening nurse if it was time to give her pain meds. The nurse said that she didn't have anything ordered. ??!! WTH!! She stated that the plan was to call the office ON MONDAY to get something!!

I'm sorry, but I found that to be totally unacceptable. I went to assess the lady, then I called the doc at home, woke him up, and got an order for Vicodin. She was actually able to sleep for a few hours, and stated that she 'felt less like crying'.

Now, I don't feel like every situation calls for narcs, or even meds. One LOL will complain of her knees hurting, and I've found that if I take a couple of minutes to rub lotion on her knees, she gets relief and can go to sleep.

CapeCodMermaid, RN · Oct 2, 2006

Some doctor named Beers must have had lots of time on his hands one day so he studied many drugs. The ones that are BAD to use in the elderly population were put on a list which he named after himself. Old people are old people no matter where and some drugs are just not good for them. Darvon and Darvocette have metabolites that really affect livers...valium is on the list, Benadryl...it's very extensive. You can do a google search to get a copy. As for not calling docs for pain meds....yikes!!! Call 'em and if they give you a hard time, let your medical director AND administrator AND the DNS know.

DusktilDawn · Oct 2, 2006

I NEED SOME INPUT HERE...I'M GETTING TEASED AT WORK AND CALLED THE"TYLENOL QUEEN" BECAUSE I GIVE TYLENOL OR PAIN MED ORDERED TO MY DEMENTED PATIENTS THAT CAN'T ASK FOR THEIR PRN'S OR DON'T REMEMBER THEY HAVE PRN'S TO TAKE. I DON'T GIVE THEM JUST BECAUSE...I USE BODY LANGUAGE AS ASSESSMENT TOOL OR ASK "HOW ARE YOU FEELING TONIGHT" IF THEY CAN TALK AND GO WITH WHAT THEY TELL ME. IF THEY SAY, "OH, THIS WEATHER IS MAKING ME ACHE ALL OVER" OR SOMETHING SIMILAR I WILL ASK DO YOU NEED SOME TYLENOL OR SOMETHING TO HELP RELIEVE YOU? NINE TIMES OUT OF TEN, THEIR RESPONSE IS YES. MY CO-WORKERS OBJECT BECAUSE THEY SAY, WELL THEY WILL ALWAYS SAY YES. I DON'T AGREE. I DON'T FEEL MY CO-WORKERS ARE LISTENING OR OBSERVING WHAT THEIR PTS NEEDS ARE...DON'T HAVE TIME ETC. ANOTHER REASON FOR THEIR OBJECTIONS IS AT OUR FACILITY, TYLENOL HAS TO BE SIGNED OUT SIMILAR TO A NARC AND IT "TAKES TO MUCH TIME OR TROUBLE" FOR THEM TO DO SO UNLESS THEY ARE SPECIFICALLY ASKED FOR A PRN. AM I WRONG IN TRYING TO HELP RELIEVE DEMENTED PERSONS ACHES AND PAINS ESPECIALLY WITH A DX OF ARTHRITIS IF THEY CAN'T ASK FOR IT?

Your not wrong at all. There are times when dementia patients ARE agitated because they are uncomfortable or are in pain. These are the type of patients that may not be able to verbalize their discomfort or pain. I think it's wonderful that you take the time to assess and to ensure that these people are comfortable and not suffering pain needlessly. I'm willing to bet that you have an easier time settling these patients than your co-workers.

I once had a dementia pt that was extremely agitated, he was practically on the ceiling. The report I had received was that this pt had received 2 units of PCs with lasix in between, no mention of him being changed (he was incontinent). First thing I assessed was his bladder, which was distended. Amazing how fast this patient calmed down once he was catheterized and all that pressure in his bladder was gone. It's so important for nurses to be able to assess the needs of patients that are unable to articulate them for themselves. Too much bother to sign out Tylenol???? Shame on your co-workers.

banditrn · Oct 3, 2006

Some doctor named Beers must have had lots of time on his hands one day so he studied many drugs. The ones that are BAD to use in the elderly population were put on a list which he named after himself. Old people are old people no matter where and some drugs are just not good for them. Darvon and Darvocette have metabolites that really affect livers...valium is on the list, Benadryl...it's very extensive. You can do a google search to get a copy. As for not calling docs for pain meds....yikes!!! Call 'em and if they give you a hard time, let your medical director AND administrator AND the DNS know.

:chuckle :chuckle Good one, capecod!! Yes, I did google it, but I'm not sure how much good it will do me.

I've not had any problem with any of the docs I've called at nite - most of them were ones I'd worked with at the hospital. I don't call for piddling stuff, and I know how to ask for what I want after all these years.

It's our DON who made the rule about not calling them - she told me 'After all, this is only a nursing home.' And I still don't care - I'll call when I consider it appropriate.

Schmoo1022 · Oct 3, 2006

Be proud of your title. You are doing your job well. Unfortunately, I have seen the same thing as The Commuter in my facility. Anyone giving frequent narcs are under a watchful eye. I don't give a rats a$$, because I assess the pt.and if I feel it is needed, they are medicated and I document to back it up.

These poor dementia Pts need your good assessment skills!!

TrudyRN · Oct 3, 2006

I think you're right on. Bless you for caring for our frail elderly loved ones. They deserve excellent care and it sounds like your patients are blessed to have you.

msnursekim · Oct 5, 2006

:flowersfoThanks to all of ya'll for making me feel better! I was doubting myself there for a while...good thing came from this. Have new grads on duty that read the site and have started asking me questions on how to pick up on body language with access of demented patients...getting some good teaching in. thanks again "the Tylenol Queen"

one2one · Oct 5, 2006

I absolutely agree with give Tylenol and other PRN meds based on the asessment- if they need something-give it regardless of what other nurses might say. I've worked PRN in a longterm care facility for many of my nursing years. I've also found that if you have pt who aren't sleeping at noc may need pain meds. I also discovered that they may not be sleeping well because they are cold. I was surprised how many people would go to sleep just by putting a warm pair of cotton socks on their feet. It works wonders.

lisamc1RN, LPN · Oct 6, 2006

I agree with the others. It's a title to be proud of! I, too, give more pain meds than most. There is one case in particular that no one was giving this patient any pain meds because she couldn't ask for them. Everyone assumed her agitation and her constant state of of diaphoresis were due to her diagnoses and side effects of medications. After a week of medicating this patient with regular tylenol, the diaphoresis was almost nonexistent and the agitation had significantly reduced. She now has a routine pain med and she is like a totally different person. :) I truly believe that we are guilty of UNDERmedicating for pain than we are of overmedicating.