Last night I had a patient who was in for pneumonia and cxr showed a small pneumo on the left. The patient was in no distress, 02 sat 96-98%, reparations 18. It was an 83 year old man, but he looked as if he had taken care of himself....maybe 70. Anyways, he had a pain pill due and so I gave it at 1930. He had been getting that, so I had no worries. About 2300 he asked for something to make him sleep and I looked and saw that he had gotten a Xanax the night before. Not thinking, I gave it. I should've thougbt more about his diagnosis and age, but for some reason I just gave it. The man was so sweet and I felt so bad because he was in pain from an abscesss that he had drained earlier that day. Plus, we give out Xanax like candy where I work. Everyone gets that or ambien or Ativan and regardless of if theyre in there with respiratory problems. I've never had any problems with patients handling it with pain medicine either. But this patient was different. He didn't take hem often and it just didn't go well for him. By about 0300 he was saying he felt awful, drowsy, weak. I knew immediately I made a mistake. His 02 was still 97% and no distress, but I'm positive it worsened his condition. His lungs sounded worse on the right and he just felt terrible. I felt so bad. I know the doctor who sees him will be upset that he got that, but I honestly feel like it shouldn't have been on his list. A lot of times people just use a list of meds from the nursing home or go by the patients last home med lost from their past admission. They don't always ask what the patient actually takes(depends on the nurse). But I always do. Unfortunately I didn't admit that patient and I had looked to see if he had been taking it and he had....so I gave it. It's definitely a learning experience and I will be treating all of my patients exactly the same when it comes to passing meds from now on. I understand now why were taught to do things a certain way in school. Give the lowest dose, least amount of meds to ease symptoms....not the most u can give. Start with a pill and then dilaudid for breakthrough, and so on. That would save me from hurting patients who can't tolerate a whole lot. It's just that since I've started working almost every patient asks for and gets dilaudid. If they're ordered a pain pill they don't even bother trying it. We're pretty much just feeding addictions. It's rare to see a patient who doesn't ask 30 minutes early for their dilaudid that's due very 2 hours. Anyways, I just had to get hat off my chest. I hope that I didn't harm the patient too much and will definitely never just give something again.
