iv dilaudid

EJSRN, BSN, RN · Nov 11, 2008

In my place of employment it is the drug of choice, and like you said everyone has this on their PRN mar page. Some doctors are just push overs. I have had pts on morphine, and they will say "the last tiime i was here i got dilaudid, and i liked that better" WHAT?!!! This is crazy. The pt will be in their room laughing with family and oob in their room and it just doesnt go along with a VAS score of 10/10. I know pain is subjective, but come on ppl....

EJSRN, BSN, RN · Nov 11, 2008

where i work i start my own iv's. we have no iv team.

I love my cat! · Nov 11, 2008

I work PACU, dilaudid is often ordered along with zofran (typicall). Works faster and Morphine with short half life. Works better as it is 10 x stronger than morpine as well.

We use it in out PACUs, too.

I notice that my patients have a lot less "itching" with dilaudid. We rarely use demerol.

WhyattMorgansMom · Jun 7, 2009

I had a CS in Jan 09 and only requested Motrin, but then since have had a TOA that turned really bad and when I was getting IV Morphine, I actually begged to not just get the saline she was giving me. 3 rounds of Morhpine IV and I was still thinking I was getting just a flush, after 2 surgeries and some other things, I was on a PCA Dilaudid pump and it was the only sweet relief I got. Going to PO Dilaudid was the hardest, much slower and not as potent (same dose amazingly). I was given Fentanyl and it just knocked me out. This is a miracle drug!

PostOpPrincess, BSN, RN · Jun 7, 2009

Since I work in PACU, it's like WATER....yes, an excellent drug for my post-op patients....

WhyattMorgansMom · Jun 8, 2009

The only "negative" to Dilaudid was the first IM round, man did it burn and sting and hurt! I actually have a scab where I got it. The iv stuff, easy as pie. Usually I am not a "wimp," but that IM sure hurt for over a week and had a huge bruise too. Did she push it too fast?

fozzyboy · Jan 21, 2011

I am new to the site but and I realize these posts are a few year old but I have to say I am disgusted my some of the judgements that are being made about patients and the use of Dilaudid (not everyone who posted are catagorized in the mix but unfotunately it is the judgemental bad attitude of a few that ruins the profession) I do not dispute that there are those who come to the ER for a "high" and those individuals know how to work the system. With that said I will say this:

I am an RN who happens to have had to go through an extended and chronic health issue which has forced me to go to the ER several times due to the N/V, explosive diarrhea, and undescribable excrutiating pain. I so often run into this judgemnetal mentality by many nurses and doctors. Just because I know my own body (I have owned it for 33 years) and I know what works and what doesn't does not mean I am a drug addict. I realize that because the nurse or doc spends 5 minutes with me that they think they know me but you don't. Untill you live in my world and walk in my shoes no one has the right to judge me or any other patient for that matter.

Here is what angers me over this whole thing is that nurses who have a snotty judgemental attitude frankly disgusts me. I want to say to those of you who just assume someone is drug seeking WHO CARES. Even if that is the case that is not our role as nurses. Our oath states that we will be advocates for our patients and if the patient says they are in pain then there are in oain and your job is to advocate for them until you are able to get them relief. Most of you have no idea what ir is like ti lay in agony while people ar judging you and making false accusations against you. Personally if your patient is c/o pain and is telling you the meds they are giving are not working your job as a nurse is to do everything in your power to get orders for the pain medication the patient ia requesting because it has worked in the past.

Pain is whatever the patient perceives it to be it i subjective and nursing ethics are clear that we are to take the patients c/o of pain seriously and exhaust all possibilities ti help them not accuse them of things.

My last point/questions is why is it so bad to ask for a certain medication in the ER. How is this different then someonegoing to their PCP and asking for Viagra or cilias?

Seriouslly before you start judging patient stop and try to put yourseld in yhrit shows and just do your job and advocate for them and show them compassion.

regularRN · Jan 21, 2011

In my experience, Diluadid seems to have fewer side effects than morphine - less nausea, less itching and more effective pain control.

divaRN* · Jan 31, 2011

I understand that we are not going to change anyone who is med seeking and "pain is subjective". I get it and I have absolutely no problem being in a patients room Q2 to give pain medication when they are genuinely in pain. I also have to problem calling the MD and advocating for the patient if what they are getting is not controlling their pain. What I do have a problem with is the patient that will be sound asleep, wake up, call for pain meds because they are "having sooo much pain" and when i bring them their medication less than 5 minutes later they are sound asleep. Then when they wake up a few hours later they are mad I did not wake them up to give them their meds. Or when they set alarms on their cell phones to wake them up when they are due. Or when I give them their pain medication and they keep calling me Q15 min to complain that their pain is "sooo bad" and their dose of IV dilaudid is not strong enough. However when I am not in the room they are chatting on the phone or resting quietly then the second I walk in they start moaning. I do not have the time to be called into a patients room every 15 minutes to play games. Or if i do not bring them their mediation within 2 minutes of them calling because i am tied up they call again, again and again until I go in the room. Then they rip me a new one for 'being too slow". This is when I tell them I was with another patient at the time and came in as soon as I was available. I do have an 8 pt assignment and while I make every effort I can to bring them their medication in a timely manner it is next to impossible sometimes to bring it within 2 minutes because I am in the middle of something i can not stop. I have other patients that are unstable, need IV BP meds ABX etc. We give dilaudid out like it is candy at the hospital i work at. I have had a pt with chest pain who when it told him i would bring him nitro and morphine he told me he would not take anything except dilaudid because that is the only thing that works. I have also had to code grey patients because they were getting hostile over pain medications. It just really bothers me that their are patients that really need me and I am wasting all my time being called into a room to argue with a med seeker about pain medication. I am sorry but there is only so much dilaudid you can get. 4MG Q2H is ALOT and no MD in their right mind would order more. Just as an aside I think it is interesting how we use morphine GTTs for CMO/hospice patients and that works very well for them but it is never good enough for a healthy patient with a headache.

sorry for the vent.

fozzyboy · Feb 1, 2011

DivaRN

I too understand your frustration don't miss understand me I would agree that there are those who as you say set there clock by there pain med schedule. I am not only speaking as an RN but also as a patient with a chronic illness that when flared up causes me great pain. Most days I deal with it with my pain management docs but when it rears its ugly head and my urine has so much blood in it that it looks like cherry koolaid and I am vomitting perfusely I have no other alternative but to go to ER usually after a lengthy conversation from my docs trying to convince me to go. I am always reluctant because more often than not I am labeled and if you have never been accused of being a drug addicted it is a horrible feeling. I do not fit the normal stereotype because generally I go to the same Er everytime and they all know me. When the pain is so excruciating and I am vomitting your damn right I want the diluadid because I have a right to be out of pain and well it is my body I have owned for over 30 years and I know it better than some ER doc who met me for 2 minutes, never examined me or even come close to the cot I am on he just pops in says his name and asks 2 or 3 questions then he is gone and does nothing. I underwent 3 psych evals 1 as a consult during admission and 2 I requested and all 3 agreed I did not fit the bill as a drug addict so to speak yet my chart is flagged. This is what I have to go through everytime i need emergency care.

Yes I blame those who are using the ER or the hospital to get a fix but I also blame judgemental doctors and a lot of nurses who ask me what usually works for you and when I tell them torodol and dilaudid I am automatically a druggy how is that fair or right. That is all I am saying. Ya when I am in the hospital I usually ask for my meds when they are due (unless I am asleep) only because I want to stay ahead of the pain because as you know chasing the pain just takes up so much more time. Now what I don't do is chew out a nurse who did not drop everything to cater to me. I am a very patien person and I know nurses are over worked and waiting a few minutes is not going to kill me. And I know how easily it is to get tied up with another patient. I do not press my light every 5 minutes or get ****** because no one is coming right away. In fact I am usually a quiet patient However, I will say this I don't tolerate a nurse lecturing me or being rude an nasty then I m going to not only chew them out I will go to there superior. Unless I am about to do something that wll cause me harm or another harm a nurse has no business speaking to a patient by directing rude and condisending remarks, yelling, giving attitude, and/or flat out telling me "drug addicts go to the bottom of my med list or just coming in to tell me she does not feel i need my medication so I will get it when she believes I am in pain. Yes these are things that i have dealt with.

Again do not misunderstand I am right there with you on the seekers. I guess what I am saying is just take a moment to understand the patient before labeling them because you don't know how much that damage impedes there health care and don't make judgements based on opinions of ther staff members. Let me give you one very personal experiance. After having a cystoscopy and lithotripsy I was in tremendous pain and they kept me. The first time I asked for my pain meds the nurse then told me she did not see any evidence that I was in pain all my vitals except heat rate where WNL duh just came out of anesthesia. Anyway I kept insisting something was wrong and she would not hear of it. Well I called for assistance and the aid helped me into the bathrom and as I began to urinate I got a undescribable pain and then blood just strating gushing out as I stood up I passed out but managed to pull the emergency cord first because I knew I did not feel right i layed there until my mother came back from lunch and found me on the floor with blood everywhere and the emergency light still on. When she questioned them as to why no one came in the aid told her well the nurse said she just wanted drugs. Ya when asked why she felt I ws drug seeking it was because a nurse who had had me in the er told her that she heard I was a drug seeker. So just be careful with your judgement.

I totally understand what you mean about frustration with people exagerating their physical pain but I urge you to live by the rule that pain is whatever the patient says it is. I am not saying you should just drop everything and run to the patient everytime they demand it. And just an FYI I was getting 4mg of dilaudid every hour after my last surgery which was number 7.

fozzyboy · Feb 1, 2011

You are absolutely correct it is a much more effective med with less side effects the only down side is it has a short half life

Horseshoe, BSN, RN · Feb 1, 2011

divarn
i too understand your frustration don't miss understand me i would agree that there are those who as you say set there clock by there pain med schedule. i am not only speaking as an rn but also as a patient with a chronic illness that when flared up causes me great pain. most days i deal with it with my pain management docs but when it rears its ugly head and my urine has so much blood in it that it looks like cherry koolaid and i am vomitting perfusely i have no other alternative but to go to er usually after a lengthy conversation from my docs trying to convince me to go. i am always reluctant because more often than not i am labeled and if you have never been accused of being a drug addicted it is a horrible feeling. i do not fit the normal stereotype because generally i go to the same er everytime and they all know me. when the pain is so excruciating and i am vomitting your damn right i want the diluadid because i have a right to be out of pain and well it is my body i have owned for over 30 years and i know it better than some er doc who met me for 2 minutes, never examined me or even come close to the cot i am on he just pops in says his name and asks 2 or 3 questions then he is gone and does nothing. i underwent 3 psych evals 1 as a consult during admission and 2 i requested and all 3 agreed i did not fit the bill as a drug addict so to speak yet my chart is flagged. this is what i have to go through everytime i need emergency care.
yes i blame those who are using the er or the hospital to get a fix but i also blame judgemental doctors and a lot of nurses who ask me what usually works for you and when i tell them torodol and dilaudid i am automatically a druggy how is that fair or right. that is all i am saying. ya when i am in the hospital i usually ask for my meds when they are due (unless i am asleep) only because i want to stay ahead of the pain because as you know chasing the pain just takes up so much more time. now what i don't do is chew out a nurse who did not drop everything to cater to me. i am a very patien person and i know nurses are over worked and waiting a few minutes is not going to kill me. and i know how easily it is to get tied up with another patient. i do not press my light every 5 minutes or get ****** because no one is coming right away. in fact i am usually a quiet patient however, i will say this i don't tolerate a nurse lecturing me or being rude an nasty then i m going to not only chew them out i will go to there superior. unless i am about to do something that wll cause me harm or another harm a nurse has no business speaking to a patient by directing rude and condisending remarks, yelling, giving attitude, and/or flat out telling me "drug addicts go to the bottom of my med list or just coming in to tell me she does not feel i need my medication so i will get it when she believes i am in pain. yes these are things that i have dealt with.
again do not misunderstand i am right there with you on the seekers. i guess what i am saying is just take a moment to understand the patient before labeling them because you don't know how much that damage impedes there health care and don't make judgements based on opinions of ther staff members. let me give you one very personal experiance. after having a cystoscopy and lithotripsy i was in tremendous pain and they kept me. the first time i asked for my pain meds the nurse then told me she did not see any evidence that i was in pain all my vitals except heat rate where wnl duh just came out of anesthesia. anyway i kept insisting something was wrong and she would not hear of it. well i called for assistance and the aid helped me into the bathrom and as i began to urinate i got a undescribable pain and then blood just strating gushing out as i stood up i passed out but managed to pull the emergency cord first because i knew i did not feel right i layed there until my mother came back from lunch and found me on the floor with blood everywhere and the emergency light still on. when she questioned them as to why no one came in the aid told her well the nurse said she just wanted drugs. ya when asked why she felt i ws drug seeking it was because a nurse who had had me in the er told her that she heard i was a drug seeker. so just be careful with your judgement.
i totally understand what you mean about frustration with people exagerating their physical pain but i urge you to live by the rule that pain is whatever the patient says it is. i am not saying you should just drop everything and run to the patient everytime they demand it. and just an fyi i was getting 4mg of dilaudid every hour after my last surgery which was number 7.

this is exactly why i do not attempt to decide which patients are "really" in pain. patients who experience chronic pain do not display grossly abnormal vital signs because their bodies have learned to compensate. i'm not going to deny pain relief to 98% of my patients based on the 1 or 2% of them who may actually be drug seeking. as far as being addicted to pain medicine, i look at it more as an addiction to pain relief. of course a patient on a long term narcotic regimen is going to be physically dependent. that has nothing to do with whether or not they are actually experiencing pain. judgmental, arrogant individuals have no business being nurses. unfortunately, our profession seems to be full of them. i'm sorry you have been treated so poorly by these types of jerks. :mad: