This is a unit where I was the only nurse, I had 3 CNA and 61 residents all in various stages of Alzheimer's.
One night I had an issue with a combative resident. After trying the usual nursing measures (Incontinence care/toileting, snack, fluids, redirecting, 1:1, music, photo books, blanket etc) to calm this resident down to no avail, I turned to the PRN meds. The patient had an order for PRN 0.5mg Ativan for increased anxiety/ restlessness. I opted to administer this, at the same time I assessed for pain but was not able to get a response from the resident because the communication was of course words uttered that made no sense, there was no facial grimacing just the combative behavior with the staff. I administered PRN Ativan for the Anxiety/Restlessness and Tylenol 650 mg at the same time in case the resident was in pain and was unable to show/communicate it.
I was written up for this. I am being told I should have tried the Tylenol and then later the Ativan.
Can I not make the choice to address two issues with two separate medications simultaneously? There was no way to verify pain, I thought it best to address it just in case.
Is this a colossal mistake, what would you have done?
