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Medication tidbits an ER nurse should always know

Emergency   (68,143 Views 69 Comments)
by RNstdntSVSU RNstdntSVSU (New Member) New Member

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You are reading page 6 of Medication tidbits an ER nurse should always know. If you want to start from the beginning Go to First Page.

Anoetos has 2 years experience and works as a RN.

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But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it' date=' and I know the pt will be so thankful I just got them high.[/quote']

Ok, but how do we know that? If pain "what the patient says it is" and if people living with chronic pain are able to sleep with it except when it flares into breakthrough and otherwise might not show vital symptoms, how do we know?

All I know is that I didn't become a nurse to be a judge. If I wanted to be a judge I'd have gone to law school, and if I'd wanted to be a cop, I'd have gone to the academy. Patient safety is one thing. Would I give dilaudid to someone who was in severe respiratory depression just because it was ordered? Of course not. But that's not what we are talking about here. Here we are talking about nurses who take it upon themselves to decide when and how much pain medication the patient needs.

As for the real seekers: the IVDA's who hop from hospital to hospital, our docs don't give them anything but Tylenol or Motrin, maybe Toradol if it's flank pain this week.

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Anoetos has 2 years experience and works as a RN.

9,924 Visitors; 738 Posts

But I feel like I've derailed the thread with my rant. Sorry about that folks. I yield.

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Esme12 works as a emergency ,critical care,cath lab,open heart,traum.

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But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it, and I know the pt will be so thankful I just got them high.

while I don't always mix it in a IVPB I never push it fast...that is not how the PDR says it can be given.

Dosing:

IV: (opiate naive) Start: 0.2 - 0.6 mg q2-3h prn. Pain, acute: 1-2 mg IV (slow - over 2-3 min) q3h prn.

If they complain that is too bad.

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lvnlrn works as a RN.

3,370 Visitors; 54 Posts

I drew up Valium and put it in a 10 cc syringe of saline. Immediately it precipitated, turning into a nice cloudy mixture. I had to waste the syringe and put the second dose in a 3 cc syringe. I had no precipitate in the pts line when I flushed with saline after giving it. Hth.

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lvnlrn works as a RN.

3,370 Visitors; 54 Posts

Artemis Safe Dose Pro iPhone app is my go to app for double checking peds meds before giving them. I've caught overdosages with it. You just enter how many kgs they weigh, the med you're giving, and it tells you how many mgs to give, and figures out the mls to give based on different strengths of the med available.

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sserrn has 1 years experience and works as a Emergency Nurse.

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Regarding the dilaudid, which I realize has been beat to death already, forget all the stuff about drug seeking, chronic vs acute pain, getting a high or not getting a high. Shouldn't even be a consideration. Best practice is to push over AT LEAST 2 mins. If it makes me uncompassionate to not 'push it fast', I'm totally cool with that, whether the pt is in real pain or not.

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9,100 Visitors; 531 Posts

But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it' date=' and I know the pt will be so thankful I just got them high.[/quote']

This.

She wanted IV Benadryl with dilaudid and morphine. Pushing slow won't hurt the patient.

If they are stable I will push as directed by the drug guide for my facility.

Most of these patients I have encountered already have low blood pressure or decreased respirations from drugs on board already. Why would I push it just to make the patient happy? Should we start administering heroin too? All in the name of customer service right?

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9,100 Visitors; 531 Posts

while I don't always mix it in a IVPB I never push it fast...that is not how the PDR says it can be given.

Dosing:

IV: (opiate naive) Start: 0.2 - 0.6 mg q2-3h prn. Pain, acute: 1-2 mg IV (slow - over 2-3 min) q3h prn.

If they complain that is too bad.

Exactly! We aren't supposed to push fast and minor risking my license for their high!!! Push as directed and no faster!

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9,100 Visitors; 531 Posts

Regarding the dilaudid' date=' which I realize has been beat to death already, forget all the stuff about drug seeking, chronic vs acute pain, getting a high or not getting a high. Shouldn't even be a consideration. Best practice is to push over AT LEAST 2 mins. If it makes me uncompassionate to not 'push it fast', I'm totally cool with that, whether the pt is in real pain or not.[/quote']

Exactly! Very well said!

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