New grad with a question

beeker · Mar 29, 2012

double

missladyrn · Mar 29, 2012

NO, that is not ok. You are the patient advocate you need to speak up for them if they are not being treated for pain.

Perpetual Student · Mar 29, 2012

If someone gave me lip as to why I medicated someone for pain I'd bust 'em in the lip. OK, probably not. But it would be very tempting.

It is inhumane to leave someone to suffer like that. Some of your coworkers are very ignorant. Unfortunately, as a newbie you're in a nasty predicament. Rock the boat too much and it'll cause you trouble. Or don't advocate for your patient and be guilty.

If a fellow is demented not medicating him for pain probably isn't going to magically make him a/o x4. He probably needed more pain medication, not less, and perhaps a switch to a different drug.

RNperdiem, RN · Mar 29, 2012

I deal with this dillema sometimes in trauma. Confusion/ withdrawl happens sometimes.

You are caught between ortho and another set of doctors and the patient is not getting enough relief.

In this situation I would bring it up on rounds where you are not dealing with cross-covering doctors and lay out the facts. This patient has dementia, has had a big ortho surgery and is not getting enough pain relief with ice and Tylenol. What is your plan for this man, docs?

Vespertinas · Mar 29, 2012

When you're on your own and you do everything to help YOUR patients feel better on YOUR shift, pay no mind to that RN who rolls her eyes when you gave Toradol. Just feel confident that you did what you believe was right. If you're up to it, down the line when you get report and you see that Toradol was available PRN and she didn't give any all shift, you can ask HER why she elected not to.

For the record, we are careful to give Toradol if the patient has renal insufficiency (in which case Toradol can STILL be given, just in smaller doses). We hold for risk for/history of bleed (GI ulcers, coagulopathy, on coumadin/asa) or are on loop diuretics for something more important like CHF (because it will interfere with the effectiveness of the diuretic).

nurseprnRN, BSN, RN · Mar 29, 2012

toradol is not a narcotic and will not affect level of consciousness...unless the poor fella gets some relief from it and gets some sleep.

as to any rns who let an elderly person go two whole days after major orthopedic surgery with no pain relief at all, well, i have to believe that what goes around, comes around. they'll be old someday.

leslie :-D · Mar 29, 2012

this is crap. :mad:

i don't care if one is confused or not, i would much rather have someone confused and pain-free...

versus confused and now, agitated from pain.

as an experienced nurse (with a big mouth and temper), i would have told the doc (who said no to narcs) that i was going to go over his head and find someone who would order appropriate analgesia.

this is just plain cruel and ignorant.

no reason to deny anyone pain relief.

leslie

Merlyn · Mar 29, 2012

I am almost finished with orientation and about to be on my own. I have a concern about a patient I had last week, and another instance of the same issue that popped up again last night. I had a confused patient, elderly with history of dementia, who had fallen and broken his hip. After the surgery to fix it (with pins) he was extremly confused, pulling at ivs and catheter etc. One of the Drs (not the ortho) wrote an order to dc all pain medicine due to confusion. This man was clearly in pain, guarding, grimacing, and moaning that his leg hurt. Bp and pulse high, but still quite confused and pulling at tubes. Long cardiac history had been given prn meds for bp several times. Preceptor said ok to call md. I called the md on call and was given an order for tylenol and ice prn, he would not let him have anything else. Tylenol did seem to help a little bit and of course we repositioned the best we could. But he still appeared to be hurting. Looking back at the chart, this man had had NO pain medicine given for 2 days. None. Ortho Doc had seen him twice. I wanted to call the ortho doc on call to ask for something else but was told no it could be handled in the morning. I passed it on in report, but no one seemed overly concerned about it. The charge nurse said it was fine, because pain med would make him more confused. Preceptor just shrugged her shoulders.
I came across a similar situation last night, confused elderly woman, fell and broke her humerous. No pain medicine for the last 24 hours. Had only tylenol ordered. Had previously had morphione ordered and given, but patient got agitated after morphine so it was dc'd with no new order for anything else. Different charge nurse, she did let me call the md who gave me an order for pain medicine, got an order for toradol and gave to patient. At shift change day nurse demanded to know why I gave a confused patient toradol. My preceptor told me the toradaol was fine and the patient did need it. Day nurse just rolled her eyes.
Is this normal? Leaving confused people to just suffer? Shouldn't a non narcotic pain reliever be ok? And if they are confused anyway, why not give them something to ease the pain? Am I missing something?[/quote
Not OK. I would call the pt advocate. That day nurse could roll her eyes, her head or roll on the floor. No matter, she's not the one in pain if she was she would be the first one to call a nurse to call the doctor for pain pills. He should have been medicate.

RainMom · Mar 29, 2012

Wow.... I've worked ortho for about 6 months now & EVERYBODY has pain meds available, no exceptions, and often have more than one kind ordered so there are options if one doesn't work well (or work a little too well).

Vespertinas · Mar 30, 2012

By my count, at least 7 employees on this one unit treat this situation like it's normal. It's possible you may have misunderstood *some* parts of it like how the charge RN did or did not react to your concerns but on the whole, this place sounds fercockt. Great advice and all that we're giving on what *should* happen or what is right but this new RN is up against ingrained patterns of treatment. I'd say you lay low and transfer ASAP.

OnlybyHisgraceRN, ASN, RN · Mar 30, 2012

You did the right thing advocating for your patient.