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?