New Nurse Pain Med Question

[ricksy]

Hi. I am a new nurse working my first job in LTC (RN) for about 4 months. I am older (second career---know some of you younger ones question my motives for second career), but it is the job I wanted...anyway, in clinicals we were never to pass pain meds/narcs without full set of vitals, specifically respirations....so here is question. In my facility, I have been watching and NO ONE but me seems to follow that protocol. Specifically resident on Dilaudid.... I always do and chart it. Any answers or responses????????? Thanks in advance!

[CapeCodMermaid, RN]

I've been in long term care for more than 30 (yikes) years. In no facility has it been a standard of practice to do a set of vital signs before administering a narcotic. There is certainly no rule against it, but if the patient has been taking a percocet three times a day for 15 years, what is the point of checking vitals?

If they are narcotic naive, then I would check 15-30 minutes after administering the dose. At any one time, we'll have 8 or 9 people on PCAs. We don't even know when they are going to dose themselves so it would be impossible to do vitals signs.

There is a study just out that indicates there are people in the HOSPITAL who don't need to be woken up every 4 hours for vital signs. We need to do what is reasonable.

[Pepper The Cat, BSN, RN]

If a pt is alert enough to c/o pain and request an analgesic, I think it's pretty save to assume that they are alert enough to receive said narcotic.

I work I rehab. If I checked vitals every time I gave a narcotic, I would get nothing else done.

[BiohazardBetty]

Nursing school is not really like real nursing.

Amen!

[loriangel14, RN]

A quick assessment of LOC should be enough.I have never heard of doing a full set of VS before a narc unless they are symptomatic.

[wooh, BSN, RN]

If pushing narcs is so risky, then PCAs should be restricted for patient safety because the nurse isn't there to monitor the patient for every dose of narcotic. And a basal rate! Don't even go there.

Don't be silly. I have my patients that are on a PCA to get their own set of vital signs before pushing the button. Including temp. If there is a basal rate, then they obviously should be 1:1 in the ICU, how else are we going to get the constant vital sign readings we need?

[SoldierNurse22, BSN, RN]

Don't be silly. I have my patients that are on a PCA to get their own set of vital signs before pushing the button. Including temp. If there is a basal rate, then they obviously should be 1:1 in the ICU, how else are we going to get the constant vital sign readings we need?

Now that's dedication.

[fairyluv]

i am a new nurse (less than a yr) and work LTC. there are times where I will get VS before giving the narc, but only if I feel that the res. is presenting a prob. Maybe there LOC is a little off or they seem out of sorts, so to speak. You know there is something off but can't quite put your finger on it. I give 11 routine pain pills on my hall plus a number of PRN pain pills. In our facility, we have 1 BP cuff, 1 Thermometer, 1 Pulse Ox. For 90 res. and the only routine VS we get our the skilled residents and those who are on antibiotics. If I need a set of VS stat, I have to go to each hall and find out where the VS equip is, which takes more time looking for the equipment than it does to take the VS. If I were to do VS before I give pain pill, I would spend most of my shift looking for the equip. Which I had to do tonight (not for narc VS) for a res who seemed out of sorts and had a very swollen lymph gland, that was pink and warm to the touch. Finally found the equip and res VS were stable, but presented with a low grade temp and c/o pain to the area after recieving her routine pain med. I sent her out. Was not comfortable with the low grade temp and swollen lymph node that big.

[SoundRN7]

Fairyluv - Are you permitted to bring and use your own equipment? If so, I would recommend that you do that, then you won't need to go searching for equipment. It's pretty lousy that your facility only has one set of tools. My facility has a few sets of tools but their reliability is questionable at times. I always keep my own stethoscope and BP cuff handy in case the work ones are acting up.

In our facility, we have 1 BP cuff, 1 Thermometer, 1 Pulse Ox.

[Irish RN]

I work medsurg and only take VS prior to BP meds. I assess LOC prior to pain meds and I also ask the patient if they've ever had the med before, any previous rxns, I educate on s/s, etc. I dilute as needed and push slow. I usually stay in the room to complete an assessment, do wound care, hang meds, etc. so I'm there if the patient has initial rxn to the IV pain med.

Wanted to add, change in VS is usually a late sign of clinical deterioration.

[wyogypsy, RN]

Maybe in acute care, but this is LTC, this is their home. People who take narcotics in their homes do not take vitals before or after, and though the residents in LTC have nursing staff there, full vitals are not necessary any more than they would be if they were in their own house. I assess for pain both before and after, but vitals each time a pain med is given is not needed. If you have post-op patients with increased pain it is good to check for a temp, but not necessary for the person who needs medication for their bad knee or back which is a chronic condition.

[Over-the-hill-Nurse]

What it boils down to is this: check your facility's policy and procedure book. Every facility should have them. You need to think logically and without emotion and do what is ethically correct for the patient as your patient is the "center" of your discussion and do what is best for the patient. If your place of employment requires you to take vs prior to and after administration of any narcotic, then you should do so. I personally would assess my patient and take vitals prior to giving a pain med and reassess afterward to ensure that they recieved pain relief and document my findings. Pain is subjective. For the most part, they are also a PRN which does require documentation on the back of your MAR, and in your Nurses notes. Again, if your facility has a policy and procedure for giving narcotic pain meds, follow it. Just because it is a LTC facility, it has no bearing on what you do for your patient. Your patient should be up front and center in what ever you do. Each patient should be treated individually according to "your assessment" of that patient. It doesn't matter what any one of us thinks as you have to be able to do what is ethically best for your patient and in the long run, you will be able to say that "you did everything you could for that patient" and feel good about it.

[satkr]

Many of the things that we do while in nursing school are intended to guide you to look at the areas that could be affected. In nursing school you also have an instructor that is responsible for every medication you give. That instructor is assuming responsibilities for your actions upon her or his license. The more time that you are a floor nurse you will look at things in a more streamlined quicker fashion. We always keep an eye on areas of concern with all medications. Respirations for pain medication. You were taught in school that narcotics can retard the drive to breath. So you will become observant as you go on in these areas. Narcs can slow down their bowels also. It is part of the big picture that you pull together when you chart. At the facility I work at they require continuous pulse ox monitoring for 1 hour before and 1 hour after doses of 2mg IV dilaudid...Not spot checking, continuous. Your vitals are a picture of what is happening at that moment in time. You are new to the floor. You are full of new knowledge. Soon new nurses will be judging your movements too....Try to relax and not be so concerned about what others are doing. Do your job to the best of your abilities (I am sure you are doing a good job). But remember, the others you are judging are your brothers and sisters....Be the difference not the critic. Good luck to you sister.