New Nurse Pain Med Question

wooh, BSN, RN · Jul 11, 2013

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.

Don't use uncalibrated unapproved by the facility equipment. Sure it's more convenient, but if/when something bad happens, that alone can get you thrown under the bus. Even if the reading was accurate, what proof do you have of it?

TBlase · Jul 12, 2013

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!

Tell just one of your 20, or 30 LTC patients on chronic pain meds that you can't give them their drug based on your VS assessments. Just one. Then get back with me, after you are discharged from the hospital with groin injuries.

VANurse2010 · Jul 15, 2013

I think it should be mentioned that you can't just hold meds because you feel the VS are out of parameters and call it a day. If you don't have specific parameters to hold then you should be notifying the MD. Page the MD for holding a po narcotic for a BP of 105/60 or a RR of 13 a couple times and see how well that goes over.

wanderlustnurse88, RN · Jul 24, 2015

I know I'm bringing back an old thread but wanted to ask something without starting a new topic.

I had a nurse yell at me for not checking vital signs after giving IV dilaudid for a pt with acute cholicytisis. It wasn't the first time she got dilaudid, she takes extended release dilaudid at home. I had been in and out of there over the hour and a bit that we were getting her ready to transfer to a more acute facility. I had done am vitals beforehand and I could just tell by looking at the pt that she had no altered level of consciousness.

I felt very belittled on the fact that she was talking down to me and questioning my nursing judgement. I'm not sure who is in right. I know I need to monitor the pt for effectiveness, but doing a set of vitals after each administration?

CoffeeRTC, BSN, RN · Jul 24, 2015

No. I prob wouldn't have either. Id assess for resp depression.

Whit2389 · Sep 7, 2015

Tell just one of your 20, or 30 LTC patients on chronic pain meds that you can't give them their drug based on your VS assessments. Just one. Then get back with me, after you are discharged from the hospital with groin injuries.

I think that the majority of the time you will be able to administer the medication. It is mostly just to show that the reason the patient crashed is NOT because you gave dilaudid with a respiratory rate of 9 breaths per minute.

stippie09, ASN, RN · Sep 14, 2015

When in LTC, it is quite difficult to do a full set of vs when giving a narcotic. Here's why, you have a average or 20-30 residents any given day, 3/4 of those residents get prn pain meds either q4 or q6. If you are doing your med pass and 3 people ask at once, can you really stop to do a full assessment on every person before giving a Norco/percocet 5/235mg?? No you dont. What you need to do is look them in the eyes, determine if they are unusually sleepy or their breathing is off in any way (then you want to do a full assessment). Yes, with something as strong as dilaudid I would definitely cover all your bases first. But chances are, these people have been taking these pain pills for years and it rarely affects them. But you should follow up.