Tylenol for 10/10 pain?

[notanumber]

LTC - had a LOL with acute pain, likely exacerbation of undiagnosed compression # after a fall a week ago. Screaming, grimacing, little to no relief with repositioning. She did have a PRN for extra strength Tylenol, however given the level of pain exhibited and knowing it would exacerbate the issue to sit her up and give PO, I called her MRP. MRP very unhappy that I called him without first giving Tylenol and seeing if it worked and directed me to do so.

Was I wrong?

[Lady_Leijing, BSN]

I've never worked LTC, but I worked on a Med-Surg unit. I would have done the same thing.

[Kooky Korky, BSN, RN]

You probably should have tried it.

You should have seen how she was after an hour or so.

Then, if not improving, call MD. Don't know what an MRP is, guessing it's Medical _______ Provider.

I know you wanted to get quick relief for her, so understand your thinking.

Perhaps there is not really a right or wrong, just different ways of looking at the situation.

How is she now?

Was this on Nights?

[notanumber]

Kooky Korky said:

You probably should have tried it.

You should have seen how she was after an hour or so.

Then, if not improving, call MD. Don't know what an MRP is, guessing it's Medical _______ Provider.

I know you wanted to get quick relief for her, so understand your thinking.

Perhaps there is not really a right or wrong, just different ways of looking at the situation.

How is she now?

Was this on Nights?

MRP = Most Responsible Physician

This was on nights, at 2300. We had trialled giving Tylenol at hs the night before and the same pain recurred then, but resolved with repositioning. This time it didn't resolve, hence the phone call. My thinking - in addition to getting some quick relief - was that if I gave her the tylenol and it was not effective, it would be less bothersome to the physician to be contacted at 2300 at the onset rather than later at night. I've had perturbed replies from not doing this (e.g. "The patient was showing symptoms in the evening and you call me at *this* hour??").

Res is doing well now as reported to me. Very perplexing.

[RestlessHeart]

Kooky Korky said:

You probably should have tried it.

You should have seen how she was after an hour or so.

Then, if not improving, call MD. Don't know what an MRP is, guessing it's Medical _______ Provider.

I know you wanted to get quick relief for her, so understand your thinking.

Perhaps there is not really a right or wrong, just different ways of looking at the situation.

How is she now?

Was this on Nights?

Kooky, I just wanted to tell you I love your nic, I giggle jus' a lil everytime I read your posts. I also wanted to say your posts all seem so well thought out and well placed. Im glad you contribute here.

Hmmmm, Im 'sposed to be stalking someone else on AN....I forget who...Sooo I think Ima stalk you (or is it called creeping) LOL

Have an awesome week, stand strong

[CoffeeRTC, BSN, RN]

Sounds like she needs something more than just when the pain is unbearable. I would have given the tylenol and then called.

What ended up happening? did you get a different order.

[notanumber]

CoffeeRTC said:

Sounds like she needs something more than just when the pain is unbearable. I would have given the tylenol and then called.

What ended up happening? did you get a different order.

Monitored for not quite two hours with no change in symptoms, then saw some improvement, and further repositioning resolved it almost completely. Still very painful on lying->sitting->standing. Pain more or less disappeared over the next few days. Mysterious and frustrating.

[ComeTogether, LPN]

Not wrong, but in that situation "I gave Tylenol with no relief" I can always go ahead and give the tylenol after I get the order for the stronger med and see how it helps, but at least then you have the order when the tylenol doesn't touch it.

[Here.I.Stand, BSN, RN]

I've worked in the rehab unit of a SNF. Based on how quickly (and by that I mean how NOT quickly) the pharmacy tech arrived with newly ordered meds, absolutely I would want to get that ball rolling ASAP. Giving Tylenol and waiting an hour to reassess, in the LTC setting could mean many hours of avoidable suffering. Plus, having a 2nd med on hand doesn't mean you MUST use it. You could give the Tylenol while waiting for the stronger meds to arrive, and if it is effective, great. I would much rather err on the side of caution when it comes to pt comfort.