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Pain meds and low BP?

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by fsh1986 fsh1986 (Member) Member

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tewdles has 31 years experience as a RN and specializes in PICU, NICU, L&D, Public Health, Hospice.

3,156 Posts; 30,837 Profile Views

But you held her long acting opioid rather than the prn. That makes it soooo much more likely that she will experience significant pain.

Because you did not say what the diagnosis was, the type or location of pain was, the resuscitation status or prognosis of the patient we cannot possibly know how to assess this situation.

If that patient is an end of life patient we would give her meds...no matter the setting. Palliation of symptoms is a balance of considering "numbers" while treating the symptoms.

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canned_bread has 11 years experience and specializes in Cath lab, acute, community.

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It's tricky, because if something happened and you DIDN'T give it (such as patient complaint), you aer in trouble. If you did give it, and something happened, trouble there too! I would document, document, document as well as inform the nurses around me and give it. Then I have covered my butt, because I was TOLD to give it!! I would also inform the doctors about any drop, and also chart the BP frequently, especially prior to dose and perhaps 30mins after to see any change.

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corky1272RN specializes in Med Surg, Home Health, Dialysis, Tele.

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The nurse has to rely on her/his critical thinking and assessment skills. You cannot be forced to give narcs if you think it is inappropriate. Go to your charge nurse if the pt starts hollering that she isn't getting it. If the pt is asleep when it is time for a scheduled narc, chart that and reassess later. Even if the pt isn't falling asleep/drooling when it is time for a scheduled or PRN narc, I don't give more than 1 or 2 at a time (depending on the meds/situation), even if they take it all at home at the same time. I just explain that it is different in the hospital and I have to make sure that it is safe. That is my job. Some understand, some get very angry. :eek:

 

I have had times where I wouldn't give certain meds at the same time. The pt became very angry, I explained the situation to my charge nurse, he agreed with me. But even if he didn't agree, he would either support me or give them himself. BUT if he decides to give the meds, he will take over the pt. Noone better demand that you give meds to a pt, because it is your license it anything goes wrong. I try to know beforehand if there will be an "overlapping" of meds. I will talk to the pt and let that person pick which ones are given & omitted. One time the house supervisor even got involved, she disagreed with my decision but still backed me. :up:

 

Suggestions that it is ok to give a bunch of narcs together just because the person takes it at home that way is a flawed way to think. You must keep in mind that the pt is getting other meds in the hospital that aren't taken at home that could increase (or decrease) the efficacy of the meds. Plus the person's current medical condition can change their tolerance.

 

 

As for the BP, don't look at the #, look at the pt (and trend). You have to keep in mind what is the pt's normal, that is part of the critical thinking. :yes:

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