pain meds

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pt. today is post ankle fusion, hx of djd/oa. woke up with left arm pain. xray of elbow, forearm and wrist negative. not real sure of whats going on, but thats not my question. what i want to know is your opinion of this - pt had previously been confused at times - not aggressive or trying to get out of bed, but saying off the wall comments. so the dr. at that time decreased percocet and tegretol dose, has since been more clear - still says weird , random stuff , has a strange sense of humor so hard to determine what he is serious about , due to the extreme pain he is c/o the dr wrote for morphine 2mg im q 2hrs as needed, lpn - primary nurse- this is team nursing felt this was inappropriate due to previous confusion - that we are unsure of the cause but possibly percocet. she felt motrin was a better choice. barely touching that man caused extreme pain that his now 1 percocet was not even touching. i feel like since we don't know if it was percocet, tegretol, or something else, that we should at least try the morpine. just because percocet makes someone confused doesn't necessarily mean morpine will and he still deserves pain control untill ortho consult tomorrow and the origin of this pain is determined and fixed. what do you think?

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Specializes in OB/GYN, Peds, School Nurse, DD.

What do I think? I think that nurse ought to undergo an ankle fusion and then be giving ibuprofen for pain. :mad: The old hag. Even confused people need pain relief.

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Specializes in ED. ICU, PICU, infection prevention, aeromedical e.

2mg of Morphine is really a little dose, especially when that patient has already been on narcs. Give the morphine. Why would you allow a patient to suffer when there is an order for something to help?

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Specializes in Army Medic.

Being disabled with chronic pain disorder I can say that morphine and percocet are two completely different animals.

Morphine does not cause the euphoric high you get off of percocet when it's administered in low doses - I have found this to be true for myself, as well as with patients I was caring for while in the military.

It does a better job of dulling out pain, without making you loopy. In my opinion you should respect what an MD - who has gone through extensive training with these things, and not a nurse with an ego.

Is there any prior history of mental illness? Is he a Veteran or ex Police Officer, any other old high stress job?

There are a million things that could onset delusional behavior due to increased anxiety coupled with prior mental history.

Either way, motrin is something you give for a sprained ankle, not for inpatient's after a major surgery. If he's in pain - your primary objective should be to control that pain.

Has he shown any signs of being a danger to himself or others with his behavior when on the pain meds?

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Confusion is a common side effect, and albeit annoying, seems manageable in this situation.

I think that the pain management is being mishandled. And MORPHINE IM--that's just...what can I say...I am a recovery room nurse and I titrate IV meds to the point of tolerable pain.

Please, please, please...consider how much pain this patient is having and address it immediately.

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Specializes in Med Surg, ICU, home&pub health, pvt duty.

What was the pt's age? Geriatric?

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Specializes in OB/GYN, Peds, School Nurse, DD.
Confusion is a common side effect, and albeit annoying, seems manageable in this situation.

I think that the pain management is being mishandled. And MORPHINE IM--that's just...what can I say...I am a recovery room nurse and I titrate IV meds to the point of tolerable pain.

Please, please, please...consider how much pain this patient is having and address it immediately.

I had my thumb joint replaced a couple years ago. It's a pretty painful surgery--they cut off the proximal end of the thumb bone, replace it with a balled up tendon they pull out of your arm, and put it back together with pins. To say I needed pain relief would be an understatement. My doctor gave me Percocet. :redpinkhe Good man. The only side effect I had was confusion and amnesia. I am told that I called every number on my cell phone and started talking to people. Finally someone in my family called my husband's phone and told him what was going on. He confiscated my phone until I was off the narcotics. I have no memory at all of doing this but I'm told I was really the life of the party. :clown:

If my doctor had just given me ibuprofen I would have chewed his hand off.:devil:

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Specializes in med-surg.

I agree with you, and if it were me, I'd give the morphine. You have to control his pain, that's a non-negotiable. Morphine and Percocet are two very different drugs, and just because one causes confusion, doesn't necessarily mean the other will. It's just cruel to hold off on giving pain medications to someone in severe pain. Give the morphine, if pt get's confused again, call the doc and get something else.

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Specializes in Cardiac Telemetry, ED.

I'd give the morphine AND the Motrin. I'd also try heat and cold therapy if not contraindicated.

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to answer some questions - no dangerous behaviors, he is in late fifties , i believe. no previous mental history.

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Specializes in LTC/Behavioral/ Hospice.

Confusion is not a reason to undermedicate this man. The priority is his pain! Poor guy. I hope he's been medicated sufficiently now.

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has he been assessed for ETOH withdrawal? and NSAIDS interfer with healing....

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