Pain Meds

roser13, ASN, RN · May 29, 2012

This is where nursing judgment comes into play. You look at the entire picture of your patient's pain treatment. What's currently on board? How does the patient rate the pain? Then you choose a compatible pain med that, in your judgment, will be sufficient. You don't want to, for instance, give a Percocet to someone complaining of 1/10 pain. Nor would you give Tylenol to someone complaining of 8/10 pain.

In terms of your response to the patients' questions about the differences between the drugs.....make sure that YOU know the differences so that you can educate your patient. For instance, what's the difference between Percocet and Vicodin? If you don't know the answer, you can research the two drugs for the patient and give them the appropriate answer.

sbostonRN · May 29, 2012

If they have all of those ordered and they are a fresh post-op, I would just try them all to decide which is best. I've had patients who barely responded to Dilaudid but had great relief with Oxycodone, or who had many side effects with Percocet but none with Vicodin. It's really just about trial and error to determine what is the best choice for that patient.

Perpetual Student · May 29, 2012

The difference between oxycodone and Percocet is the acetaminophen in the Percocet. Most patients seem to understand that when I explain it. The pertinent difference between hydrocodone and oxycodone is that mg for mg the oxycodone is more potent. Some patients experience different side effects with one or the other, or express a preference. I'd just let the patient choose. One thing I'd like to point out is if it's the Vicodin with 500 mg of acetaminophen I'd go with Percocet instead when possible to avoid excessive acetaminophen over the course of the day.

I recommend giving one of the acetaminophen containing meds (e.g. Percocet or Vicodin) first assuming the patient hasn't already had too much acetaminophen for the day. Then reassess after an hour or so and give some oxycodone if the patient's still in significant pain and not overly sedated.

Also, whenever possible try to use other interventions along with the opiods. An NSAID such as ketorolac (Toradol) or ibuprofen (Motrin) can be very helpful. Using ice where appropriate can make a huge difference, as can appropriate positioning (e.g. elevating an affected extremity, raising the knees a bit in an abdominal case).

brownbook · May 29, 2012

There are chemical differences in all those pills. You should memorize their ingredients, amounts of Tylenol, amounts, type of "codone", extended release, etc. That is all essential for a nurse to know.

However honestly the KISS (keep it simple stupid) way is to ask the patient what they have used before. They may tell you "vicodin never works for me, only percocet works."

If they say they have never used pain pills and ask your advice on which one to try you can simply (honestly) say something like, "Percocet (or whatever) is considered to be a little stronger but every body is different.... Vicodin is great and routinely used for post op pain." They may say okay I don't want anything too strong, or they may say (or give you a look of ) no way, give me the strongest pill, I am hurting a lot.

It is the "art" of medicine. There is no cook book.

ebear, BSN, RN · May 29, 2012

Why is a patient ordered oxycodone and hydrocodone at the same time? Ask doc to review. :coollook:

BluegrassRN · May 29, 2012

I also check and see what they've been receiving, and assess whether it's been working for them. If we are starting from scratch and there are options, I usually tell the pt what they have ordered and ask them if they've taken any of those pain meds before. Based on their pain score and their previous experience (good or bad), I'll then make the decision what to give.

classicdame, MSN, EdD · May 29, 2012

IMHO the MD ought to write the order more specifically, like if pain is 1-3 give Med A, if 4-6 give Med B-----

But the above posts are right. Learn the differences and eventually you will have a spiel to tell patients. Look on your patient education resources to put the info into lay language.

KelRN215, BSN, RN · May 29, 2012

Why are the MDs ordering all these meds? Percocet is acetaminophen and oxycodone and, if given the choice, I would give the percocet over the straight oxy any day. When I worked in the hospital we hardly ever used percocet because it was peds and the hospital didn't carry the already mixed elixir but we always gave tylenol with oxycodone.

I used to work on a floor that was part surgical and this is how we typically did pain meds in the post-op period:

The immediate post-op period, morphine was used. For those who had surgeries where a lot of muscle was cut, valium was also used. People with sensitivities to morphine or who had insufficient pain control with it got dilaudid. After 24 hours, one was expected to transition to PO pain meds unless one was vomiting. Many patients were started on Toradol on POD 1 as well. We didn't use hydrocodone at this hospital. It was basically the surgeon's preference as to whether the child got oxycodone or codeine after transitioning to PO pain meds. The general consensus was generally that oxy was better than codeine at this hospital.

ORoxyO · May 30, 2012

Why is a patient ordered oxycodone and hydrocodone at the same time? Ask doc to review.

This is common occurance. You don't administer both at the same time, but you choose which is appropriate for the pain level. Some of our patients go home with both and are given pain ranges for each med with strict orders not to take them together. I'm sure many of them do though.

RockinChick66 · May 30, 2012

T if it's the Vicodin with 500 mg of acetaminophen .

Can I point out that vicodin with 500mg of acetaminophen is no longer available. The FDA has banned. No longer available in our hospital any way. IF the doctor writes for this, our pharmacy with auto sub it for the 5-7.5-10/325.

In any case, I use my nursing judgement as to what pain med I give. I assess the pain scale for the patient. If his/her pain scale is a 10, I"ll give the strongest I have and alternate that with the pain pills. If oxy is ordered with norco, I usually just give the norco and will only give the oxy in case of extreme unmanaged pain.

You have to learn how to use your judgement and make decisions.

Perpetual Student · May 30, 2012

Vicodin with 500 mg of acetaminophen is still out there--I got a bottle myself very recently. It has indeed been banished from the inpatient end of our system, however.

As to the posters questioning why oxycodone would be ordered along with Vicodin or Percocet, it's obvious that the intent of the provider is to adequately manage the pain. For a lot of folks 2 Percocet or 2 Vicodin q4 or 6h will not be sufficient to control pain, but add in a dose of 5-10 mg of oxycodone in the middle that interval and the patient may remain quite comfortable.