Patient pain medication

[Nursing36578]

I'm working through a case study and having a hard time about an 84 year old woman who fell down stairs and sustained multiple injuries and is very ready, whiny and clutching the nurse in pain. Dr ordered morphine 5 mg orally q 4hr prn and Ativan 1 mg IV 3 times daily prn. Which med would I give first?

if administered morphine and she continues to complain of pain 3 hours later and dr ups the dose, is she at risk of addiction? And what makes her a candidate for being under treated for pain?

thank you kindly in advance

[AliNajaCat]

I would suggest the Ativan be given orally TID and HS and something like Vocodin for her pain.

Morphine wears off too fast. IM Demerol50-75 as needed.

Demerol 50 mg is equianalgesic to 2 aspirin, and it's a horrible drug to give to old people due to the effects of its metabolites. I haven't actually seen it given to anybody for years.

[SnowbirdRN]

Perhaps the Ativan is also ordered for muscle spasms which could greatly reduce pain.

[CapeCodMermaid, RN]

Never use demerol in an elderly person. They can't metabolize it. The ordered meds are fine. Anxiety can increase pain. No one who is truly in pain is going to become addicted to it. She's OLD. You try falling down the stairs and see how much YOU hurt. She's OLD. Went from home on a stretcher with strangers on a hard gurney to an ER with strangers on a hard gurney. It's scary, disorienting and painful.

[KelRN215, BSN, RN]

No one who is truly in pain is going to become addicted to it.

This. The odds of becoming addicted to prescription narcotics taken as ordered to treat pain is extremely low and nurses should not withhold pain meds out of fear of the patient becoming "addicted". You're not going to create an addict by treating pain.