thanrose

I have a patient that has complicated list of problems R/T past abuse of chemicals of various sorts. Let's say metabolic encephalopathy to start. Medical management is keeping the possibility of her recovering enough to live on her own to some extent. (Not likely.) In the past, she's been a palliative care patient where they started her on heavier narcotics. She's told me she prefers the oxy meds to the morphine even though dose for dose the morphine is demonstrably stronger. Okay, maybe she's not metabolizing the morphine as well as she should. Of course, blood work has been done again and again. I told her the morphine should work, so she asked me for something stronger. I suggested, "What, like heroin?" And she said, "No, that never lasted long enough. " The new pain management doc has gone the route of DCing any oxy, and going to All Morphine, All the Time advocacy. The usual caveats apply. The thing is that she's absolutely doped to the gills now, delusional, whiny, no safety awareness. We have Narcan available, but I don't want to pull out the big gun yet. Nurses on other shifts seem to wholeheartedly believe that even someone with her history, and her demonstrated hypochondria, can get any narcotic that is prescribed as long as it's within the orders. "Hold for lethargy" may as well be written in Latin. Apparently, walking in the hall with your eyes closed and wearing nothing below the waist is not worth documenting. She's even picking at her own skin as a result of the extra morphine. I'm the only nurse she trusts even when I tell her I'm holding back a narcotic due to her behavior. Not as a threat, but because of my nursing observations. Guess I'm just venting here. I find I have to educate my fellow nurses even more than the patients at times. I'm even okay with the pain management doc DCing the PRN oxy, considering the current crisis, although I might have suggested that the doc actually read the relevant nursing notes before making changes to the regimen.