BrazoriaLVN

Well, a one time extra dose. He gets 75mL QID!

Thanks, but I know how lactulose works. What I'm asking is in the absence of a bm after giving lactulose, would mixing MOM with the lactulose somehow negate the ammonia lowering effects of the lactulose or help it along?

So we have a patient with end-stage cirrhosis that always gets back critical ammonia levels. A few days ago he was really woozy and sure enough is ammonia came back at 109. MD ordered another dose of lactulose now and check labs later. My question is, if the method of action of lactulose is ridding the body of excess ammonia by bowel movements, would any laxative work? After the extra dose of lactulose I gave the pt still hadn't had a bm after 8 hours. My coworker said to mix MOM in it next time to get it working faster but I'm not sure if that would work and I'm not comfortable doing it without an order anyway. What do yall think?

Wow...virus by mail. Didn't they already do that with anthrax? :

I'm sorry...huh?

Or he could just wear a sheet, pour a glass of water on himself, and be a wet blanket...

I saw a thread last week and it was so funny to me, I couldn't believe it! It was great! I can't believe the fantastic experience I had. All the threads on that site are hilarious. I make their lives funnier. Shouldn't they be funnier to me?

Yes! Stadol D/C'd yesterday, Fentanyl patch upped. I'll keep you updated on how it goes but unfortunately no changes so far.

So did you need it single or double spaced?

I agree. With the amount he has going on, I wouldn't have the time anyway!

He actually has had a fentanyl patch for quite a while. His alprazolam is bid so it's given when he is up. The boredom aspect is really something to think about though. He does have extensive family that visits 5-6 hours every day, and he gets up in a geri chair every day, but it seems like when he is alone in his room his pain is worse. Not to discount his pain at all, but I wonder. An anti depressant would be a good think to think about, and I love the pet therapy idea. I hate to say I am sick of him, but I am sick of the behaviors. But when you have pretty much everything wrong with you, as he does, I can't say I wouldn't do the same.

He gets alprazolam bid and q 6 prn and temazepam @hs.

I have a resident at my SNF...rheumatoid arthritis with contractures of upper and lower extremeties. This man is sometimes confused, but mostly with it. Gets Norco, Oxycodone, Soma, Lyrica, Stadol, Voltaren Gel, Baclofen with no relief whatsoever. Screams constantly. All PRN meds are given exactly at the intervals (i'm there 6 hours to the dot.) He is friendly when we are in the room, then when other staff goes in he tells them how we never give him any meds, are such bad nurses, nobody cares about him etc. I frequently have the aides tell me he is complaining of chest pain and when I go in he wants to talk about his TV show. When I ask about the CP he denies ever saying it. I feel so guilty for saying this, but I am SICK and tired of hearing "OH GOD HELP HELP HELP" all day long. I am sick of being told I don't do anything for this man. I am so sick of other residents telling me to give him something. I already did! There's nothing else I can do! Turned, repositioned, offered a snack, one on one, everything...nothing works! MD knows...has ordered everything under the sun...she is just as frustrated as us...I'm so tired.

ahh, yes. because when you have back to back codes, residents falling every five minutes(with lovely ten page incident reports to complete after every event!) and a giant med pass, you will go ahead and take fifteen minutes to keep fetching ice for someone who insists it "isn't cold enough." just because we don't come and help with every little itty bitty thing does not mean we "have a stick up our ass." i can come and help you do your entire round. i was a cna before, i'm not too good to clean. but remember, when i go to do my round, you can't go and pass my meds/do my tx's for me. go to nursing school and get a job and see how you feel about it then.