RJKitts

Okay, so I haven't been doing homecare for a long time but I have been with this one client since Dec. I work FT with him as well as one other nurse and we have 2 PRN LPNs. He is a 26 y/o quad who is on vent/trach. So here's the problem, he was on methadone 40mg TID when i started and up until 2wks ago continued on that med. He went and saw a pain mnmgt Dr and they switched his methadone to oxycontin 40mg TID. He also had 8mg Dilaudid and .5mg Xanax available PRN. Okay so he comes home from Dr and started taking the Oxy, 2 days into it he says its not working and he wants it increased. Me and the other FT nurse talked to him and his fiance (whom he lives with) and they decided to give it a few days before calling pain mgmt Dr. In the meantime we only work 7a-7p M-F and 9-9 Sat-Sun, so I guess he was taking the methadone with the oxy at night and not telling us. When I went into work on Mon after being off the weekend he had an increase HR, trouble breathing and very anxious, looked like pneumonia to me. His dad mentioned withdrawl, when I mentioned that to the PT he said there was no way because he had been taking the methadone (NO ORDER) at least everyother night along with his other meds. So at night this is what his meds looks like. 1 Oxy 40mg, 1 Dilaudid 8mg, 2 Xanax 0.5mg, and Methadone 40mg. I don't want to say he is not in pain. But he doesnt wake up when we give him a bath, yet he tells me that his left side hurts. He can't feel anything from his High neck down. This scares me bc although we are not giving him this med that he has no order from we have to deal with the after effect when we come in the AM. So anyways took him to hosp, admitted with pneumonia and collapsed lung. The first thing out of his mouth was I need Dilaudid IV and benadryl 50mg. He asked for and he recieved. He asked again in 3 hrs and got it again. It just scares me, I love working there. All nurses get along as well with his family. I just am concerned about the drug usage. What do you guys think?

I am an LPN for 3 almost 4 years and wishes that I would've went the RN route, because now after finishing school and working I feel that I always make an excuse not to go back. Where I'm from there are not a lot of job opportunities for LPNs mostly LTC, no hospital in this area will hire an LPN unless they want to work as a PCA. But I also feel like new grads from RN school aren't getting hired either. In a LTC setting where I was we had 2 brand new RN's with BSNs come to work for $20/hr which is what the LPNs were making and we all were doing the same thing. But my dream is to become a travel nurse, so RN I will have to get to broaden my possibilities in that field. But in my opinion a nurse is a nurse and we all contribute to patient care so if you're happy with that, we need LPNs as much as we need RNs and STNAs.