Question about pain management

nursephillyphil, BSN, RN · Mar 8, 2018

what you give will be at the discretion of the MD who orders it. They all have their benefits and limitations. you may be giving norco 5's between 1-2 tablets depending on pain level, same with morphine. Just pay attention as some facilities have limits placed on how much a pt can receive of a medication in a set amount of time. ie 20 mg limit of morphine in 4 hour time frame. you may be able to stagger meds too, just document the patient's pain level response to the medication and if necessary discuss with the MD if any adjustments need to be made. just be wary of giving so much that they lose their respiratory drive.

RNperdiem, RN · Mar 8, 2018

For med-surg patients post-op, I like to start with the oral meds like Percocet. I try to keep them on a regular schedule and caution patients about not letting the pain get too severe and having to play catch-up on pain control.

I would save the morphine for breakthrough pain, pre-medication for big dressing changes or right before physical therapy where PT might be painful.

I use my hospital formulary that is on the computer at work. It is free and very comprehensive.

ruby_jane, BSN, RN · Mar 8, 2018

Are there standing orders or is it physician preference?

allnurses Guide · Mar 8, 2018

If you have spinal surgery patients, don't underestimate the strength of Valium in combination with their pain medications. It is a small muscle relaxant and also treats their anxiety about being in pain, which is huge in this particular population due to long-standing issues and usually higher than average tolerance to opioids.

nursephillyphil, BSN, RN · Mar 9, 2018

dont forget the stool softeners

vanessaem, BSN, RN · Mar 9, 2018

Start with getting a pain level then take it from there.

mmc51264, BSN, MSN, RN · Mar 9, 2018

Why are they not giving single ingredient pain medications? PO oxy, dilaudid, etc and then tylenol? I work on a post-op orhto floor. All pts get scheduled tylenol and then usually a narcotic with an IV breakthrough (if appropriate). Some get mobic/celebrex and perhaps gabapentin/Lyrica depending on hx.

IV morphine is not long lasting. The Percocet and Norco should last 4ish hours. What do they order for pts that shouldn't have a narcotic?

klone, MSN, RN · Mar 9, 2018

What you give, when, should not be at the discretion of the nurse. It should be clearly defined in the order (e.g. give one Percocet for pain of 1-3; give 2 Percocet for pain of 4-7; give Morphine for pain of 8-10).

Not having well-defined parameters stated in the order is a common finding with TJC and will get your facility in trouble. As will having duplicate therapies for the same issue, which forces the nurse to work outside her scope of practice by having to decide if she should be giving Percocet or Morphine. That is not the nurse's call to make; it should be addressed in how the orders are written.

aship, BSN · Mar 10, 2018

We do have the parameters but I guess I just get tripped up with pain management overall because if different situations.

For example, there was a patient who had minimal pain but then it got pretty high so the parameters indicated morphine. I gave it to her but the effects didn't last very long so then I felt like I had to keep giving her morphine because she still met the parameters. She had Percocet ordered as well but didn't meet those parameters because her pain was higher but I just felt like if I was able to give her that it would've been more helpful overall.

mmc51264, BSN, MSN, RN · Mar 11, 2018

My question has always been. Mind you this is short term, s/p TJR. Why do we wait until a person is 10/10 pain to give the 15 mg of oxy when we know that 15 mg Q4H keeps the pain at bay. We use a wide variety of multi modal pain meds: mobic/celebrex, flexeril, benzo, short-acting narcs, scheduled tylenol, Gaba/Lyrica, ice, regional nerve blocks, lidocaine and Flector patches. There are so many options, pts should not ever be in 10/10 pain. I am lucky that we have a dedicated pain management team. We use ketamine and lidocaine drips for out of control pain. Very few PCAs and actually very few pts need the IV breakthrough.

It is so frustrating when we get a pt from an OSH that all they did was give massive quantities of IV dilaudid Q2H. They are all almost always too sedated, constipated and then when they get to us, very demanding that they are getting "that liquid stuff"

I have a long history of orthopedic injuries and procedures (kind of had to be an ortho nurse LOL). I understand pain and I feel that I am a good advocate for my pt without overdoing it.