Time between Meds

thinwildmercury · Jul 27, 2014

For the pain meds, do you have a scale that helps you decide which to give? At the last hospital I was at, you used the pain scale to determine which drug to give and the doctor wrote in the orders: (ex) Tylenol for pain level 1-3, Toradol for pain level 4-6, Dilaudid for pain level 7-10. Even if your MDs don't write the orders that way, you know if a patient is having post op pain 10/10, you shouldn't start out with a Tylenol. Otherwise, I would give the weaker med regularly and give the stronger med for breakthrough pain.

I would have given the lorazepam as scheduled because the doses were so far apart. If the prn dose was given closer to the scheduled dose time, I would have waited until closer to 2200 to give it.

I am a new nurse though so I'm interested in what others would do.

CardiacKittyRN · Jul 27, 2014

Our pain medications have parameters on the order.. For example, Tylenol or ultram could prescribed for "mild pain" (1-4 on pain scale) or sometimes says for headache or fever also. Then the typical orders for moderate pain (5-7) it's usually either lorcet 7.5 or Percocet 10/325; severe pain (8-10) is your morphine, or rarely diluadid. But you have to look at the situation too... Some people underrate or exaggerate their pain, I look at their case and decide..

Also, I think it would have been ok to give the Ativan. It's a rapid acting anxiety medication, so it's duration isn't super long. I'd just look at the pt.. If they're not out of it or super drowsy and vitals are good, I'd give it!

Twinmom06, ASN, APN · Jul 27, 2014

since Tylenol/Motrin/Ultram or Toradol are not narcotic I don't worry about time in between. Our Ortho patients get Ultram and Tylenol together scheduled and Morphine/Dilaudid PRN - I usually will wait an hour between narcs (ie Percocet first and an hour later if they are still in pain then go to Morphine/Dilauded).

bear14 · Jul 27, 2014

Sorry it was 1848 not 1648. I worked last night.

pixie6089, BSN · Jul 27, 2014

On the ortho floor I regularly float to, we alternate ultram or Tylenol with dilaudid or morphine. All the other floors do recommend Tylenol for mild pain, lortab or Percocet for mild-mod pain, and morphine or dilaudid for severe pain. If the patient has been taking lortab or Percocet, I would not ever give Tylenol unless they havn't had it in greater than 24 hours and they state to me they aren't planning on taking it again soon because those things already have acetaminophen.

delphine22 · Jul 28, 2014

Some people underrate or exaggerate their pain, I look at their case and decide.

IMO (and what I was taught) it is not my place to decide if the pt's pain is "real," since I can't feel what they feel. People who have been living with chronic pain for years are often able to talk, move, eat and sleep while feeling pain that would have me on my knees bawling. Pain is what the pt says it is, where they say it is and how bad they say it is. Yes, even if they have been labeled a "drug seeker."

If the MD orders it, scheduled or PRN, and the pt's vitals are stable and they are not oversedated and I feel in my nursing judgment it is safe to give, I give it as ordered if they ask me for it and tell me they are in pain.

CardiacKittyRN · Jul 28, 2014

IMO (and what I was taught) it is not my place to decide if the pt's pain is "real," since I can't feel what they feel. People who have been living with chronic pain for years are often able to talk, move, eat and sleep while feeling pain that would have me on my knees bawling. Pain is what the pt says it is, where they say it is and how bad they say it is. Yes, even if they have been labeled a "drug seeker."
If the MD orders it, scheduled or PRN, and the pt's vitals are stable and they are not oversedated and I feel in my nursing judgment it is safe to give, I give it as ordered if they ask me for it and tell me they are in pain.[/
I was speaking more about people who say 10/10 every single time you ask them no matter if they've had diluadid 30 minutes ago or are obviously just saying 10/10 every time for the hell of it. I am with you that chronic pain is real and I was medicate promptly for any reported pain. But just because someone says their pain is 10/10, doesn't mean I'm automatically going to jump to the morphine or diluadid first; we'll try a Percocet first then if that doesn't help I'll give the stronger narc. I do always just my judgement to decide what I think we should try first, but I NEVER withhold without a good reason (bad vitals, somnolent appearance, depressed respiration). But you have to be honest, you know there will always be those people who if they never their morphine was q1 they'd ask for every hr on the hr.. This is all I'm saying about overrating pain. And even in that situation, as annoying as it would be, id still give it.

Code Red · Aug 16, 2014

IMO (and what I was taught) it is not my place to decide if the pt's pain is "real," since I can't feel what they feel. People who have been living with chronic pain for years are often able to talk, move, eat and sleep while feeling pain that would have me on my knees bawling. Pain is what the pt says it is, where they say it is and how bad they say it is. Yes, even if they have been labeled a "drug seeker."
If the MD orders it, scheduled or PRN, and the pt's vitals are stable and they are not oversedated and I feel in my nursing judgment it is safe to give, I give it as ordered if they ask me for it and tell me they are in pain.

I was thinking it you said it. I think your absolutely correct.