timing of meds

lifejourney · Nov 12, 2004

You are doing a good thing to ask a lot of nurses. Now what you have to do is decide how you will practice. It sounds like you already know what you are comfortable doing. Go with your instinct. I, for one, tend to err on the side of caution regarding pain medication, especially if I haven't previously taken care of the patient (to be familiar with what works for him) and the patient does not normally take a lot of pain medication (i.e., at home for chronic pain). My rule of thumb: you can always go back and give the sleeping pill, but if the patient slows down or stops breathing on you, you can't take the sleeping pill back. When you give a pain med, you should be evaluating how the medication is working. If the medication has had enough time to work and the patient still needs the restoril, give it. On the other hand, if you go back in, evaluate, and the patient is sound asleep, you haven't hurt anything by not giving it.

Hang in there as a new grad. There is so much to learn and so much responsibility. Keep asking questions! It's the only way to get through that first year out of school!

I am a new grad and have a question that I haven't been able to get answered. If you have a pt who needs a pain med such as Dilaudid and also asks for a sleeping pill such as Restoril should you wait a certain amount of time after giving the Dilaudid before giving the Restoril? No two people have the same answer and this pops up fairly frequently. One seasoned RN said to wait at least an hour several others said they don't wait at all. I prefer the wait awhile to be on the safe side but there are a lot of daring rangers out there that I work with that don't seem to think there is an issue (CNS depression etc)

leslie :-D · Nov 12, 2004

definitely give the dilaudid first then go in and evaluate outcome.

then you could assess as to whether patient needed sleeping med.

leslie

NurseFirst · Nov 12, 2004

definitely give the dilaudid first then go in and evaluate outcome.
then you could assess as to whether patient needed sleeping med.
leslie

I agree...it makes more sense to wait. If you are giving a medication which has, as its side effects--drowsiness, then it only makes sense to me to wait to see how that med affects the patient before giving them another med which will make them drowsy/sleepy.

To me this is just common sense. A friend of mine was given reglan for post-op N & V. Guess what? The reglan made her nauseated. But at first, rather than stopping the reglan (duh!?!?), they gave her another medication to deal with the "nauseating effects" of the reglan. Huh ?!?! (They finally did stop the reglan...I'm not sure what made them decide to do that second.)

But the whole polypharmacy thing makes me wonder. I know two people, I being one of them, who were on a bunch of meds and finally felt better when they (I) stopped them--and started from scratch. It's probably not something that a physician could legally recommend without ramifications...but sometimes I think ppl are on just too many meds--esp. with the elderly, for whom the effects can be quite variant from the textbook medication effects.

wooh, BSN, RN · Nov 12, 2004

Depends on the patient. There are patients you can empty half the Acudose into their system and they'll just a get a wee bit drowsy. For some, you err on the side of caution. It also depends on how acute the pain is. If they're newly post op, and the pain is severe, I'll give them all I got to get the pain down (and that includes sleep meds, sleep is best after surgery to help the body heal). 2 days post op, when the pain should be more under control, I'll err on the side of caution. I'm probably a "daring ranger" but I've had been in severe pain before, and until after a shift change when a nurse took pity on me and gave me everything in the orificenal, I was begging for death to take me away. You've got to use your judgement, every situation is different. That's why we have to have licenses to give drugs and they don't just pull someone in off the street and say, "give this, this and this!)

talaxandra · Nov 12, 2004

I just want to echo everyone who's said you're on the right track to ask - the most important thing any of us can do!

People are so variable that, until you know how your patient reacts, acting cautiously is always the better option, even if they (the patient or other nurses) tell you you're being pedantic. As lifejourney said, you can always add a med, but you can't take one back once it's been given.

Good luck :)