What have I done?

SuesquatchRN, BSN, RN · Nov 17, 2007

The doctor knows the condition and prescribed something for pain that contained acetominophen. The patient's pain was relieved and nothing bad happened.

Wait for a real problem to worry. You'll get one.

ERRNTraveler, RN · Nov 17, 2007

I wouldn't worry about it- like Sue said, the doctor knew about the patient's condition & wasn't concerned. Just because a person has hepatitis, that doesn't mean that they can NEVER have acetaminophen. It all depends on the severity of their illness, what their LFT's were, etc.

caliotter3 · Nov 17, 2007

Commend yourself for realizing the connection, but don't worry about it. Like the others have said, the doctor is aware of the diagnosis and the percocet, I suppose, was only ordered PRN or for that one single instance.

Agnus · Nov 17, 2007

Nothing.

There were two other people checking this script the MD and pharmacy. Now if the pt is still getting percocet when you return you might ask the perscribing MD about this.

It is highly unlikely any harm was done. Further more Hepatitis patients do get to take percocet. Yes acetaminophen is toxic to the liver. It is not nearly as toxic as the disease. There are very few meds that are not metabolized by the liver.

A lot of this depends on the extent of the Hepatitis. What pain meds do or do not work for this patient.

A person can survive nicely with only 10% of their liver functioning.

You are right to question this script but do not be so upset.

adnstudent2007 · Nov 17, 2007

Thank you so much for all your replies. I am feeling a little better. I know the md "should" have known the pts condition, but I work night shift and it was an on-call doc. In the short time I've been here, I've been asked several times by docs what they should order! That scares me for this very reason. They went to med school, not me. Is that common everywhere?

ERRNTraveler, RN · Nov 17, 2007

Thank you so much for all your replies. I am feeling a little better. I know the md "should" have known the pts condition, but I work night shift and it was an on-call doc. In the short time I've been here, I've been asked several times by docs what they should order! That scares me for this very reason. They went to med school, not me. Is that common everywhere?

You'll have that every now & then- especially with new doctors or residents. If I have a suggestion on what med to give, I'll suggest it by saying something like "Zofran has worked pretty well for Mr. Puker in the past." But if you don't have a suggestion, or don't know what has worked for this patient in the past, and the doctor asks you what to give, I would just say something like "I don't know, what medication do you think is most appropriate?"

ginger58, ASN, RN · Nov 17, 2007

Thank you so much for all your replies. I am feeling a little better. I know the md "should" have known the pts condition, but I work night shift and it was an on-call doc. In the short time I've been here, I've been asked several times by docs what they should order! That scares me for this very reason. They went to med school, not me. Is that common everywhere?

Congratulations on graduating from NS!

When calling a doc for meds and if you think of it while you're on the phone instead of after you've hung up, like happens to some of us, just ask if this will be a problem with HIV. You did good.

Where I have worked if a pt has renal or liver disease they try to keep the Tylenol dose below 3,000 mg per 24 hours. Even if he got 1 or 2 doses before his doc got there he'd be fine.

Keep up the good thinking.:balloons:

Tweety, BSN, RN · Nov 17, 2007

A couple of tylenols every now and then isn't going to throw a person into liver failure, nor with someone with liver problems is it going to exacerbate their condition. Relax.

Sometimes you have to weight the benefits. I've given Tylenol to liver failure patients before with temps because giving a motrin might have increased already increased bleeding times. A patient in pain deserves pain medicine as well.

Definately in the future clarify with the MD if you think the patient will be taking a lot of the percocets, maybe asking for percolones instead.

Good job.

pagandeva2000, LPN · Nov 17, 2007

I would not worry about it either. The next time you see the doctor, ask him why he prescribed it. Not in an accusing way, but, tell him what you were thinking and say that you want to know for future reference. I had a similar situation where a patient told me that she has allergies to chewable aspirin, and I saw that the intern prescribed chewable aspirin. I went to him and he changed it to enteric coated. Now, being a new nurse, I thought that this person should not take aspirin at all, and asked him about why he made that choice. He explained to me that because the medicine would uncoat in the intestines and be absorbed there, that an allergic reaction probably would not incurr. Now, am I sure? Not really; but I documented what he said, took his word for the moment, asked a few others who told me the same thing, and I gave the script to the patient. I looked at it as to say that I did inquire as a nurse, received a response that made sense to me, and documented everything that I did. Patient seems to be fine. I told her what to expect in regard to an allergic reaction, she didn't call back, and all of this is in the chart.

Agnus · Nov 17, 2007

Thank you so much for all your replies. I am feeling a little better. I know the md "should" have known the pts condition, but I work night shift and it was an on-call doc. In the short time I've been here, I've been asked several times by docs what they should order! That scares me for this very reason. They went to med school, not me. Is that common everywhere?

Very reasonable reason to be concerned. I was thinking (had it been the primary doc)that this little detail might have momentairly slipped his mind.

By the way when I talk to an on call Doc. one of the first things I tell him is the pt's Dx

Doctors are human. I will never forget questioning the following order. "Pap smear normal. Repeat in 2 weeks." I asked him, "Is this really what you meant to write."

Well of course it was not. He turned 20 shades of red and said,"What was I thinking!" (about himself). Then joked, "yea, I really like to do paps."

We do need to question orders that seem off to us. You will learn that some of the hard and fast "rules" we learned in nursing are not really hard and fast. Docs have to weigh risk benefits every time they prescribe. The cardiac med that you were taught to hold in nursing school if bp was too low the cardiologist want you to give.

caliotter3 · Nov 18, 2007

I can see your added concern since the doc was on-call and not expected to know the pt. Like said before, when you get a doc who is unfamiliar with the pt, then give them the dx so they have a better picture.

As for your question about being asked what to prescribe, my very first job as a new nurse, my very first call to the MD, he asked me what to prescribe. I was taken aback. He also told me that he had just woke up and was new or something like that. For some reason, I thought to open up the chart for someone with the very same problem, found an order, and said something to the doctor like "well, other doctors have ..........giving him a hint. Then he gave me an order after thinking about it and thanked me. I was scared when I got off the phone! After I calmed down, I realized that the doctor just needed some thinking time and if I had not been able to give him a hint, I would have told him so. He was still the one responsible for giving the order.