Young patient. Allergies: Compazine, Reglan, Zofran, NSAIDs, Haldol
Patient "fired" me because I wouldn't push his Dilaudid 1.5mg & Benadryl 50mg (both IVP) together. I told him I would give his Benadryl 30 min. apart. He literally yelled, "they always give it to me together". When asked what he took the Benadryl for he told me for "reactions" to Dilaudid & he was gonna bleed from itching if I didn't get it to him at. the. same. time. First of all, he get's Dilaudid Q2h & Benadryl Q4. Weird how he doesn't bleed the times he gets Dilaudid without the Benadryl. He also gets Phenergan IM Q4h.
I tried explaining my reasoning but he wanted to talk to my CN. She went in....w/ Benadryl. She totally understood my reasoning but in the end he got what he wanted. He got a new nurse & was happy because she gave him everything he wanted. These patients are so frustrating. They act like the hospital gives them an excuse to act like a child throwing a tantrum when they don't get what they want. I'm not there to give him everything he asks for....if it's not safe! Sure, he may have a high tolerance but it's my license on the line & I don't want to be the exception if something bad actually happened to him!
And because these nurses are giving in to "shut him up"...it makes it worse on the next nurse!!! Ugh...
Specializes in ED, Long-term care, MDS, doctor's office.
If this is someone who has chronic pain, these meds can compliment each other therefore making the effect more desirable. I have also given benadryl prior to medications to prevent itching (with md order and documented side effect & not true allergic reaction). But, it is your license you are working on & ultimately you should always do what is within your comfort level..
Something is really missing here. Has this patient been getting Dilaudid and benadryl together for some period of time? Several days or even more than that? Is he a frequent flyer who has been getting this combination every time he is admitted for the past few months or years?
If the answer is yes then obviously his body has a tolerance for this combination.
I have given patients overdoses of pain medications, amounts any prudent book would say to never give. They have not even gotten drowsy because they were chronic pain patients used to these massive doses.
Sometimes the patient knows his body, pain lever, and drugs, better than the nurse.
If the dilaudid makes him itch that badly I would have refused that and gotten an order for another pain med....problems solved!
The patient is obviously a frequent flyer that knows the combination gives him a better high. I'm doubting he is allergic to all the other meds he says he is.. He is a manipulator trying to get the best high he can. Kudos to the nurse for recognizing that and not allowing it to happen!
I have given patients overdoses of pain medications, amounts any prudent book would say to never give. They have not even gotten drowsy because they were chronic pain patients used to these massive doses.
and that would be your nsg judgment to use.
i'm sure op had her rationales in using her judgment as she did.
You did right. I guard my license like it's GOLD. If the CN wants to give in 2 a pt, that's her priority. And it does make it harder for the next nurse. This is why I despair of nursing, no team work, no thinking along the same lines, no accountability from patients for their behaviour.
Yes, I agree, he sounds like a manipulating abuser. However unless you are working in a drug rehab center a nurse has no business judging the patient nor trying to cure his addiction.
I completely agree with the OP and Leslie. Reminds me of a patient I had as a new grad on an ortho neuro floor (still behooves me that they hired me as a new LPN) at this hospital. He was a vet and I was sure his pain scale was out there, but he was giving me and the other nurses "his orders" complete with drug, dosage and time. He knew meds alright from many stays prior. He wanted all of our names and informed us of the attorney he would be contacting in the am. He wanted to sue us all. I was managing his dilaudid PCA pump that night, and after describing exactly how this contraption works in combo with his other ordered meds and the time intervals and that I had a "comanding officer" in charge of what and how I give him his pain meds he softened up. But by all means, I would have thought and done exactly as the OP did.
Dilaudid, Benadryl and Phenergan......hummm let me see and allergic to NSAIDS???
I refuse to give anyone dilaudid, benedryl and zofran all at once. I tell the pt that I am not there to snow them, just to make them comfortable and I have to keep them safe and off the floor .
We will not change the drug seekers. They have crazy high tolerances and usually they can handle it. It is about them, not us. New nurses often have trouble giving this kind of cocktail because it is not enhancing well-being. It is obviously perpetuating addiction. Yet, it is about the patient. Not us. She could have called the doc and asked if it was OK per order to administer this way. She could have documented the physician's response clearly, and administered per physicians orders. Period. Or, as I would have done; just gave it to him. It is not worth it. No addict will rehabilitate until he is darn good and ready. Nothing we do or don't do will change their childish behaviors. Don't waste your spirit on these ones, unless you have a gem of truth or experience to impart to them which may make them reflect upon their poor behavior. This kind of patient will never stop being admitted even if their chest pain is bogus. We have to be impartial and non-judgmental. But I DO get the rant. I have the rant too. Blessings.
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montecarlo64, BSN
145 Posts
If this is someone who has chronic pain, these meds can compliment each other therefore making the effect more desirable. I have also given benadryl prior to medications to prevent itching (with md order and documented side effect & not true allergic reaction). But, it is your license you are working on & ultimately you should always do what is within your comfort level..