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 M/S, Tele, Sub (stepdown), Hospice.
The OP never said anything about not feeling safe. In fact, she never gave her rationale for pushing the Benedryl 30m after the Dilaudid. Are there factual reasons for giving the two meds separately [e.g. the patient snows out when the two are pushed together or she has concerns about it affecting his respiration], OP?
I should have been clear, I didn't give the Dilaudid w/ the Benadryl because I didn't feel it was safe (my OP: I'm not there to give him everything he asks for....if it's not safe!). I only had the patient a total of 1 hour before he fired me so I didn't have time to get to know how he handled the narcs/benadryl. The last time he got the combo together...it was 20 minutes apart. He had only been there for a day & a half so he had not been on this combo for days, weeks, etc.
only op can answer why she gave 30 minutes apart, but if it was r/t above, it was a prudent decision.
leslie
Thank you & yes that's exactly why I don't push the meds together. When I get patients that do have itching w/ narcotics, I usually give the Benadryl before & sometimes at the same time depending on both doses & if they're on oxinet.
Specializes in M/S, Tele, Sub (stepdown), Hospice.
I agree with Leslie and also am thinking that the patient knows he gets an intense allergic reaction from Dilaudid (itches til he bleeds, from scratching I guess). He also knows Benadryl prevents it, it seems. If he doesn't know your rationale, he's just loudly and rudely fighting for his rights.
He wouldn't itch til bleeding on the times in-between doses of Benadryl because it would still be within its effective time frame.
He definitely could have been nicer.
He knew my rationale because I explained it exactly to him but he may not have heard me over his anger & yelling.
Specializes in M/S, Tele, Sub (stepdown), Hospice.
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 wasn't trying to judge or cure his addiciton. My mother was an addict & I know from personal experience you can't help someone that doesn't want help. I wasn't witholding his pain medication. I was practicing safely & wanting to give his medications 30 min apart. He wasn't on oxinet & I had 4 other patients so I couldn't make sure he tolerated that dose safely (he refused oxinet btw). It was also right at beginning of shift when (especially working on a m/s floor) you don't know everything about your patient right then & there. I didn't have time to look back at previous medsheets to see what he was getting & at what times....& even then, I probably would have continued to do the same or at least bargained with him to get him to be on oxinet so we can at least monitor him that way. I just never got the chance.
Specializes in M/S, Tele, Sub (stepdown), Hospice.
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.
I didn't not give the cocktail because it's "not enhancing his well-being"!!!! They're both sedating agents, he was not on oxinet, & I didn't feel safe giving the combo together. Period. I practice that way on all my patients. He was not an exception. We get a lot of patients on our floor with chronic pain & I get that. I will medicate them appropriately, monitor them appropriately. Like I said, he had only been there about a day & a half...not multiple days, weeks, etc.
I could have called the doc but I never got the chance. I was fired an hour into having him. Even if I would have told him I was going to call the doc about getting that specific order, he would have wanted to talk to the CN anyway, I just know it. It was about getting what he wanted right then.
Sorry for all the posts....been working last 2 nights & unable to respond!! Thanks for all the replies & allowing me to vent!!
I didn't not give the cocktail because it's "not enhancing his well-being"!!!! They're both sedating agents, he was not on oxinet, & I didn't feel safe giving the combo together. Period. I practice that way on all my patients. He was not an exception. We get a lot of patients on our floor with chronic pain & I get that. I will medicate them appropriately, monitor them appropriately. Like I said, he had only been there about a day & a half...not multiple days, weeks, etc.
I could have called the doc but I never got the chance. I was fired an hour into having him. Even if I would have told him I was going to call the doc about getting that specific order, he would have wanted to talk to the CN anyway, I just know it. It was about getting what he wanted right then.
Sorry for all the posts....been working last 2 nights & unable to respond!! Thanks for all the replies & allowing me to vent!!
I probably would've done the same thing, or at least told the patient something like "let's wait 15 minutes after the dilaudid and see how you do". I've found that with these patients, often just letting them know that you understand their frustration helps a lot. Then again, there are those charmers who aren't happy with anything less than you moving the sun and moon.
What is oxinet? Some kind of monitoring system? Your pulse ox?
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!
Fortunately it is not your job to diagnose whether or not the patient has a true allergy or not, or whether or not the patient is a "drug seeker". As long as it is safe to do so, nurses have an obligation to BELIEVE the patient's report of pain, as this is the gold standard of pain assessment, and to treat accordingly within MD orders. I find your statements offensive and judgmental- you have no idea where this patient is coming from and whether or not he even gets a "high" from that dose of Dilaudid. Many chronic pain patients lost responsiveness of the SNS to painful stimuli, resulting in a loss of many behaviors that we typically associate with pain.
"Oh my goodness, if you are that sensitive, maybe I had better push the benadryl and THEN after 30 minutes I can give you the dilaudid. This concerns me very much as sensitivities tend to build over time."
Specializes in Oncology; medical specialty website.
There's no reason not to give an IV pain med and Zofran at the same time. Zofran doesn't cause sedation, and it may help with nausea from the narcotic.
You people are extremely judgemental and uncompassionate being a sickle cell patient as well as health professional I can attest to the itching associated with dilaudid and morphine and have scratched in my sleep to the point of drawing blood and it usually doesn't take much to browse through a patient's recent admission people aren't boss that's where judgement congress in and I highly doubt a patient who had never had both would make it up because they wouldn't even know the effect so when it comes to things like this you listen to the patient not give them anything they want but realize they probably know themselves way better than you do
Specializes in ED, Telemetry,Hospice, ICU, Supervisor.
Its about customer satisfaction. You can always flush the line before the next medication. Patients want their drugs/meds.
When I have meth/heroin//etc patients, these guys take way more harsh stuff into their bodies. Dilaudid and benadryl are the least of their concerns.
I give them what they want, who am I to withhold medicaitons because I do not beleieve them. I got them on Q1H BP, continuous Tele SPO2 and Resp monitoring. If they tank I can see it happen in an instant.
HeartsOpenWide, RN
1 Article; 2,889 Posts
Look at it as a gift. He does not have to be your patient anymore.