In the analgesia directive, along with the nausea/vomiting directive is has “unaltered” as a condition. Is this written for the acutely altered patient who has a TBI for example? If we have a patient with a baseline GCS of let’s say 13-14 with dementia who presents with pain and/or N/V but no decrease in baseline mental status, is a patch required, or are they considered unaltered from baseline?