Hypothetical Question re: prn meds

  1. I don't know how the subject came up but here's the scenario:

    Dr. orders 1-2 mg. Dilaudid IV q4h.

    Pt doesn't usually ask for pain meds, rates pain low. You give 1 mg.

    In only one hour, Pt reports no relief.

    Do you give the other 1 mg? or do you make the Pt wait?
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  2. 25 Comments

  3. by   sunnygirl272
    OOOhh...that's a toughie....will await replies....
    i would want to give the other 1mg....but dunno if that flies......maybe call the md? we know they love it when we call them....
  4. by   AmAnRN
    i have been taught to give the other half of the dose if no relief. cuz if u call the m.d. after only giving the 1mg, wouldnt you think he/she would say, "well why didnt you go ahead and give the other half??" just my 2 cents.
  5. by   Sleepyeyes
    But then, doesn't the problem become when to give the next dose?

    I mean, suppose you go ahead and give it. Then the next dose for the full 2 mg has to be 4 hours from the 2nd mg instead of 4 hours from the first mg.

    Either way, it seems the pt has to wait.

    Maybe I'm getting this wrong?
  6. by   gwenith
    I would give the other half.

    When I had to write a competency for drug administration I included administration of PRN medications as I feel this is the essence of medicaiton administration and much more demanding than following the 5 or 6 "R"s of correct administration.

    In administering PRN medicaiton the nurse must first accurately assess the need and required dose, administer and then evaluate the effectiveness of the dose. When viewed this way it is obvious that this skill requiers a higher cognitive ability than dispensing and yet it is rarely assessed.
  7. by   Sleepyeyes
    OK, so here's what I have:

    2pm: 1 mg Dilaudid given for 4/10 pain
    3 pm: pt reports no relief
    3 pm: pt given 1 mg Dilaudid

    and the next dose would be at 7 pm--with the pt having only a total of 2 mg of med on board for only 3 hours out of 5?
    Last edit by Sleepyeyes on Apr 12, '03
  8. by   Sleepyeyes
    sorry i look so stupid in this issue, but i really have forgotten. i usually give the entire dose unless the pt doesn't want the whole thing, and they usually don't change their mind.

    so please, this is a serious question.
  9. by   KC CHICK
    You're making this too hard.
    Why not just give the next 2mg at 1830 and call it even?
    I have one question though....how come it took an entire hour to assess that the IV med wasn't effective enough? You should be able to get that info in the first 10-15 minutes after IV administration. I could understand waiting an hour for a PO med, but IV??? It doesn't take that long to get in the system and work.

    This patient could then have been given the other 1mg of pain med a max of 15 minutes after the first dose
    ............. and this question about med timing never would have been an issue.

    Anne
    Last edit by KC CHICK on Apr 12, '03
  10. by   ShandyLynnRN
    Originally posted by Sleepyeyes
    OK, so here's what I have:

    2pm: 1 mg Dilaudid given for 4/10 pain
    3 pm: pt reports no relief
    3 pm: pt given 1 mg Dilaudid

    and the next dose would be at 7 pm--with the pt having only a total of 2 mg of med on board for only 3 hours out of 5?
    That's what I do. Then, if I find that the second dose helps, I will give the full 2 mg when it is due again. If the patient is hurting before the four hours is up, then I might give the next dose 30 min early since we have 30 min before and after meds before it is an error. ---OR----I might give 1 mg, and then TWO hours later give the other 1 mg, and get them on a 2 hour schedule if that works better for them, and they are still only getting 2 mg every four hours.
  11. by   Sleepyeyes
    Thanks very much for the input, I'll remember it.
  12. by   bklynborn
    I agree with KC CHICK..........assessment of effect is done sooner with IV meds.............10 to 15 minutes IV, 30 minutes for IM and 1 hour for PO.................
  13. by   eldernurse
    Shandy Lynn has the right idea. Our hospital actually has a policy about that. It has guidelines. I hate it when a physician writes an unclear order to give 1 or 2. It feels like I am prescribing.
    This is one of the reasons I love the ER. There is always someone (MD) to ask, and clarify.
  14. by   ShandyLynnRN
    Originally posted by bklynborn
    I agree with KC CHICK..........assessment of effect is done sooner with IV meds.............10 to 15 minutes IV, 30 minutes for IM and 1 hour for PO.................
    Oh yeah, I was gonna add that too. Then you wouldn't have to worry about the whole timing thing.

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