Why do I feel like I'm doping my patients?

  1. I don't know if this is just where I'm doing my clinicals or if other students and nurses have noticed this but does anyone feel like they end up "doping" their patients when they come on because the previous nurses haven't given them anything? I got a patient the other day and she had nausea, pain, fever, the works, she was complaining, vomitting and in pain. I looked at the medex and she was getting regular medication for the stuff on schedule, but she also had a bunch of PRN meds ordered. She had Zofran for nausea, morphine and pecocet for pain and tylenol for fever, and all the spaces next to them were blank. No one had ever given her any of her PRN meds, so I gave them to her. I felt like I was doping her up though. This isn't the first time this has happened. Is there a reason nurses don't give patients all their PRN meds? Has anyone else experienced this?
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  2. 15 Comments

  3. by   fergus51
    This is my absolute pet peeve in nursing. I don't know why people won't give the PRN early since that usually decreases the need for them. If you wait till a patient has spent hours in pain you will have to give them more analgesia. They will probably go to sleep soon after, but that isn't because you are doping them, it's because they are exhausted from being in pain.
  4. by   babynurselsa
    Mikey,
    You acted to alleviate your patients symptoms. Do not feel bad about responding to your patients needs.
    We can only hope that up until this point that she had not been vomiting and without pain.
    I have too often encountered the same thing and it chaps my hide. I have said it before and I will say it again. If this was your mom or wife or sister would you not make sure that they recieved tx for their pain and vomiting????
    Just because the last person did not medicate this patient should not make you question yourself for medicating the problems that you see or are reported to you by said patient.
    Would you question yourself because you performed and documented peri-care on a patient because the last shift didn't? Would you say "Well they didn't void or poop on the last shift so I guess I don't need to check on this either." Of course not, or at least I hope not.
    Hang in there, treating symptoms as they are presented to you is never wrong regardless of what the last shift did or did not do.
  5. by   sharann
    Chart what you find then treat the symptoms as needed. You are not doping the patient(that word invokes a negative feeling to me), you a medicating to relieve pain and nausea. This is not to say that it excuses poor nursing assessment on the previous shift. As a student you can only do so much. When you are on your own you can spot chroniclly poor care and then take the issue up with management.As I said, just document how you found the patient so if anyone questions you you have your strong assesments to back you!
  6. by   mstigerlily
    This makes me sad when I see this. When I first assess them I ask them about allergies, reactions to medications, what they have been taking for pain/nausea, if they want to call me to ask for them or if they want me to bring them when they are due or wait till they call me or if they want to be woken through the night for them even if sleeping (some say yes), if new patient - if the pain meds make them nauseous and have they had them before? Then every time I enter the room (which is supposed to be at least every four hours to do pain assessments/check on mom/baby), I always ask if they are in pain, how they are feeling otherwise, do they need anything for pain? Not even a Motrin?

    I've come on shift and seen they've had nothing for pain all day and when I've done my initial assessment been told, "No one asked me all day if I needed anything" or worse "I asked but no one came" or "I asked for 2 percocets that you gave me last night that worked great and they brought me a Motrin instead"! Also, if they have gotten nauseous/vomited or state they have nausea/vomiting from the oral meds I like to give the nausea medication as ordered prophylactically with the pain meds and time them just right so they can be given with them throughout the shift so the pt is free of pain and nausea.

    It's much harder to get on top of their pain when it's already gotten bad and of course it sucks to have be nauseous and vomiting BEFORE you get the nausea medication. I like my patients to be as comfortable as possible.


    Quote from MikeyBSN
    I don't know if this is just where I'm doing my clinicals or if other students and nurses have noticed this but does anyone feel like they end up "doping" their patients when they come on because the previous nurses haven't given them anything? I got a patient the other day and she had nausea, pain, fever, the works, she was complaining, vomitting and in pain. I looked at the medex and she was getting regular medication for the stuff on schedule, but she also had a bunch of PRN meds ordered. She had Zofran for nausea, morphine and pecocet for pain and tylenol for fever, and all the spaces next to them were blank. No one had ever given her any of her PRN meds, so I gave them to her. I felt like I was doping her up though. This isn't the first time this has happened. Is there a reason nurses don't give patients all their PRN meds? Has anyone else experienced this?
    Last edit by mstigerlily on Nov 8, '05
  7. by   Gompers
    I think I'm guilty of this. I work with babies, and you can't always tell what's bothering them. But it bugs me when I come on to care for a baby that had a circumcision or hernia repair (pretty minor NICU stuff) the day before, and the nurse before me says, "Yeah, he really didn't seem to need Tylenol or anything, so I didn't give it." Heck, the poor kid had a scalpel to him yesterday!!! Like you get some badge of honor for not needing to give the pain meds? I say load 'em up and make them feel better!!! So I always give PRNs, pretty much as often as ordered, just because I know that if that poor baby goes a whole day with NOTHING, maybe then he'll get so uncomfortable that one little dose of baby Tylenol won't touch his pain later on.

    Same thing with sedation meds. I'm a big fan of them. It's not that I want my patient to sleep all night and not "bother" me - not that at all. It's just that I want them to have some uninterrupted, restful sleep, because that's when all the best growing and healing occurs.
  8. by   Bipley
    In my experience this happens more with terminal patients than with others unless we are talking an exceedingly lazy nurse. Some nurses are fried and they just don't care anymore. But when it is a terminal patient, that makes me more angry than anything else. I've been known to call the previous nurse at home and ask what time the TERMINAL patient got their pain meds?

    I have an attitude when it comes to this topic and I'm proud of it.
  9. by   bluestar
    Quote from fergus51
    This is my absolute pet peeve in nursing. I don't know why people won't give the PRN early since that usually decreases the need for them. If you wait till a patient has spent hours in pain you will have to give them more analgesia. They will probably go to sleep soon after, but that isn't because you are doping them, it's because they are exhausted from being in pain.
    I agree. Well said.
  10. by   SteveNNP
    NICU nurse here.....My peeve is when I come on at 645pm and my patient on a vent hasn't had morphine/versed all afternoon because "he wasn't moving" or "his pressure was a little low" PLUS versed does nothing for pain....you have to give a narcotic for pain! If I was on a vent, I'd want prn drugs every hour! well, that's my rant. I am known affectionately as the "drug king" on my floor, because if my pts haven't been medicated within the last 2 hours, they all get the morphine/versed cocktail, or whatever's ordered as soon as report's over. That way by 730-8pm they are nice and calm, and I can assess them without them crashing and burning. The RT's also like the pt's snowed, so their blood gases look better, their spo2 is more stable, and there is less risk of complications in a baby who is calm, as opposed to fighting the vent. Well, that's my 2 cents. PRN drugs are there for a reason, and most people have the sense to use them when they are needed.
  11. by   txspadequeenRN
    I agree!!! I handle meds for alot of hospice patients and it burns me when I walk into report and hear the patient has been pain free all night then I go into the room and he has increased SOB, grimicing and facial frowning. LAWD , I spend all day getting the patient comfortable again.. Which is not my complaint but if the patient had been medicated properly it would have saved the patient alot of undue pain and anxiety.




    Quote from Bipley
    In my experience this happens more with terminal patients than with others unless we are talking an exceedingly lazy nurse. Some nurses are fried and they just don't care anymore. But when it is a terminal patient, that makes me more angry than anything else. I've been known to call the previous nurse at home and ask what time the TERMINAL patient got their pain meds?

    I have an attitude when it comes to this topic and I'm proud of it.
  12. by   babynurselsa
    Yes Steve, I have walked in on a baby on an oscillator who is pavulonized. I see hat the baby had not recieved any morphine for 2 DAYS!?!?!?!
    WHen I asked why the nurse said, "Well he wasn't moving around or grimacing."
    *****?!?! This brain child thought that pavualon would provide sedation or analgesia. We had a little heart to heart about looking up the freaking meds if you haven't given them before or don't know whst they do. DUH.
  13. by   Bipley
    Quote from SteveRN21
    NICU nurse here.....My peeve is when I come on at 645pm and my patient on a vent hasn't had morphine/versed all afternoon because "he wasn't moving" or "his pressure was a little low" PLUS versed does nothing for pain....you have to give a narcotic for pain! If I was on a vent, I'd want prn drugs every hour! well, that's my rant. I am known affectionately as the "drug king" on my floor, because if my pts haven't been medicated within the last 2 hours, they all get the morphine/versed cocktail, or whatever's ordered as soon as report's over. That way by 730-8pm they are nice and calm, and I can assess them without them crashing and burning. The RT's also like the pt's snowed, so their blood gases look better, their spo2 is more stable, and there is less risk of complications in a baby who is calm, as opposed to fighting the vent. Well, that's my 2 cents. PRN drugs are there for a reason, and most people have the sense to use them when they are needed.
    Fantastic post! Just thought it deserved repeating!
  14. by   Bipley
    Quote from txspadequeen921
    I agree!!! I handle meds for alot of hospice patients and it burns me when I walk into report and hear the patient has been pain free all night then I go into the room and he has increased SOB, grimicing and facial frowning. LAWD , I spend all day getting the patient comfortable again.. Which is not my complaint but if the patient had been medicated properly it would have saved the patient alot of undue pain and anxiety.
    I have to post one of those "personal experience" stories. It just explains my point well.

    My Dad had terminal colon CA, he died 4/26/05. When I flew home to say my good bye's I knew it was the last time we would *really* be able to talk but honestly, I didn't think I was going to be attending a funeral as well.

    I got home and I found my Dad suffering. His vitals showed extreme pain, he was moaning and groaning, he was obviously hurting. His meds were typical, some PRNs, some other stuff, and Oxy's 20mg q8h. Nobody could figure out why he was in so much pain with all the Oxy's and prn Vicoden. He was vomiting about 30cc of blood every 10 minutes or so. Gee, I wonder why those pain meds weren't working??? Grrrrrrrrrr

    I had to beg, plead, and fight for an order for Duragesic. You know how long it takes for those to kick in, it isn't like IV Morphine where they are better after a few minutes. He was really hurting.

    I called and requested a Fentanyl drip, PCA, anything. They said no, his pain was managed with Oxy's. I explained, it did no good.

    Do you know I actually thought about crushing some Oxy's and blowing them up his nose? I just wasn't sure how to get it up there to be really honest.

    Why should a terminally ill CA pt on hospice be in pain due to stupidity?

    I put his 100mcg Duragesic patch on his arm and heated it up with a blow dryer. He looked at me like I was nuts but you know what? It worked.

    Then he died a couple of hours later. My poor Dad, I will never forget the pain he was in. That image is burned into my brain for the rest of my days. I can't imagine the pain he experienced.

    I think I had this weird belief that I don't know where it came from. If we really work hard and take care of our patients, the world pays us back by taking care of us and our own when it is our time. I don't think I realized I had that line of thinking until my Dad died. Then I realized that this line of thinking? Total crap.

    People die in pain and there is no reason for that. It's due to stupidity and lazy staff and nothing more.

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