Question about PRN administration

NurseCubanitaRN2b, BSN, RN · Aug 16, 2009

That's a good question and I wish I had an answer to it. But what I've seen nurses do is that they will try one to see if it works. If it doesn't work then they will try the other. Personally I'd rather give Ativan than Seroquil because from what I've notices, patients on seroquil seem to have more side effects of the medication than ativan. But that's just from my personal experience, maybe another nurse has a different experience. I've never seen a nurse give two medications for the samething at the sametime.

essential · Aug 16, 2009

Thanks for the reply. Yes, I agree that one medication should be given first to see if it works then if it dose not, another one should be tried.

This particular pt asks for both PRNs everyday at almost same time. Dr's order dose not say anything other than how often each med should be given.

I was not sure if I could refuse to give her one of PRNs at the same time even pt request. Of course I could ask DR about this.

sasha2lady · Aug 24, 2009

I dont do 2 at the same time. I try a before b. Now...what I have seen done is say....a nurse gives ativan and tylenol at the same time.....something like that. Ive done that myself...but if it was say...xanax and ativan.....no...I wont do it. What I had trouble with was stuff like....ok..say the pt is on scheduled ativan @ 9 am 2 pm and 9 pm.....with a prn thats q 4.....if they are acting up at 4 pm and obviously need that prn ......when would be a good time to give it? If they had something at 2 ..i try to hold off til at least 430 or 5 if i can. Just depends on the pt and the situation.

essential · Aug 24, 2009

Thanks for your input, sasha2lady. What I understood from you and previous poster is, I need to use critical thinking, gain knowledge and more experience!

saintplatypus · Aug 27, 2009

First of all, I have never seen Seroquel as a prn. but I reckon it could be. Seroquel is an antidepressant and is usually a routine medication. Ativan is a benzodiapine used for anxiety, seizures, and shortness of breath. The two could be administered safely together, however your patient may experience drowsiness as possible side effect. Usually with prn medication I give one, and assess it's effectiveness in about an hour. If the patient states it hasn't provided relief, I usually wait another hour an assess again. If still no relief I may give a second prn medication. I like using this method because there is a lesser chance of an adverse effect occuring, and it's possible relief could be accomplished with the first medication. But there are always exceptions, and when the patient makes a request it is often difficult to not comply because they want what they want, even if you have educated them as to why it's contraindicated. So use your best judgement, and if you make a bad decision, learn from it. And trust me we all have made mistakes and bad choices.

Good Luck

JCLVN67 · Aug 28, 2009

Seroquel is not an antidepressant, it's an antipsychotic and is used as a mood stabilizer in mania. I have had a few patients who have had it as a prn, but they usually take it scheduled as well. I usually don't give 2 prns at the same time for the same reason unless the Dr's order expessly states that to be acceptable. I have given 3 prns together for the same reason for extreme agressive behavior, but the the orders for Haldol 10mg IM, Ativan 2mg IM and Benadryl 50mg IM all stated that they may be given together. Hope this helps.

loriangel14, RN · Sep 1, 2009

I see a lot of pts with PRN orders for Haldol and Ativan and we give them together but usually we have already established that they work best if given together. Sometimes there is an order for "the cocktail", 2 mg of Haldol and 1 mg of Ativan drawn up together.

Seroquel PRN is very common where I work and used in tandem with PRN Ativan.

essential · Sep 1, 2009

So PRN Ativan and Seroquel could be used at the same time...but someplaces and some people never do it.....

Since I have NO experience, I just worried about anything.

I feel that very often the orders are not specific and I think too much, maybe.

For example, a pt has scheduled percocet 2tabs once daily and PRN orders of percocet 1 tab and 2 tabs q6 for each. Pt complains about pain after she got the scheduled meds. Should I wait 6 hour for PRN?

Also, how can I decide to give her 1tab or 2 tabs?

Should I just ask pt?

Thanks for your time for reading this and answering to the question.

NurseCubanitaRN2b, BSN, RN · Sep 1, 2009

I would have a very hard time giving both Ativan & Seroquel at the sametime. That's because I've seen the side effects of seroquel and it seems to really affect them pretty bad. Even though ones an antianxiety and the other is antipsychotic. But that's just me since I'm new as a LVN. I'm more cautious.

Regarding percocet, that's a pretty strong drug as you know. I would wait before giving the PRN medication after the scheduled one because you have to give it time to settle into the system. There are several dosages of percocet you have the 2.5/325, 5/325, 7.5/500, & 10/650. So it all depends on which dosage we're looking at.

essential · Sep 1, 2009

Both scheduled & PRNs are 5/325.