okay, this could be a stupid question/story, but my degree is not in nursing - i start this summer
so, when i was in the hospital after a c-section (with my 2nd child) and my son was in NICU - i was prescribed to lortabs (2 every four hours). since i was staying in the hospital, i didn't have to go out and get a prescription - the nurse brought it to me...while i was there.
when i had my first child, i was released from the hospital the next day after my c-section - went to the pharmacy, and took MAYBE 5 or 6 pills once i was home. the rest stayed in my med. cabinet.
but with my 2nd child being in NICU and me being stuck at the hospital without being able to breastfeed, hold him, and do all the things new mothers usually do - i was a nervous wreck and stir crazy - wanting to walk to see him, wanting to walk to the ice machine, wanting to put on make up, wanting to go develop pictures - wanting to do ANYTHING besides sit in the hospital bed without my baby!
point being - since i was doing so much running around, i actually needed the pain meds this time. so, after about 6-7 hours without, i asked the nurse if i could have some and she was nice and brought them to me. i suspected that she'd bring me some 4-5 hours later. when she didn't, i asked again. she brought them to me. i asked if they could just bring them to me when they had the chance (around the time i was prescribed) because i would be needing them and i didn't want to bother them - and she said no, and that i had to ask for them. i felt like a drug addict begging for meds every 4-5 hours! i hated it. and after a few times of asking, i felt like THEY were treating me like one!
why do you have to ASK for pain meds in the hospital when they're prescribed after surgery? i'm sure there's a reason - it just made no sense at the time.
I dont think there is anything wrong with giving PRN pain meds continuously if they are in pain.
If a patient is continuously requesting PRNs for pain, a critical thinker would realize that there is likely an underlying problem that needs to be addressed. The patient requires reassessment by the nurse and/or MD instead of just a blind "OK, here's your PRN." I'm not saying not to give the PRN, but one also has to tackle the underlying issues as well.
If your in pain someday i hope some opinionated nurse witholds some meds from you
wait until you become a nurse and you will see the "real world" nursing as opposed to school textbook nursing. and if you work in ltc or snf, good luck giving all the prn pain meds "continuously" to 25+ patients.
or better yet, have two sickle cell pts in addition to a dka pt and then come back and tell us how you gave the sickle cell pts their dilaudid around the clock. this in addition to titrating fluids for the dka pt and doing q 1 hour finger sticks.
I dont think there is anything wrong with giving PRN pain meds continuously if they are in pain. If your in pain someday i hope some opinionated nurse witholds some meds from you
I seriously hope you were joking with this comment. As as student, you simply don't know what you don't know! I surely hope you use your CRITICAL THINKING skills in the real world once you become an nurse.
You should be assessing a pt's pain level prior to giving a pain med and one hour after administration. If a pt is STILL complaining of 10/10 pain, then I would hope you would call the doctor and ask for another type of pain med or have the PRN med change to a schedule med. I will not be just "continuously" giving out pain meds WITHOUT assessing the pt's pain needs.
And tell me how you would "continuously" give out pain meds to two sickle cell pts, while dealing with a crashing patient, on top of getting a new admit? I really want to know......
whats wrong with communication? I guess if it was me, I would assess the pt as required after an hour to see the effect of the med. then i would reassure the pt that if this is not working, to please use the call light and let me know,. I reassure the pt that I want them to call me. If in our conversation/ communication I am seeing that the pt is having lots of post op pain, of course i will be on it to see them around the time for the next prn.
Each pt is an individual. If one is noticing that prn's are being used often, then maybe pt needs to be reassessed if that is not an expected outcome. key word- communication- talk with your pt !
I seriously hope you were joking with this comment. As as student, you simply don't know what you don't know! I surely hope you use your CRITICAL THINKING skills in the real world once you become an nurse.
You should be assessing a pt's pain level prior to giving a pain med and one hour after administration. If a pt is STILL complaining of 10/10 pain, then I would hope you would call the doctor and ask for another type of pain med or have the PRN med change to a schedule med. I will not be just "continuously" giving out pain meds WITHOUT assessing the pt's pain needs.
And tell me how you would "continuously" give out pain meds to two sickle cell pts, while dealing with a crashing patient, on top of getting a new admit? I really want to know......
And this is in a hospital setting.
By continuously he was referring to q 4hrs or whatever the ordered parameters are, not every 5 minutes. I don't think anyone is arguing that a pain assessment is not required, which includes identifying concerning factors such as a change in pain control needs or an unidentified cause of pain. I don't agree that changing the order to scheduled is the best way to address this situation since if they don't need the pain med they shouldn't be given it, which is the flexibility that prn allows.
If you're busy, ask your NTL or another nurse for help.
By continuously he was referring to q 4hrs or whatever the ordered parameters are, not every 5 minutes. I don't think anyone is arguing that a pain assessment is not required, which includes identifying concerning factors such as a change in pain control needs or an unidentified cause of pain. I don't agree that changing the order to scheduled is the best way to address this situation since if they don't need the pain med they shouldn't be given it, which is the flexibility that prn allows.
If you're busy, ask your NTL or another nurse for help.
Where I work, we don't have nurse team leaders (weekends alt program), nor do we have techs or CNA's. Alot of times we are fully staffed 4 nurses for 12 pts, but sometimes we are short staffed.
What I described is a real life situation I was recently in when I worked the stepdown unit. And the other nurses are busy with their own heavy pt loads.
And there was a time when I had a chest pain pt stating Morphine was not working for him (PRN q 3 hours), so I called to get the dosage changed. That still didnt help. So I called and got it changed to Fentanyl and that seemed to control his pain. And it still was a PRN order, but he didnt call out as much as he did when he had Morphine ordered.
In MY nursing judgment, if a certain PRN med is not working, I'm getting to the bottom of it. Either I'm going to ask for change in dosage or a change in med all together. I have noticied once the PRN med has been changed, some pts states their pain has been controlled and they don't "need" it as often. I let them know the PRN order is still there just in case.
nope, that is NOT what prn means, it means as needed....that means the nurse gets their butt into the patients room on or about the time it could be given and ASSESSES the patients pain and decides if it is needed.
Even a fresh post op HAS to be re-assessed before giving PRN pain meds! Key word is PRN. It's a totally different story if it was ordered routine every 4 hours.
Are you purposefully misreading my posts? At no time have i said, and actually quite the contrary, that you dont assess, but blindly give. In fact my first post to this thread was about ASSESSING the patient! Assessing for pain is a BIG part of post op care, what part of that is so hard for so many of you to understand?
I feel sorry for your patients. You must put them through extra ******** that is totally unneeded. Just give them their damn medication when they ask for it, you clearly cant think critically past that.
I will not "JUST GIVE" them the "damn" pain medicine when needed. I will REASSESS!!! That is critical thinking!!!Sorry if that hurts YOUR feelings but MY patients are happy!!! So you think with less than one year of nursing experience you already have it with critical thinking?
Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
If a patient is continuously requesting PRNs for pain, a critical thinker would realize that there is likely an underlying problem that needs to be addressed. The patient requires reassessment by the nurse and/or MD instead of just a blind "OK, here's your PRN." I'm not saying not to give the PRN, but one also has to tackle the underlying issues as well.
That sentence speaks volumes...