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.
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.
However, if the patient is taking the prn med frequently then it defeats the purpose of a prn and needs to be changed to regular dosing. An additional prn can also be ordered for breakthrough, etc. Orders can always be changed so if the patient no longer needs the regular dosing, just have it dc'd.
Pain management is a continuous process which should be addressed by every nurse qshift or more frequently if required and pain mapping is a useful assessment tool when pt's pain in poorly controlled - it is every nurse's responsibility to advocate for proper pain control and follow-up.
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
This explains a lot about the kind of nurse you'll be:) Like I said come back here once you are done with Nursing school and explain to me exactly how you would handle this situation. As for now, am not going to listen to ivory tower nursing:D
That's not true or I hope you meant to say statistics show African Americans and red heads have LOW TOLERANCE for pain.
What my nursing text says is not that they have a low tolerance for pain but that pain meds are not as effective on them especially on redheads.....the book is Brunner and Suddarth's Textbook of Medical and Surgical nursing 12th edition, Lippincott Williams and Wilkins
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.
Needing another dose of Vicoden every 4 hours does not mean it's not working, that's exactly how it's supposed to work.
However, if the patient is taking the prn med frequently then it defeats the purpose of a prn and needs to be changed to regular dosing. An additional prn can also be ordered for breakthrough, etc. Orders can always be changed so if the patient no longer needs the regular dosing, just have it dc'd.
Pain management is a continuous process which should be addressed by every nurse qshift or more frequently if required and pain mapping is a useful assessment tool when pt's pain in poorly controlled - it is every nurse's responsibility to advocate for proper pain control and follow-up.
The purpose of a PRN is for it to be used in the presence of certain circumstances and not to be used when those circumstances don't exist. Calling a doc to get the order changed to scheduled, when having it prn poses no barriers and allows for necessary flexibility, and then calling him back later in the day to ask if we can hold the scheduled dose or move it back an hour (since it is now scheduled) as the pt's pain is controlled at the time the scheduled dose is due is why MD's get annoyed with Nurses.
Needing another dose of Vicoden every 4 hours does not mean it's not working, that's exactly how it's supposed to work.
Vicodin...Not Vicoden jeez!
MunoRN if vicodin is supposed to work that way, how then do you explain scenarios where it's ordered every 6 hours? Do call doctors to change the order explaining to them that it doesn't work like that? Pain management is subjective and unique for each patients. And yes there are patients that abuse pain medicine, you as a nurse should be able to use your critical thinking skills to identify this and teach them. Please don't take this to mean I don't give my patients pain meds, I do, am just extra careful and I hate creating drug seekers:nurse: Pharmacology is not the only pain relief method:)
What my nursing text says is not that they have a low tolerance for pain but that pain meds are not as effective on them especially on redheads.....the book is Brunner and Suddarth's Textbook of Medical and Surgical nursing 12th edition, Lippincott Williams and Wilkins
Pain meds are not effective on them because they have LOW pain threshold. It's something genetic. I know because this was my research paper 3 and a half years ago on my final semester of my BSN.
I think I now understand what you meant. They are are not properly medicated because doctors forget that pain meds are not effective on them so they end up being undermedicated.
MunoRN if vicodin is supposed to work that way, how then do you explain scenarios where it's ordered every 6 hours? Do call doctors to change the order explaining to them that it doesn't work like that? Pain management is subjective and unique for each patients. And yes there are patients that abuse pain medicine, you as a nurse should be able to use your critical thinking skills to identify this and teach them. Please don't take this to mean I don't give my patients pain meds, I do, am just extra careful and I hate creating drug seekers:nurse: Pharmacology is not the only pain relief method:)
q 6 hour dosing of Vicodin is not unusual, but it's based on the APAP component of typical Vicodin formulations (usually 500mg), not on the effective duration of the drug. Vicodin ordered as up to 2 tabs q 4 hrs would exceed the recommended 4 Gram/24 hr limit of APAP, which is why you'll sometimes see it ordered as q 6hrs, some Docs will instead write q 4hrs, NTE 8 tabs/24 hours. If the patient is requiring every available dose, the Doc will often write for a plain PO narcotic to be available as well in case the 24hr limit is reached and pain control is still needed. The best solution, and what most hospitals have moved to, is replacing Vicodin with Norco (typically 325mg APAP), so that the effectiveness duration and the APAP limit don't conflict.
I think we all agree that narcotics should not be the primary method pain control, and yes some patients abuse narcotics. But even if needing additional doses of vicodin q 4hrs were by itself an indicator of abuse, it's not our place to be stingy with it because we are suspicious. We can notify the MD of our concerns and they can then make the pain requirements more stringent, add activity level parameters, alter the timing, change it to a pseudo narcotic such as tramadol, or D/C it all together.
Pain meds are not effective on them because they have LOW pain threshold. It's something genetic. I know because this was my research paper 3 and a half years ago on my final semester of my BSN.
I think I now understand what you meant. They are are not properly medicated because doctors forget that pain meds are not effective on them so they end up being undermedicated.
You missed the point...boy, did you miss the point.
The point of most of this discussion is not withholding PRN medications, but giving them around the clock ONLY because a patient ASKS for them around the clock and not re-assessing pain, whether they are in pain or not.
That is not how PRN pain medications are supposed to be administered....in school on an exam or in the real world of nursing.
nope,YOU missed the point......this thread is NOT about giving without assessing..
I don't know any experience nurse who would awaken a pt to ask them they needed a prn. We do NOT give prns w/o a pain scale assessment, so it isnt as though we could even admin something IV. I also do not ask pts if they want a prn, nor would I honor such a request as the OP. I would routinely visit the pt and inquire about pain. If at hour 4 he doesn't want anything he may actually have to make the effort at hour 5 to (gasp) press call bell. The OP struck me as unreasonable, entitled and likely abusing narcotics. At the very least, she completely misunderstands medication ores and the role of the professional nurse.
Belle Epoque
156 Posts
However, if the patient is taking the prn med frequently then it defeats the purpose of a prn and needs to be changed to regular dosing. An additional prn can also be ordered for breakthrough, etc. Orders can always be changed so if the patient no longer needs the regular dosing, just have it dc'd.
Pain management is a continuous process which should be addressed by every nurse qshift or more frequently if required and pain mapping is a useful assessment tool when pt's pain in poorly controlled - it is every nurse's responsibility to advocate for proper pain control and follow-up.