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.
Could it be bc the drug addicts have a high tolerance? I've known people who have taken narcotics for recreational use and took more on a regular day than I'd ever dream of taking or ever DID take when I have legit pain after surgery. For example, what about someone that takes "OC 80's" - obviously 10mg of lortab or whatever is not going to phase them in NO pain, so it def. wouldn't alleviate real pain. Just wondering.
I'm really curious as to how this is handled.
I'm sure this is the case. But sometimes it gets so frustrating knowing that someone suffering down the hall needs the pain meds so bad but can't have anything yet, but someone, say, post op day 4 still gets the hard core stuff. This is county hospital, I'm not sure if it's like this at every hospital.
I'm sure this is the case. But sometimes it gets so frustrating knowing that someone suffering down the hall needs the pain meds so bad but can't have anything yet, but someone, say, post op day 4 still gets the hard core stuff. This is county hospital, I'm not sure if it's like this at every hospital.
I get your point. It was frustrating for me when my husband had legit pain and was told to take benadryl, yet I told the doctor I was having sharp pains (not constant by any means) and I get some home with a prescription for narcotics I didn't need.
prescriptions usually say "every four hours OR as needed"
QUOTE]
Doctors' orders written in hospitals are not written this way. If so, a pt. could say more was needed in 1 or 2 hours.
Our percocet orders are: Percocet 1-2 tabs, q 4 hours prn. This means a patient can have 1 or 2 tabs, but not less than 4 hours from the last dose.
Thanks. Yeah, the prescriptions I've had that say that were in a bottle from the pharmacy, and I would assume the "or as needed" or even without the "or" meant later rather than sooner. The only time I've taken MORE than prescribed was when I had my wisdom teeth removed. I looked like someone had beaten my face with a bat. I ran out early and was sitting in the parking lot of the surgeon's office feeling like death almost an hour before they opened. I told him I took more than prescribed and the pain of my c-sections was NOTHING compared to that! He didn't seem to think it was a big deal and gave me more (and a different type I assume was stronger).
Thanks. Yeah, the prescriptions I've had that say that were in a bottle from the pharmacy, and I would assume the "or as needed" or even without the "or" meant later rather than sooner.).
Not everybody would assume that, and IMHO, that is why studies such as the one that resulted in taking Darvocet off the market are suspect to me. Are the studies controlled so that they know that no one took more than prescribed or are they just taking the patients' words for that. In 33 years of L & D, Postpartum nursing, I cannot tell you how many times I have caught pts lying about when they last took meds, or how much they took, and when. Maybe they don't remember, maybe they don't think it's important, but many are poor historians.
About 18 monhts ago, our Nurse Manager informed us that we were to give PRN meds AS IF they were regularly scheduled meds, including waking up patients to give them. I don't know one nurse on our unit who actually did that. It's just wrong. (That NM is now gone, that's the good news. The bad news is that she's a nursing instructor now.)
I would also like to say that where I work, if a baby must stay in the NICU, the mom is almost always discharged to boarder status. She is given a room (if any are empty) provided clean linen and meals and has access to staff for advice. She is no longer our patient and therefore we do not assess, chart, change the beds, and we do not give her any medications. Her family is responsible for getting any prescribed medications for her and she is then responsible for taking them as she needs them.....just as if she were home. In most cases, vag deliveries where I work are discharged 24 hours post delivery and c/s deliveries are discharged 48 hours post delivery.
The OP didn't mention how many days post c/s she was still dependent upon staff for medication which is why I mention this policy of ours.
This seemed interesting and pertinent to the conversation:
"RNs should remember that prn means in the nurse’s judgment. In regards to pain medications that are ordered prn, registered nurses can choose to give the medication routinely, around-the-clock. In many acute pain situations, such as post-operative or post-trauma, medications ordered q4h prn (every four hours as needed), for example, should be given (or at least offered) q4h (every four hours) routinely for the first 24-48 hours to keep ahead of the patient’s pain. Research shows that when patient’s acute pain is managed around the clock and the pain level is kept from becoming severe, the total amount of opioid needed is reduced."
I'm sure this has already been said but with "as needed" pain medicine you cannot predict with absolutely certainty that it will be needed exactly the next time it is due.
Maybe you won't be hurting in 4 hours, maybe you'll be asleep, who knows.
I'm sure this has already been said but with "as needed" pain medicine you cannot predict with absolutely certainty that it will be needed exactly the next time it is due.
Maybe you won't be hurting in 4 hours, maybe you'll be asleep, who knows.
If a patient is asleep does that mean they don't have pain? Or that is at least minor pain?
this seemed interesting and pertinent to the conversation:
"rns should remember that prn means in the nurse's judgment. in regards to pain medications that are ordered prn, registered nurses can choose to give the medication routinely, around-the-clock. in many acute pain situations, such as post-operative or post-trauma, medications ordered q4h prn (every four hours as needed), for example, should be given (or at least offered) q4h (every four hours) routinely for the first 24-48 hours to keep ahead of the patient's pain. research shows that when patient's acute pain is managed around the clock and the pain level is kept from becoming severe, the total amount of opioid needed is reduced."
you just reinforced what most people on this thread are saying. you have to use your nursing judgment! you can choose to give the prn pain meds around the clock or you can choose to offer it q 4 hours. it really depends on the situation, floor, and what kind of patients you have. and yes we already established that assessments and reassessments are done.
I would also like to say that where I work, if a baby must stay in the NICU, the mom is almost always discharged to boarder status. She is given a room (if any are empty) provided clean linen and meals and has access to staff for advice. She is no longer our patient and therefore we do not assess, chart, change the beds, and we do not give her any medications. Her family is responsible for getting any prescribed medications for her and she is then responsible for taking them as she needs them.....just as if she were home. In most cases, vag deliveries where I work are discharged 24 hours post delivery and c/s deliveries are discharged 48 hours post delivery.
The OP didn't mention how many days post c/s she was still dependent upon staff for medication which is why I mention this policy of ours.
i did mention, but it's a long thread. :) (that's me being flattered, btw)
just kidding.
anyhow, i was discharged after 2 days and got my own prescription from the pharmacy, and did stay in an empty room.
RedhairedNurse, BSN, RN
1,060 Posts
I'm sure this is the case. But sometimes it gets so frustrating knowing that someone suffering down the hall needs the pain meds so bad but can't have anything yet, but someone, say, post op day 4 still gets the hard core stuff. This is county hospital, I'm not sure if it's like this at every hospital.