asking for meds?

[backatit2]

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.

[agldragonRN]

if 75% (or even more - that's being generous) of the engineers agreed with your opinion rather than their fellow enginners - i'd think those engineers might need to re-assess their strategy - jmo. :)

because i am not an engineer. i am a registered nurse. you just agreed with me without realizing it.

you have no idea what it's like being a nurse because you're still a nurse wanna be. yet you are already telling us how to do our job.

and by the way, just because you have a non-nursing bachelor's degree does not make you an expert in nursing practice. even the mds cannot even be an expert witness in court when telling the jury if the nurse has met the standards of care in nursing. the md has to hold a nursing license as well in order to do so.

angel, rn

[klone, MSN, RN]

you have no idea what it's like being a nurse because you're still a nurse wanna be.

damn, why so snotty?

fwiw, i am an rn (not a "wannabe") and i still disagree with you. so what does that mean?

[agldragonRN]

damn, why so snotty?

fwiw, i am an rn (not a "wannabe") and i still disagree with you. so what does that mean?

not being snotty. just responding to her reply saying that opinions who disagree with her are wrong.

you are an rn so your opinion regarding nursing practice and judgment carry more weight.

[eriksoln, BSN, RN]

I think also, something that has been list in all of this is respect for the fact that nursing tends to have an aesthetic nature to it. Much like if I and another artist were told to paint a picture of a mountain landscape. Our paintings would no doubt look quite different, but the primary purpose is served in that we now have a painting of a mountain landscape. I may focus more on the trees, have my view be from the ground looking up and have no snow on the peaks. The other artist may go with a birds eye view, lots of snow on the peaks, no tree's at all.

Beauty is in the eye of the beholder though. What makes one painting better/right vs. the other.........well, that depends on the buyer. If the buyer LOVES the birds eye view and picks the other artist's painting over mine for that reason, then for that instant, their picture was "better".

With medical care, the "beholder" is the patient. I outlined how I would have dealt with the situation the OP was in and pointed out a few common mistakes I see frequently that sabotage pt. care. My approach to managing pain, like painting, is only good if the beholder see's the beauty in it. I can quote any article, any nursing theory and play semantics with "PRN" or any other word, but if my pt. isn't satisfied with it, it's all for not. They'll give my institution 1's and 2's on the PG survery, perhaps complain about me, and tell other would be future patients to avoid my facility. As "right" as my theory may be, its useless being right if the patient doesn't see the beauty in it. Too much of that, and I'll be in the unemployment line squawking about "I know I'm right, PRN means this and that not that or this". Another nurse booted outta the system because they have all the answers, but no solutions.

My approach is mine, yours is yours. I focus a lot on avoiding the jaded/burned out habits that the Nurse Ratchet types tend to take on. I can honestly say, when it comes to my nursing delivery, there is much room for improvement, but when it comes to pain management, I hear a great many thank-you's and almost nill complaints. If you can say the same about your approach, good for you, we've both achieved the primary purpose. Neither of us is smarter/more qualified for it. Thats the aesthetic nature of nursing.

[klone, MSN, RN]

I focus a lot on avoiding the jaded/burned out habits that the Nurse Ratchet types tend to take on. I can honestly say, when it comes to my nursing delivery, there is much room for improvement, but when it comes to pain management, I hear a great many thank-you's and almost nill complaints. If you can say the same about your approach, good for you, we've both achieved the primary purpose. Neither of us is smarter/more qualified for it. Thats the aesthetic nature of nursing.

Great post. That's what I don't understand - as long as you're still working within the confines of your medication orders, I don't see why it's such a big deal to grant the patient's wishes to have medication brought every 4 hours. Like I said before, it seems that some people are just being ornery.

[RedhairedNurse, BSN, RN]

Yes, if a patient is asleep they are not in pain.

Wrong!!

[MunoRN, RN]

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.

why would you choose not to offer it every 4 hours in this situation?

[netglow, ASN, RN]

I probably shouldn't have used the word "already", but the meds with the most rapid onset are usually used first, given via your IV, second as an intramuscular injection, and third as an oral medication. That would be the general sequence, with variations depending on each doctor's routine.

But a sleeping person isn't an unconscious person. And sleep goes through cycles of awareness wherein someone could be having a physiological response to the pain just below their awareness as evidenced by guarding, grimacing and restlessness.

OK, trump card here for all.

I had endometriosis IV. It was quite active years ago and I had severe pain for years. No worries now, I researched and found a K/A surgeon, and I've been golden since. Anyhoo. I needed to remain on heavy and hi doses of pain meds (nsaids) during active times back then. I needed to keep blood levels consistent 24 hours to keep this pain manageable. If I lapsed, I WOULD NOT BE ABLE TO REGAIN MY MANAGEMENT LEVEL FOR PAIN. I learned to set my alarm throughout the night during the bad times, so that I could wake just long enough for nsaids and crackers, then reset the alarm and back to sleep. Should I get surprised and have my cycle early or late, I would actually dream that I needed to wake myself up or get in trouble with pain that I could not overcome. This dreaming was learned response. It was to avoid a trip to the ER for ramping up.

[agldragonRN]

why would you choose not to offer it every 4 hours in this situation?

if it's appropriate to be given every 4 hours and patient wants it that way, i will try my best to honor it but i will still ask the patient to use the call bell in case i forget or i get behind due to unforeseen events.

[klone, MSN, RN]

if it's appropriate to be given every 4 hours and patient wants it that way, i will try my best to honor it but i will still ask the patient to use the call bell in case i forget or i get behind due to unforeseen events.

which is reasonable, but not at all what you were saying at the beginning of this thread. at the beginning, you were saying that if it's prn, they must ask for it, and if they need it every 4 hours, it should be a scheduled order.

i do the same thing - i will tell them that i'll bring it in at the earliest time it's due, but if they haven't seen me within 15 minutes of that time period, hit the call bell in case i got involved with something else.

[netglow, ASN, RN]

It's called pain management folks.

Know the etiology/pathophysiology of the pain that it is YOUR JOB to manage. Learn your pain meds, learn your pharmokinetics, and learn your patient and you will be better nurses.

[MunoRN, RN]

if it's appropriate to be given every 4 hours and patient wants it that way, i will try my best to honor it but i will still ask the patient to use the call bell in case i forget or i get behind due to unforeseen events.

that's essentially what the patient was asking for, which you felt could not be followed as-is earlier. i'm not sure why you think that the patient making such a request proves they are misinformed about nursing practice even in your recent posts if you agree that their request is possible after all.