asking for meds?

Nurses General Nursing

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okay, this could be a stupid question/story, but my degree is not in nursing - i start this summer :D

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.

Specializes in Critical Care.
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 realized I forgot to save the link earlier (California State Law interpretive statement by the Board of Nursing).

http://www.rn.ca.gov/pdfs/regulations/npr-b-27.pdf

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Specializes in Cardiothoracic ICU.

cant believe this is still going. To the poster in blue type, you must understand that just cause you are an RN, your posts still don't make any sense.

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Specializes in Wound Care, LTC, Sub-Acute, Vents.
cant believe this is still going. to the poster in blue type, you must understand that just cause you are an rn, your posts still don't make any sense.

as long as my patients are happy with my nursing care, that is all that matter.

and just fyi, i am one of the favorite nurses on my floor. my patients are very happy when i come back from vacation or long week-end off. i am one of the few nurses who spend time and talk to my patients instead of just shoving meds in their mouths and leave because you have 20+ more patients to do. the lols who refused meds such as antibiotics from other nurses call me to try and give it to them and most times i am successful.

anyway, i hope you find a student nurse who can provide you nursing care on this "post-op" day you will have in the future.

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Not where I work, the drug addicts (seekers) seem to get what they want, it's amazing the way doctors will give the addicts 2mg of dilaudid q2h but the ortho pt only gets 4 of morphine q4. Doesn't make sense but I see it all too often. I've heard that some doctors do this just cause they don't want to listen to the addict gripe! It frustrates me to no end!

Thats awful!!! At our hospital their name goes on a list and if they come in through the ER the physican knows if they are asking for pain meds that they are not to give them any. Our docs are to worried about the dea getting involved!!!!

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

That is not true. Pain again is subjective. Just because a person has fallen asleep does not mean they are not in pain. It is a very hard judgment call for us as nurses, do you give a pain or do you not, I think 90% or more of our pt's are truely in pain and are not drug seeking. I have had many patients ask for a pain pill and when I get in there they are dosing off but are still in pain. You have to remember they are exhausted. They do not get to soundly sleep. We are constantly waking them up to check on them or their room mate or a noise outside their room wakes them up.

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Specializes in ortho, hospice volunteer, psych,.

i have carefully stayed out of this debate/discussion until now. last friday, my husband had surgery on his rt foot and ankle. he has been in agonizing unrelenting pain for weeks and weeks. when i finally

strong armed him into seeing our internist, he was immediately sent to a surgeon -- right then.

she dx what i had thought it was -- a venous stasis ulcer. it was debrided weekly for four weeks, but suddenly there were two more plus a lump. the debridements were done without any sedation or local.

he was sent home with percocet. the next a new rx for double the amount when he had more than half left.

it only got bigger and bigger. more pain, more meds, more pain, different narcotics... i'm concerned about all the tylenol he's ingesting.

so now we wait... and wait... for the biopsy results on the lump and for the craters to heal and

for the unyielding dreadful pain to subside. we presently have seven bottles of various narcotics

in a small lockbox in a kitchen cupboard, but none work. one crater is so close to his ankle bone that i'm terrified.

the instructions on the labels were ambiguous at best. "take 1 or 2 pills q 4h prn for pain" what we have been doing is for me to assess his pain. he takes 1 pill (tablet) and we reassess in 2-3 hours. he almost always gets some relief but not enough to be quite comfortable. he's up about once every hour all night long. if he takes 2, he gets dippy, dizzy, and nauseated.

this isn't a inactive retired rn /c a masters typing this. it's a very tired and worried wife who hasn't slept much in the past week instead.

my husband was brought up as a christian scientist and usually getting him to take any type of pill is a battle. he takes his pain meds, but feels as though he's "weak" when he does. for someone who didn't give many pain meds in psych, plus having been inactive for seven years, i am in over my head.

he needs better pain relief as do many patients. many patients are sent home with inadequate pain relief and/or poorly worded orders on the label.

i apologize for my ranting and rambling. i have not been this tired since one trip to the former soviet union or grad school.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

I'm sorry you are going through that, Kathy!! :-( Do you think it might help to start a thread to the Wound Care nurses? A pain specialist that will help you get ahead of this? You two clearly need more help! Prayers for you and DH.

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Specializes in ortho, hospice volunteer, psych,.
i'm sorry you are going through that, kathy!! :-( do you think it might help to start a thread to the wound care nurses? a pain specialist that will help you get ahead of this? you two clearly need more help! prayers for you and dh.

thank you, nursel56. thank you for your prayers and your suggestion. he's normally very stoic about any pain he feels, so when he tells me it hurts, i know it really does.

i just feel so useless because i can't take proper care of him the way i am now. he has an appointment on thursday, when we should get the biopsy results. i keep telling myself that if it were really bad, we'd have heard something by now.

thank you for the pain specialist suggestion too. i'm simply too tired to think coherently right now.

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Specializes in Med Surg, Ortho.
Thats awful!!! At our hospital their name goes on a list and if they come in through the ER the physican knows if they are asking for pain meds that they are not to give them any. Our docs are to worried about the dea getting involved!!!!

Well most of these addicts that I speak of usually have some sort of chronic problem or something that has probably led to addiction and/or opioid tolerance. I don't work in our ER but I'm sure they have such a "list."

I'm mainly talking about something like this for example.....Take a sickle cell crisis patient that has the crisis resolved after a few days of treatment and is ready for discharge but still continues getting that 2mg of dilaudid q2h. Then, I'll see a fresh post op patient getting something like 2mg of morphine q4h laying in bed crying needing more pain relief, nurse calls the doctor to try to increase pain med with no success.

Another example.......pancreatitis patient with only slightly elevated enzymes, again resovled and almost ready for discharge and still getting the strong stuff like 1-2mg of dilaudid q2h, again while the room mate, brand new post op, is just getting 2 of morphine q4h.

I guess It just depends on the doctor, who knows. At times, it's scenario's like this that get very frustrating, because there are some patients that are in a lot of pain. And, I'd say approx 95%, or more, of my pts that can get oral or IVP pain meds q2-4h, whatever the time frame may be, will ALWAYS want it spot on each and every time, on time, regardless; they say they are in pain and they want the drugs! And most pts want the pain med to be automatically taken to them without asking, happens a lot even after explaining to them the need for further pain assessment prn.

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Specializes in Medical.

I was taught that the standard dosing of morphine was 1mg/10k (1mg/22lb) four-hourly, less for precarious patients (elderly/impaired hepatic or renal function/respiratory compromise), so I'm amazed by the mentions of 2mg 2/24 - no wonder these patients are in pain.

Hydromorphone is only rarely used where I work, so I can't comment on its dosing (the only patient I've given it to recently gets 8mg orally upto 4/24 and has a combination of acute and chronic pain issues).

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In my area Talaxandra, Dilaudid is more common.

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Specializes in OR, ER, Oncology, CPC.

Just let's take care of our patients!!!!!! Assess their pain and medicate per dr's orders. We are not supposed to be labeling patients as addicts. Let an MD do that. Jeesh, assess the pain and medicate if needed, Simple as that. Yes it is good practice to see what level their pain is all throughout the shift. In fact it is a requirement that all my nurses did in the ER. Let's just practice nursing and not diagnose. Have a wonderful holiday.:nurse:

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