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.
PRN pain meds are usually "as required" (PRN). However, as previously mentioned, assessing pain is part of every visit made to a pt., hopefully at least once an hour - although in reality it is way more often.
As for the window of an hour - I do not apply this to PRN pain meds... I'm not going to dose anyone with Percocet X2 Q4hrs before the four hours has elapsed. I care about my pt.s' livers. Having said that, even though we may be assigned several pt.s most do not require regular pain meds, so with those that do, I anticipate as much as possible by asking if they would like me to bring the med every four hours, or if they would like to call me for the med. Funnily enough, given the choice, they generally say they they will call me and require fewer pain meds - maybe they feel more in control?
Specializes in Professional Development Specialist.
i never requested to be awakened - lol - wow, how the story unfolds!
prescriptions usually say "every four hours OR as needed"
i could see the nurse needing to assess if meds were requested before 4 hours had passed which would justify the "as needed" portion. but if the md says every four hours i don't see how it's up the nurse if it has been at least 4 hours or longer.
Pain medications are not written every 4 hours OR as needed. If they were written that way someone might think they can take it every 4 hours, or every 10 minutes if that is what they "need" and then do some serious damage to their body or their life. It is written "every 4 hours PRN." Meaning we can give it to you at most every 4 hours if you ask. If you ask every 2 hours we would have to call the doctor and ask if they can change your script. In the meantime we would say no.
PRN does mean you must ask for the medication at the time you need it. Many pain meds come with serious side effects, like sedation and or severe liver or kidney damage. If you are an alert and oriented person then you should be reasonably able to use your call light and tell the nurse when you are in pain. If you don't tell us you are in pain, we cannot assume. If we brought you your pain meds every 4 hours and something were to go wrong, our license and our livelihood would be on the line. (Perhaps you had an underlying liver problem we didn't know about, and the dose of Tylenol you ended up receiving was more than your body could tolerate and your liver completely shut down.) We would have to justify to a court why we gave you medication outside the doctor order when it was ordered by request. We would be asked "did you assess the patient?" "did the patient call you and tell you they were in pain?" Answering that they told you 12 hours ago to bring their meds every 4 hours would not be acceptable. We must assess for PRN meds and they must be requested. The consequence can be losing our license to work as a nurse or worse! If a nurse had time, it would be nice to have the nurse come back and assess you every 4 hours. But at some point, the responsibility is on you, the patient, for not speaking up and simply asking.
This is a problem of your nurse not educating you well about what PRN means. Not of your nurse being mean or lazy or whatever.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Maybe we're just talking semantics, as hopefully the nurse who just brings the med in after four hours also assesses the patient's pain level at that time. As much as we would like to believe a request for a prn pain med is brought right in, even a fantastic nurse can get swamped or have something unexpected occur. Some patients want to head that off at the pass if they have had a delay in getting their med after it's asked for.
The point is neither the nurse or the patient can see into the future, so we have to assess "starting from scratch" each time even if it doesn't seem to the patient as if things will change much. They can.
i think it would be safe to assume that ANY c-section patient who had the surgery on a Monday for example would be legitimate in requesting pain meds every four hours on Tuesday. But especially if it's a patient who doesn't have their child with them and is up and moving around more than the average post op patient.
i have most def. had pain meds where it says on the bottle "take 2 every 4-6 hours OR as needed." either way, i stated that i can understand a nurse assessing or denying a request that's less than 4 hours, but if it's been 4 hours if that's what ws prescribed, those are the docs instructions so i can't see the nurse saying, well, it's been 5 hours but you've been up doing such and such so i don't think you need them.
It is not about laziness, it is about the order being written as needed. I, as a nurse, cannot tell you (nor can you tell me) what your pain level is going to be like in 6 hours, in 8 hours, in 12 hours.
I am happy to bring pain meds if a patient ask for them...when I give them pain meds I usually say, "You can have more at such and such time"...so when you feel the pain start to come back you need to ask so your pain is more manageable.
You will not appear to be a drug addict...in fact, drug addicts tend to want their pain meds brought to them right on the hour they are due around the clock while they are admitted.
PS: Whatever physican sent you home 24 hours post-c-section was an idiot and put your life at risk in doing so.
it wasnt 24 hours. i checked in at 4am and had the surgery a few hours later. i started asking the following morning (24 hours had already passed) when i could go home. he said he would check back later and ultimately i ended up leaving late that evening - and i had people at home with me to support me and was barely taking any meds. he's a great doctor and has a higher demand than supply.
PRN does mean you must ask for the medication at the time you need it. Many pain meds come with serious side effects, like sedation and or severe liver or kidney damage. If you are an alert and oriented person then you should be reasonably able to use your call light and tell the nurse when you are in pain. If you don't tell us you are in pain, we cannot assume. If we brought you your pain meds every 4 hours and something were to go wrong, our license and our livelihood would be on the line. (Perhaps you had an underlying liver problem we didn't know about, and the dose of Tylenol you ended up receiving was more than your body could tolerate and your liver completely shut down.) We would have to justify to a court why we gave you medication outside the doctor order when it was ordered by request. We would be asked "did you assess the patient?" "did the patient call you and tell you they were in pain?" Answering that they told you 12 hours ago to bring their meds every 4 hours would not be acceptable. We must assess for PRN meds and they must be requested. The consequence can be losing our license to work as a nurse or worse! If a nurse had time, it would be nice to have the nurse come back and assess you every 4 hours. But at some point, the responsibility is on you, the patient, for not speaking up and simply asking.
This is a problem of your nurse not educating you well about what PRN means. Not of your nurse being mean or lazy or whatever.
PRN means as needed based on our assessment, not based on patient request, although our assessment can be triggered by a request, it is not required, just like they don't have to request their scheduled meds in order for them to be available.
Most percocet formulations contain 325mg of acetaminophen, meaning it can be given 2 tabs q 4hrs and still be below the recommended max of 4 Grams/day, and without any known liver failure/insufficiency, no you don't risk your license by giving these as ordered, even it involves bringing them to the patient every 4 hours, assessing their pain, and giving it.
You do have to be more careful with 500mg APAP vicoden, although any place that hasn't yet switched to Norco (325 APAP) needs to catch up.
Specializes in Professional Development Specialist.
Yes, assuming we are talking percocet it is below the 4G/d recommended limit. However each patient is different. My point wasn't so specific but that the nurse needs to be able to answer more than just "12 hours ago they told me they wanted pain meds q4." If I CAN assess the patient every 4 hours because I know their pain meds may be wearing off, then by all means I will. However that isn't always possible.
Of course, I don't work OB. I have an 8 hr shift and 15 patients.
Bottom line, nurses walk a fine line between ordered pain meds, the patient needs, and their responsibilities. The poster never mentions how often the nurse assessed her or entered the room. Having been an OB patient I can only say it was 1-3 times a shift personally. You're assuming a nurse has so little going on that she can remember in 4 hrs to come back with pain meds. Maybe a baby got very sick, maybe a mother started bleeding out. Is it so much to ask that the healthy patient push her call bell for pain meds?
Everyone is so quick to blame the nurse. But a patient able to communicate her pain is surely able to push her call light. Instead much later she is complaining to a website that it wasn't managed. A simple call light request or a conversation with her doctor may have had vastly different results. I have been a patient where I was begging for help that never came, but this is about someone who never spoke up.
Specializes in Professional Development Specialist.
i have most def. had pain meds where it says on the bottle "take 2 every 4-6 hours OR as needed."
That is extremely dangerous, if you ask me. But that is not the way it is written on any doctor order I have ever seen, which is different than your bottle at home. IMO that is a pharmacy issue or the doctor issue. If you took even Tylenol "as needed" you could kill your liver. Even my ibuprofen says 1-2 tables every 4-6 hours while symptoms persist. My stronger meds say 4-6 hrs as needed, not OR as needed.
Honestly I medicate my patients when they say they are in pain. If I see they look like they are in pain I will ask them if they hurt. If they say they need pain meds I never say "you look fine." Pain is what the patient says it is, and it's not my job to pass judgement. Maybe that's just what they are drilling into us in school these days. But if I have a very sick patient, it may slip my mind that you told me to come bring you pain pills in 4 hours. I have to prioritize and if you don't communicate your pain while I have 1,000 other things going on, it may happen that you are forgotten. I know us nurses are easy targets, but there's more to it than that.
i think it would be safe to assume that ANY c-section patient who had the surgery on a Monday for example would be legitimate in requesting pain meds every four hours on Tuesday. But especially if it's a patient who doesn't have their child with them and is up and moving around more than the average post op patient.
ihave most def. had pain meds where it says on the bottle "take 2 every 4-6 hours OR as needed." either way, i stated that i can understand a nurse assessing or denying a request that's less than 4 hours, but if it's been 4 hours if that's what ws prescribed, those are the docs instructions so i can't see the nurse saying, well, it's been 5 hours but you've been up doing such and such so i don't think you need them.
It's entirely possible that you received a prescription for home that said that.
However, the orders that the docs write in the hospital aren't written that way. There are Scheduled Meds (ie take every 4 hours), and PRN Meds (take every 4 hours PRN). No med is Scheduled or PRN.
Yes, assuming we are talking percocet it is below the 4G/d recommended limit. However each patient is different. My point wasn't so specific but that the nurse needs to be able to answer more than just "12 hours ago they told me they wanted pain meds q4." If I CAN assess the patient every 4 hours because I know their pain meds may be wearing off, then by all means I will. However that isn't always possible.
Of course, I don't work OB. I have an 8 hr shift and 15 patients.
Bottom line, nurses walk a fine line between ordered pain meds, the patient needs, and their responsibilities. The poster never mentions how often the nurse assessed her or entered the room. Having been an OB patient I can only say it was 1-3 times a shift personally. A simple call light request or a conversation with her doctor may have had vastly different results. I have been a patient where I was begging You're assuming a nurse has so little going on that she can remember in 4 hrs to come back with pain meds. Maybe a baby got very sick, maybe a mother started bleeding out. Is it so much to ask that the healthy patient push her call bell for pain meds?
Everyone is so quick to blame the nurse. But a patient able to communicate her pain is surely able to push her call light. Instead much later she is complaining to a website that it wasn't managed.for help that never came, but this is about someone who never spoke up.
WOW - it's scary that a nurse who is assumed to be semi-intelligent would come to THAT conclusion after reading my post. you said i'm assuming a nurse has so little going on that she can remember to come back in 4 hours with pain meds? did you even READ what i wrote? i specifically said that instead of bothering the nurse, i asked if she could bring it AROUND the time i was due WHEN she had the chance SO THAT i wouldn't have to bother her. obviously, i assumed that she WAS busy and instead of me having to call for her and ask her every four hours, she could just come by every 4, 5 hours when she had a chance and bring them.
secondly, when did i COMPLAIN that it wasn't managed. it was most definitely managed. if a nurse wants me to bug them every 4 hours and have them come to my room to ask for something when they already know full well what i'm calling them for, then you best believe i'll fulfill that request. i NEVER said that "help never came and i never spoke up."
you are seriously making things up. SHOW ME where i said that. thanks.
i think it would be safe to assume that ANY c-section patient who had the surgery on a Monday for example would be legitimate in requesting pain meds every four hours on Tuesday. But especially if it's a patient who doesn't have their child with them and is up and moving around more than the average post op patient.
Sounds like the nurse was appropriate in not bringing you your medications around the clock like you asked. You've repeatedly mentioned the stress you were under by not having your child with you and in the NICU. It sounds less like you were in pain (although I don't doubt that after major surgery you did have pain, but you've already told us you can handle similar pain without much use of narcotics) and more under severe stress. The narcotics work not by actually killing your pain, but they work in your brain to make you not care about the pain (and other stressors in your life).
The nurse should have worked with you to identify the sources of stress and help you reduce them without the aid of narcotics, but it sounds as if you were using them inappropriately, though I doubt you realize this.
Sounds like the nurse was appropriate in not bringing you your medications around the clock like you asked. You've repeatedly mentioned the stress you were under by not having your child with you and in the NICU. It sounds less like you were in pain (although I don't doubt that after major surgery you did have pain, but you've already told us you can handle similar pain without much use of narcotics) and more under severe stress. The narcotics work not by actually killing your pain, but they work in your brain to make you not care about the pain (and other stressors in your life).
The nurse should have worked with you to identify the sources of stress and help you reduce them without the aid of narcotics, but it sounds as if you were using them inappropriately, though I doubt you realize this.
i think you are seeking ways to repudiate the OP's complaint.....she already said she was moving around more than the first one, and didnt have the distraction of the a baby to care for, thus being in more pain from the moving around and more aware of it d/t lack of distraction.....last time i thought about it, a Csection was major abd. surgery....would you be saying the same about an appy? gallbladder?
regularRN
400 Posts
PRN pain meds are usually "as required" (PRN). However, as previously mentioned, assessing pain is part of every visit made to a pt., hopefully at least once an hour - although in reality it is way more often.
As for the window of an hour - I do not apply this to PRN pain meds... I'm not going to dose anyone with Percocet X2 Q4hrs before the four hours has elapsed. I care about my pt.s' livers. Having said that, even though we may be assigned several pt.s most do not require regular pain meds, so with those that do, I anticipate as much as possible by asking if they would like me to bring the med every four hours, or if they would like to call me for the med. Funnily enough, given the choice, they generally say they they will call me and require fewer pain meds - maybe they feel more in control?