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.
If you felt I was being critical of your choices- that wasn't my intention. I'm sorry you had such a difficult time in the hospital.
i apologize. i just thought saying i should have rested more post-op was a little condescending considering the situation, but i guess i took it the wrong way. hypothetically, anyone who has just had surgery def. should be resting - but i think anyone who has had a child would agree they don't know what they'd do if they gave birth and were left in a room "alone and empty handed" if you will.
it's a sore spot. i even wrote a lengthy research paper about the affects of separation after birth on the mother and infant. it went into detail about oxytocin, bonding, etc. it's a very difficult thing for someone who has been built up to expect a problem-free birth. i think everyone should be educated to some extent even if it's just a conversation with the doctor about what could happen and what that might be like. to the poster that mentioned maybe i wanted meds because i was stressed, i still don't agree that i was requesting them as the result of being stressed vs. pain - but pain meds do alter your mental state to an extent so it very well could've been a factor that my mind was so focused on what i could do to stay busy, that was one more thing to add to the agenda. i don't know.
when my son was in NICU, they called in a specialist who wanted to speak with me. he asked me if i did any drugs while i was pregnant which of course i didn't. that was insulting actually bc i'm a normal, educated person and it just threw me off guard. they told me at one point that they didn't know what was wrong so maybe the nurse i dealt with had been told my baby was in NICU and they weren't sure why so she was skeptical. i still don't know. when all was said and done, i was told they think he swallowed a lot of fluid when coming out. i find it hard to believe it took so long and calling in a specialist to come to that conclusion, but by that point, i didn't care. i was just glad it was over and i could take him home.
Specializes in Nurse Leader specializing in Labor & Delivery.
Not sure what your training is, but your answer is completely wrong.
I disagree. We will often have post C/S moms say "Please just bring it whenever it's due." Especially at night, they often ask to bring more in every however many hours. Of course, I will still assess their pain when I do so, but there is nothing wrong with just bringing in meds every 4 hours, if that's what they've requested in advance.
Specializes in Nurse Leader specializing in Labor & Delivery.
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.
No, a med like that for S/P C/S would be "q4h as needed", not "OR as needed". Because you don't give it automatically q4h, and you also couldn't give it more frequently if they do need it before 4 hours.
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.
A c-section is major surgery and sending a patient home in 24 hours isn't even time enough for an infection to set up. The problems with c-sections that I have seen typically start showing up at the 48 hour mark.
I'm glad our physicians refuse to send home anyone post c-section in less than 72 hours, otherwise they are signing out AMA. There is a laundry list of things that can go wrong after 24 hours and frequent, in-patient assessment is needed.
Sometimes people have to be protected from themselves.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I'm pretty familiar with that issue, as when my children were born I basically went from Dr Spock rigid schedules to a completely different view of parenting in about 2 seconds flat. Then I went bananas reading everything I could get my hands on about attachment problems and "natural" mothering -ie do you let your baby cry himself to sleep, etc
I was also a leader in a Mother-Child support group that met weekly for 8 weeks, but most continued on - for 8 years in some cases. Bonding with those other moms was priceless. I saw firsthand the various dynamics that occur within these groups since they were put together randomly when enough moms for a group put themselves in the queue. After a while you start to notice subtle differences.
I'm not sure how old your son is now-- but I do know there are things that occur in the birth process that crank up very vivid memories. For me it was when the OB was busy with her episiotomy and said "don't push now". I didn't, but the baby moved forward anyway and she made the ucchhhh disgusted sound saying "I told you not to push!! Well I pretty much felt like crap at the time instead of being elated over the birth of my daughter.
I really hate it that there are people in obstetrics who don't know what comments and queries cut deep with new moms. The "get some more rest thing" was really only an allusion to the notorious lack of sleep parents of newborns get.
Every 4 hours PRN means every 4 hours as/when needed!!! Does not mean around the clock period!!! If a patient needs pain medicine constantly every 4 hours then there is a problem. Either the pain medicine is not working or the patient is abusing it. In that case I will do some teaching about the pain medicine and I will also suggest to the patient that I call the doctor for something else. Most of the time if a patient is just abusing it, they will refuse my suggestion to call the doctor about changing the pain medicine.
I am not going to give you pain meds when you don't need it evidenced by unstable vital signs and drowsiness. I am not being mean, you will thank me some day for saving your life:)I will also not wake you up to give you pain medicine. I realize that pain is subjective and it is what the patient states but I will also watch for abuse of pain medicine and teach accordingly.
Being alert and oriented, just ring the call bell and remind the nurse that you need pain medicine, sometimes we have a lot going on, I may not remember that your pain medicine due, because there is about 3 others whose pain medicine is due at one time or another, we have doctors to deal with, family members, phone calls etc. I will try to remember but it's hard!
Lastly, you nursing students who are acting all self righteous about PRN pain meds, wait till you get to the real world then come back and share with us exactly how you handle 5 patients who have 2 or more PRN pain meds and want them all around the clock. This happens to me a lot: You have a patient with Dilaudid ordered q 4 PRN and Norco q 4 PRN and at shift change when am introducing myself to the patient she goes "Nurse can I have my dilaudid at 8pm then my Norco at 10pm then dilaudid at midnight, let's keep that schedule for the night, am in a lot of pain." Yeah right! It's not happening. " We can't do that ma'am, taking pain medicine around the schedule means there is a problem, I am calling your doctor to adjust your pain meds since dilaudid and Norco are clearly not working." "No that's fine, I will keep my dilaudid the way it is.":uhoh3:
OP, I'm going to skip over the tremendous amount of indignation, self-righteous entitlement, and general whining that has gone on in this thread and cut to the bottom line.
PRN, or "as needed" in non-medical lingo, means just that. AS NEEDED. IF NEEDED. I as a nurse have no crystal ball to predict whether or not a patient will be in pain 4 hours from now. Nor does the patient have that crystal ball. Nor do I have some mind-meld capability to telepathically know that a patient who is up and around, getting pictures developed and attending to personal grooming is having pain.
If you are having pain you get appropriate measures to address that pain, then in an appropriate time interval I will reassess whether or not those measures have worked. If not, then I will address with the prescriber whether or not a new plan of action is needed.
I'm sorry that you feel that your having to actually see if you are actually having pain, and communicating that to your nurse, constituted a bad hospital experience.
PRN, or "as needed" in non-medical lingo, means just that. AS NEEDED. IF NEEDED.
You just reminded me of a few of my patients who are convinced that "as needed" means "on demand whenever I want it regardless of when I took the last dose." I had a patient who was on 100mg Tramadol q6h prn for pain and he was back in one hour asking for the next dose, telling me that since it was prn I had to give it to him.
I had to explain that yes, it was "as needed" but for safety reasons there was a time frame of when I could give the medication because to give it any sooner may lead to an overdose. I also pointed out that it must have started working, as he was able to storm up to the nurses station without using his walker, just to ask for it :)
Lastly, you nursing students who are acting all self righteous about PRN pain meds, wait till you get to the real world then come back and share with us exactly how you handle 5 patients who have 2 or more PRN pain meds and want them all around the clock.
Only 5? Man, I want to work where you are :) I have 6-12 depending on the day and the staffing pattern.
Don't worry, reality shock will educate the students. They will learn the realities of nursing in the real world, the biggest thing being that it's a lot different than nursing as pictured in the textbook or in a supervised clincial setting. I do hope they keep their altruistic spirit with them though as that's important to have...but they have to learn to adjust it to the reality of nursing.
You just reminded me of a few of my patients who are convinced that "as needed" means "on demand whenever I want it regardless of when I took the last dose."
Ah, the distinction between "need" and "want". I don't know if this thread is up for that discussion, whaddya think?
nursel56
7,122 Posts
If you felt I was being critical of your choices- that wasn't my intention. I'm sorry you had such a difficult time in the hospital.