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.
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.
I dont think you need the bold, to know that a fresh post op is going to need pain med! And I think your last statement was unnecessarily rude/childish; considering, I repeat, that a fresh post op IS GOING TO HAVE PAIN.
I dont think you need the bold, to know that a fresh post op is going to need pain med! And I think your last statement was unnecessarily rude/childish; considering, I repeat, that a fresh post op IS GOING TO HAVE PAIN.
My nursing experience has demonstrated to me the incredibly wide range of human responses to various conditions; e.g., patients are all individuals and what is appropriate for one is not necessarily appropriate for the next. One post-op patient will appear comfortable and decline offered pain meds after major surgery. The next will be in tears after a fingerstick for a blood sugar check.
I dont think you need the bold, to know that a fresh post op is going to need pain med! And I think your last statement was unnecessarily rude/childish; considering, I repeat, that a fresh post op IS GOING TO HAVE PAIN.
Even a fresh post op HAS to be re-assessed before giving PRN pain meds! Key word is PRN. It's a totally different story if it was ordered routine every 4 hours.
I think this feeling some have that it is a bother to assess people for pain (like, you don't "do windows" or something) is odd. I can't wrap my brain around why you feel this way.
Heck, just give the patient the narc bottle/vial and let 'em go home and administer themselves then. Why the heck keep 'em in the hospital. I am sure (by the same token) since it seems some feel it's beneath them to assess, you can send all fresh post ops home. Just tell 'em... if you bleed/bloat, become unconscious, something pops open, find someone to bring you to the ER. Done. Hey then we can all have christmas parties at work and do shots!!!!
We have to remember that everyone's pain thresh hold is different and each situation is different. As nurses we should be treating everyone holistically and individually. I personally think if meds are prescribed PRN and patient requires them 4 hours then give it 4 hourly and get the order reviewed by the doctor and changed if necessary. I too will not wake someone up to give them pain relief but if they are awake and request it then I will give it. If the med is a narc I will not obtain it without knowing the patient is awake so not to waste it.
See my patient had hers PRN but she wanted it right when she could have it next. She even wanted us to wake her up. I always did. Some nurses wouldn't and that would result in the patient waking up an hour later screaming and crying in pain (so not only would she be in pain while waiting for the med to kick in, she'd lose sleep and not want to attend therapy). I just wouldn't do that to my patients. I, of course, always assessed her pain before giving her a pain pill. And she always needed it. I don't think that it would be appropriate to have it changed to a scheduled med because she won't always need them and when she goes home I wouldn't want her to think she HAD to take them every 4 hours and get hooked on them or something.
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:
Maybe we need to review the basic pharmacokinetics of pain meds. Both Vicoden and Percocet have half lives of 3-4.5 hours, so it would make sense a patient with persistent pain would have inadequate pain control at around 4 hours if a half dose or less in insufficient for adequate pain control. Needing subsequent percocet/vicoden every 4 hours is not a sign it isn't working or that the patient is abusing it, it actually a predictable part of how the med works.
I wouldn't necessarily wake a patient up to assess their pain either if they haven't been having pain, but you wouldn't wake a patient up who has been having persistent pain to assess their need for pain meds? Do assume that if they can sleep then they don't have pain?
Even a fresh post op HAS to be re-assessed before giving PRN pain meds! Key word is PRN. It's a totally different story if it was ordered routine every 4 hours.
I feel sorry for your patients. You must put them through extra ******** that is totally unneeded. Just give them their damn medication when they ask for it, you clearly cant think critically past that.
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.
When I commented on this I was talking about the comments I hear when I am on clinical from the nurses....there is a difference from a patient that is truly in pain and the pain meds are not working for as ordered and the patients who are truly drug seeking. I worked for my father in law whom is a family practice physican for 6 years before going to nursing school, I have seen my fair share of drug seekers:). And as I said I go to a Philadelphia nursing school and do clinicals in a rough section of Philly, i have seen drug seekers, had many as patients; however I have also had many other patients that were truly in pain and the pain meds as ordered were not helping. The nurses were "densnsitized" to these patients from dealing with so many drug seekers on the med/surg floor that it was a horrible experience for the patients who were not getting the pain relief that they needed to help them get better. So I can tell you that I will hold my patients pain to a priority! It really is a touchy topic for me, because it would annoy me to see these nurses brush off my patients and there was nothing I could do as a student
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.
If a patient is a fresh post op they may need it q4 hours around the clock for the first day - that doesn't mean they are abusing it, and it may not mean they need a new pain regimen if it is adequately controlling their pain. In an acute care hospital it is really not our job to withhold medicine for abusers(as long as breathing is ok and under the tylenol limit etc), as even addicts need pain relief. I'll never say no to some education though :) I have had a different experience than you in that my addicts (documented abuse) will agree to me calling the doc for pain med changes, (though of course they will often max any changes out as well).
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.
Of course, if their RR is very low then don't give a non-hospice patient more meds, but really, you need to reconsider the part about not waking a patient up for pain management. If you are in the room at night to get vitals and they say they are in pain, and when you come back with meds they are sleeping - please wake them up, because their pain will be out of control when they finally do wake up if you let them sleep, and those in pain do not get as restful a sleep.
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!
Agreed, and I admire your effort over the others who simply say no! What I do for this is a timeline for my daily meds, and add in time-sensitive tasks such as g-tube checks, and discharge time to a nsg home, and here I add in reminders to check on the pain of a particular patient. I continuously look at my timeline throughout the day. Its a tricky job to manage, but for those in serious pain we should try to make an effort at least.
I feel sorry for your patients. You must put them through extra ******** that is totally unneeded. Just give them their damn medication when they ask for it, you clearly cant think critically past that.
I think what she is trying to say is that we need to ask the patients their pain on a scale of 1-10 before giving them their meds so we can assess which med is best to give them (or if they need 1 tablet or 2), and this number is used for checking back in ~45 minutes to see if the pain med is working or if the pain regimen should be changed. It is appropriate and needed to assess every time in an acute care hospital.
I think what she is trying to say is that we need to ask the patients their pain on a scale of 1-10 before giving them their meds so we can assess which med is best to give them (or if they need 1 tablet or 2), and this number is used for checking back in ~45 minutes to see if the pain med is working or if the pain regimen should be changed. It is appropriate and needed to assess every time.
Well what I got from her post was that she thinks she needs to reeducate the patients and spend her time calling the doctor to get the pain medication orders change then give them medication for their pain. She spends waaaaaay to much time judging!
And if someone is in chronic pain and they come to you and say I need this at this time and this at this time... maybe it's because that's how they've found to best manage it at home?
Like I said, she spends way too much of her time judging. And she doesn't understand pharmacokinetics either, apparently.
edit: sorry if I come off rude, that nurse really got under my skin with her post.
+ I disagree with her not wanting to wake patients up. If they are in pain, THEY'LL WAKE UP ANYWAY, so now they have to wait for her to go get it, and wait for it to kick in... when she could have just brought it to them when the next dose was available.. now their sleep is disturbed on top of it. Nice nurse.
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:
I dont think there is anything wrong with giving PRN pain meds continuously if they are in pain. If your in pain someday i hope some opinionated nurse witholds some meds from you
Hey then we can all have christmas parties at work and do shots!!!!
It really is a touchy topic for me, because it would annoy me to see these nurses brush off my patients and there was nothing I could do as a student 
morte, LPN, LVN
7,015 Posts
I dont think you need the bold, to know that a fresh post op is going to need pain med! And I think your last statement was unnecessarily rude/childish; considering, I repeat, that a fresh post op IS GOING TO HAVE PAIN.