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.
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.
There seems to be some confusion here. We all agree that pain needs to be assessed prior to medicating, I don't think anyone is saying that you should just walk in the room and plop down pain meds every 4 hours and leave without saying word. And prn and scheduled are not different, pain still needs to be assessed prior to scheduled pain med administration as well.
The question is who is primarily responsible for initiating the pain assessment that goes along with every pain med administration. There are many times that it takes a call light to initiate that assessment because we are busy, but if we know a patient is having persistent pain and the pain med we gave them 4 hours ago is probably not adequate at this point, it's our responsibility to initiate that assessment when possible. Nursing care shouldn't be something that patients get only when they ask for specifically and repeatedly.
I'm not fully sure at her intention in her posts so I'll let her clarify on that one.
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?
Yes, agreed, they may have pain from arthritis or a number of other causes too, and they know their body. Collaborating with the patient on managing their pain is the best-practice.
+ 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.
I wrote a post a couple pages ago about the same thing. There have been a lot of people here saying they will never wake a patient for pain management but they haven't backed that up with any evidence of why that's the best thing for the patient. If a patient requests to be woken up at night or if they request a med and then are asleep when you come back, then, barring extenuating circumstances, they should be woken up, otherwise their pain may be out of control and much harder to manage when they wake up, and they wouldn't have had as restful a sleep.
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
wait until you become a nurse and you will see the "real world" nursing as opposed to school textbook nursing. and if you work in ltc or snf, good luck giving all the prn pain meds "continuously" to 25+ patients.
wait until you become a nurse and you will see the "real world" nursing as opposed to school textbook nursing. and if you work in ltc or snf, good luck giving all the prn pain meds "continuously" to 25+ patients.
i'm sure that would be difficult in a snf but that is not the setting in which i am talking about. in a hospital floor patients should expect enough care to be kept up on pain meds if necessary.
i'm sure that would be difficult in a snf but that is not the setting in which i am talking about. in a hospital floor patients should expect enough care to be kept up on pain meds if necessary.
snf patients need pain management as well. this is where prioritization comes in. i have a lot of non-verbal patients so i must rely on my assessment skills in order to give them appropriate pain meds. for my alert and oriented x 3 patients with two working hands, i ask them to use the call bell when they want the prn pain meds. of course assessment is needed first before giving any prn meds and i will usually "try" to stay on top of things so they can have their pain meds at the appropriate times. but as nurses know, so many things are happening at the same time and it is very easy to forget things especially when you are being interrupted every minute.
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.
Anesthesia and other medications given during surgery is very much still with the patient right after the surgery. In c-sections, many times it is not day 1 that the greatest pain is felt when trying to ambulate, but on day 2.
Why is this wrong? I had a Res that had PRN pain meds but she has requested for us to bring them to her when she could have another. She was in constant pain and never refused them when we brought them to her. She was grateful because she would worry that her call light wouldn't be answered quickly or I'd be off doing something for someone else and she would have to wait in pain for 30 min to an hour. That way she knew I would be there and she wouldn't be anxious about it in between getting the pain meds.
If she is in that much of a severe pain, then you as her nurse should advocate for her and have the medication become scheduled/ routine.
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
You missed the point...boy, did you miss the point.
The point of most of this discussion is not withholding PRN medications, but giving them around the clock ONLY because a patient ASKS for them around the clock and not re-assessing pain, whether they are in pain or not.
That is not how PRN pain medications are supposed to be administered....in school on an exam or in the real world of nursing.
you missed the point...boy, did you miss the point.
the point of most of this discussion is not withholding prn medications, but giving them around the clock only because a patient asks for them around the clock and not re-assessing pain, whether they are in pain or not.
that is not how prn pain medications are supposed to be administered....in school on an exam or in the real world of nursing.
You missed the point...boy, did you miss the point.
The point of most of this discussion is not withholding PRN medications, but giving them around the clock ONLY because a patient ASKS for them around the clock and not re-assessing pain, whether they are in pain or not.
That is not how PRN pain medications are supposed to be administered....in school on an exam or in the real world of nursing.
After reassessment, there is also a chance of the patient meeting that assessment whether they are in pain or not.
I'd also consider starting patient off with a milder dose of pain medication if I can correctly ascertain that they are not in much pain. At the same time, I'd explain to them.Not all patients are irrational- some do understand.
You missed the point...boy, did you miss the point.
The point of most of this discussion is not withholding PRN medications, but giving them around the clock ONLY because a patient ASKS for them around the clock and not re-assessing pain, whether they are in pain or not.
That is not how PRN pain medications are supposed to be administered....in school on an exam or in the real world of nursing.
When was it suggested that pain meds should be given without assessing the patient's pain? The point has been should we assess and treat pain reactively or proactively.
MunoRN, RN
8,058 Posts
There seems to be some confusion here. We all agree that pain needs to be assessed prior to medicating, I don't think anyone is saying that you should just walk in the room and plop down pain meds every 4 hours and leave without saying word. And prn and scheduled are not different, pain still needs to be assessed prior to scheduled pain med administration as well.
The question is who is primarily responsible for initiating the pain assessment that goes along with every pain med administration. There are many times that it takes a call light to initiate that assessment because we are busy, but if we know a patient is having persistent pain and the pain med we gave them 4 hours ago is probably not adequate at this point, it's our responsibility to initiate that assessment when possible. Nursing care shouldn't be something that patients get only when they ask for specifically and repeatedly.