Hello Fellow Nurses, input on giving PRN narcotic pain meds needed !!!!!

busy-bee · Sep 21, 2007

I don't understand what you mean by rule book.....follow the prn order and assess the outcome of the prn med.

lvnandmomx3 · Sep 21, 2007

If the pt says they are in pain that is what the prn pain med is there for, give it. We can't judge if someone is really on pain we have to believe what they say if they verbalize it, if they are non verbal we can assess the situation.

Lisa_RN · Sep 23, 2007

the way i feel is, if it is ordered give it as the order is written. i'm sure everyone has enfountered the frequent flyer. the ppl that no one can find anything wrong. you know all they want are narcotics. they watch the clock and call at exactly 4 or 6 hours for pain meds. you can bank on that. i does sometime can get to you, but the dr. know the patient and he still ordered it. all you can do is give it!

gentlegiver, ASN, LPN, RN · Sep 23, 2007

Big pet peeve of mine is the nurses who refuse to give PRN's to pt's unless the pt requests the med. This may work for "with-it" verbal pt's, however, so many times I see a pt in obvious pain and is incapable of requesting anything let alone meds either due to dementia or aphagia. Just follow the Dr's order, if they request it, give it, or if they look like they are in pain, give it. It can help those who really need it. Let the Dr worry about the pt's that are biding time til the next med, just make sure you let Dr know the pt is behaving in a drug seeking manner.

NataRN · Sep 23, 2007

I definitely give PRN meds per MD orders and as patient requests. If the patient is getting too sedated - I call the doctor to let know. I know that many people seem drug-seeking and it's frustrating to feed into their dependency, but the truth is that we never know for sure who is telling the truth and who is not...

When the patient seems to be too sedated, I take couple of minutes before going into the room - a lot of times they will be asleep when you go in.. Then I wait until they wake up and are less lethargic.

leslie :-D · Sep 23, 2007

i believe the op has a couple of other threads re prn narcotics.

she was curious to know if any regulations exist as to when a prn can be administered.

for instance, scheduled meds can be given 30-60 min before/after the scheduled time.

what are the parameters when it comes to prn meds...specifically, narcotics?

i've searched for links, and cannot find any, addressing the question.

the only thing i've found is if a med/narc is ordered prn q 2-4h, then you can give it q2h at the minimum.

i was taught in school, that prns have to be given as ordered, w/no flexibility or window of administration.

leslie

kanzi monkey · Sep 23, 2007

start with the lowest dose--so, if pt ordered for 5-10 PRN, try the 5. If pt is coming off a stronger pain med, I still start with lowest, maybe add some tylenol, then CLOSELY assess after giving that first dose. If pain is creeping up after the med should have peaked, then increase the dose. After that, I hold them at that dose if it seems to be making them comfortable. If they ask for pain med early and they are getting max dose, I usu. start on RTC tylenol (it's ordered PRN, but if I let the HO know, they may just write it RTC so that all nurses are consistent with dosing). If this isn't working, contact doc to discuss changing med.

Before any of this however, ask the pt. what he/she takes at home, or check their chart. If they have chronic pain and they are getting the same or lower dose from what they were getting at home, they need an increase. Possibly a pain consult if they have been taking really high doses in the past. If they are a chronic pain pt and they have taken the drug that's ordered in the past, I might not follow the "start lowest" rule because their pain can get out of control fast, and playing catch up can extend their hospital stay increasing risks of complications and generally make the patient very unhappy. In these cases, use your judgement.

If they are narcotic naive, DEFINITELY start with lowest dose, monitor for pain and nausea. Assess what pt. has been eating--if they haven't eaten yet, have hypoactive bowel sounds, distended belly, etc, I'd try to give something IVP instead of PO to prevent n/v--vomitting--not fun with acute pain.

Also, check mental status and VS. No matter what. If they are lethargic with dec. respirations, assess what they've had that day for pain control--or any other activities that may cause this. If they've had a lot of meds, give lowest dose or Tylenol, or maybe toradol if it's avail. to that pt. If they seem out of it and there is no clear reason, contact the doc to discuss. If they have a history of chronic pain with narc treatment or IV drug use and seem a little lethargic, I will use my judgement but will probably give them the higher dose as long as their VS are stable.

Also, if they're ordered for Oxycontin, I will usually give it cause it's long acting and won't necessarily depress their system or worsen mental status change. However, I ALWAYS use caution in these cases and usually discuss this with colleagues or the doc before I give it. If they are already experiencing respiratory depression, I will definitely contact the doc before giving. But remember, NOT giving will likely have consequences, so giving those long acting pain meds appropriately is really important.

I hope this helps!