Holding prn meds for attention seeking behavior

Nurses General Nursing

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I need help in making this decision. I have been a nurse for 27 years. recently I had a patient who was obviously attention seeking. she asked for a prn pain medicine but it was not given to her With her morning meds. She thought the pain medicine was in her cup of morning meds. After taking her morning meds five minutes later she stated the pain medicine was effective. After giving her one on one attention feeding her a few spoonfuls of breakfast telling her she looked nice for the day she was soothed. So was I wrong for not giving her the requested PRN pain medication or should've I just given her the PRN med and called it a day. The patient travels to a program after breakfast, at the program there are several nurses there, if the patient were truly in pain she could've asked for the medicine again and never did. What say you?

Specializes in ICU.
New acct, 1 post: I think we just did someone's homework for them again.

Yes, because a nurse would not ask after 5 minutes if a PO med was effective. It's usually 30 minutes for a PO med. 15 for an IM and 5 for an IV push. Either homework or trying to get people riled up. I will not bite here. Lol

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Specializes in ED, ICU, PSYCH, PP, CEN.

Hope and pray this student doesn't stay in nursing school. To lie and say you've been a nurse for 27 years and then ask such a question. Serious lack of integrity right out of the door. I think I'm going to puke now

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OP didn't wait 30 minutes because the pain med wasn't given, was only try to prove a point, that the patient didn't have pain in the first place.

Where OP is wrong (well one of the ways) is assuming the patient never had pain because she was distracted with attention. Sure some pain can be reduced and managed with distraction but here's the rub, your attention was fleeting and you have no idea of its half life.

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Specializes in Med/Surg, Academics.

I went through a considerable amount of moral distress associated with med-seeking behaviors for presumably acute pain when pts did not show any outward signs of acute pain. (Chronic pain is different.) I got sick and tired of trying to "wean" people off IV pain meds who obviously were improving but still wanted their Dilaudid q2 IVP and who would throw a fit at the mention of moving to PO, lengthening the timing, or reducing the dose. I educate once, get yelled at once, then I don't give a flying ****. I can. No longer be more concerned about the patient than the patient is about themselves. However, unlike the OP, I'm always honest about it.

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Thank you for your reply… Yes there are several key points missing from the story… The patient was receiving scheduled pain meds and I wanted to give her the scheduled pain med before giving her a PRN… Am I still wrong?

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Specializes in Hospice.
Thank you for your reply… Yes there are several key points missing from the story… The patient was receiving scheduled pain meds and I wanted to give her the scheduled pain med before giving her a PRN… Am I still wrong?

I think you're making it up as you go along.

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Specializes in Oncology; medical specialty website.
Thank you for your reply… Yes there are several key points missing from the story… The patient was receiving scheduled pain meds and I wanted to give her the scheduled pain med before giving her a PRN… Am I still wrong?

Yes. If s/he is in pain, the patient will need not only the scheduled med, but most likely something for breakthrough.

Ex.: Patient getting MS Contin and has MSIR for breakthrough. If patient is due for MS Contin and says s/he has pain, it's appropriate to give the scheduled med and the breakthrough med.

Do some research on pain management. Margo McCaffrey's work is an excellent place to start.

Are you really a nurse with 20+ years exp., or are you a student? Why not just tell us the full story right off the bat?

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The bottom line is: If there's a valid order for the PRN pain medication, and there's no contraindication to giving it..... just give it.

And "They don't seem painful" or "They're drug-seeking" are *not* valid rationales for holding an ordered med.

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It's amazing that so many in the medical field have no clue about pain or breakthrough pain. Maybe these people need to experience it themselves-would be interesting to see how many other medical professionals treat them as so called attention or drug seekers.

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Specializes in PACU, pre/postoperative, ortho.

I would venture a guess that had this pt been set on getting the maximum available pain meds, she would have known exactly what that pill looked like. She would have called you out on it & asked where her pain medicine was because it sure wasn't in that medicine cup!

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Specializes in Med-Surg.

So much information is missing.

She had a scheduled and prn order? What was the scheduled med and what was the prn? Where was her pain and was it chronic or acute?

Was she showing any signs of over sedation? Why did you hold the med?

It's wrong to refuse to administer a prn without good reason. And if there is good cause (unstable VS, over sedation, ect...) then the MD needs to be notified of those changes.

Unethical to mislead a patient and lie about the medications they are receiving.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
I need help in making this decision. I have been a nurse for 27 years. recently I had a patient who was obviously attention seeking. she asked for a prn pain medicine but it was not given to her With her morning meds. She thought the pain medicine was in her cup of morning meds. After taking her morning meds five minutes later she stated the pain medicine was effective. After giving her one on one attention feeding her a few spoonfuls of breakfast telling her she looked nice for the day she was soothed. So was I wrong for not giving her the requested PRN pain medication or should've I just given her the PRN med and called it a day. The patient travels to a program after breakfast, at the program there are several nurses there, if the patient were truly in pain she could've asked for the medicine again and never did. What say you?

Unethical as hell.

Dishonest.

I say that I am glad that you do not practice near me and there is little risk that any person that I care about might be subjected to this sort of nursing practice.

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