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Hypothetical Question re: prn meds

Sleepyeyes Sleepyeyes (Member)

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Well, having gotten deeply involved in pain mgmt., I can tell you that the majority of pain mgmt. authorities will say that if the pt is competent and capable of self dosing with the PCA, then PCA should be used. Since the pt has a patent IV, it seems like this would be approp. (of course, there may be other issues preventing PCA that can't be revealed here...I'm just saying what the standard of care is in general).

Again, depending on a nurse to bring a pain med puts the pt in the position of having to wait...possibly a long time, to get relief. What if the nurse can't get to the pt quickly? Pain can escalate to the point that the prn dose is ineffective. Then, too, there are nurses who are very judgemental about giving pain meds (and I am NOT saying this is the case, just a general obs.), and will say they don't think the pt really has that much pain, thus putting their own feelings in place of the pt's assessment of pain.

Check the AHCPR guidelines on pain mgmt; research by McCaffery et al, just for examples...

Remember, once the pt goes home, he will be resp. for his pain mgmt. What better place than while he is in the hosp to start learning when and how to medicate for pain.

One thing i often think about is- you sometimes cant take away all thier pain, but you can lessen it!

I go ahead a give the additional dose that is prescribed in that 4 hour period and then give the next dose, if needed, 4 hours from the first dose. I've asked the docs about this and they agree. I don't remember reading a protocol though . . .better go look it up.

If you assess the pain quicker, you can feel more comfortable giving the drug as above. It wouldn't work if you gave the first dose and then the second 1/2 before the next prn dose was due.

Good question . .


If 1-2 mg q 4his ordered....and I agree that's not an appropriate way to write it.....

If I gave 1mg at 2pm the second 1mg at ___whatever time...

.then the next dose would be given 4 hours from the FIRST 1 mg and I would then give 2 as the dose.

Otherwise you are making the patient wait an extra hour.....or you end up going in there q 2h and playing catch-up.

What is not figure out here? Give the med as written--1-2mg q 4 hr. prn. I prefer this type of order--gives me a little wiggle room so that I can scale up for pain management w/o tracking down a doc. I also prefer having oral/iv choices for analgesia--maybe pt has deep wound that requires a heavy hitter analgesia for the dressing change, but then only needs maintenance oral drub for pain relief. I would assess this pt's pain level and vitals and maybe give the 2mg right off the bat. Dilaudid is potent, but we usually way undermedicate for pain.......But if only 1mg was warranted, and then no relief, I would give the additional 1mg, and time 2nd "full" dose off the initial 1mg. If that's clear.

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