Hypothetical Question re: prn meds

[Sleepyeyes]

I don't know how the subject came up but here's the scenario:

Dr. orders 1-2 mg. Dilaudid IV q4h.

Pt doesn't usually ask for pain meds, rates pain low. You give 1 mg.

In only one hour, Pt reports no relief.

Do you give the other 1 mg? or do you make the Pt wait?

[P_RN, ADN, RN]

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.

[liberalrn]

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.