meds - confused

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If an EN who has completed and passed the meds subject was to give a patient 500g of oral paracetamol because of a headache which was prescribed, Why would she be reprimanded by the RN for not consulting with her prior.

Specializes in Complex pedi to LTC/SA & now a manager.
Well, if someone actually did order 500g of acetaminophen, you might as well have them order acetylcysteine as well and call the ICU to let them know they'll be getting an acetaminophen overdose patient. :/

Perhaps the transplant coordinator too as an over 100x overdose is going to be difficult to reverse with an ICU stay

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Sounds like this was PRN medication. If you check EN scope it will say something along the lines of prn and variable dose may only be administered in consultation with and under supervision of/ or delegated by RN.

Make sure you are clear on your scope of practice and doses of common meds.

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Let's assume it was a typo and the order was for 500mg not g of paracetamol.

The RN would be upset that they weren't consulted if the paracetamol was a PRN order as that is often the scope of practice of an EN to consult an RN before a PRN can be administered so that the RN can assess the need for the med.

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Specializes in Complex pedi to LTC/SA & now a manager.
Let's assume it was a typo and the order was for 500mg not g of paracetamol.

The RN would be upset that they weren't consulted if the paracetamol was a PRN order as that is often the scope of practice of an EN to consult an RN before a PRN can be administered so that the RN can assess the need for the med.

If you look at OP's posts they state 500g is NOT a typo.

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Specializes in Nurse Leader specializing in Labor & Delivery.
If you look at OP's posts they state 500g is NOT a typo.

They never said that, though. This is the only thing they said in response to whether or not it is a typo:

well im glad you saw that cause i didnt haha im hoping t is a typo. yes 500g admisistered and prescribed 4/24 pm

So maybe not a typo by the OP, but still quite possibly a typo wherever the OP read or heard about this. I'm still very unclear of the context. They have assured us this is NOT a homework question, but s/he didn't actually say where/what this is about.

I HAVE to assume it is a typo/misspeak, because it would be logistically impossible to give someone 500g of APAP in one dose. As someone else illustrated, that would be several liters of liquid, or, what? 100 pills?

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I dont know why you are all getting so involved with this question. It was just a general discussion, not homework, nothing serious and was NOT a typo. If you really want a solution to figure out, wait until i return back to school and im sure i will have many assignments that need to be discussed and answered! But in the mean time just chill :-)

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I dont know why you are all getting so involved with this question. It was just a general discussion, not homework, nothing serious and was NOT a typo. If you really want a solution to figure out, wait until i return back to school and im sure i will have many assignments that need to be discussed and answered! But in the mean time just chill :-)

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Well, you asked a question. Expect answers. :)

We are all still concerned about the 500 grams . . . . that is a huge overdose of medication.

I'm still not sure if you are talking about an "enrolled nurse" or the equivalent of a LVN/LPN here in the USA.

Either way, working under the RN's supervision, yes you must talk with her about administering the drug. Depending on what EN stands for . . . either before or after.

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i know the 500g is a large amount hey. Yes i think an LPN is equivalent to an enrolled nurse or EN, im only just through my first semester so its all kinda new to me. but as working wise an EN would have to be supervised under an RN at all times, im assuming its kinda the same over there.

A student EN is studying to be an EN

a EN has finished studies and registered as an EN but both still have to be supervised by RN. hope that helps ;-)

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Specializes in Nurse Leader specializing in Labor & Delivery.

So did this actually happen?

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Specializes in Complex pedi to LTC/SA & now a manager.

A student or licensed EN that administers a (likely lethal) 100x overdose of acetamenophen will likely be charged with malpractice regardless if the RN was consulted. If the RN was consulted and agreed for unknown reasons that the EN/SEN should administer a lethal dose of acetamenophen will also be held legally responsible.

Some PRN meds require additional assessments and consultation with the RN or physician.

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Specializes in Complex pedi to LTC/SA & now a manager.

For reference the single lethal dose of acetamenophen is 7.5grams. A single 500g dose is more than 33x the lethal dose.

Students should consult with their instructor or supervising licensed nurse before administering medications. Licensed EN/LPN need to follow the legal scope of practice & facility protocol regarding consulting with RN or even physician for PRN meds or otherwise. In the US an LPN has their own license and legal responsibilities but cannot initiate certain tasks/treatments/orders hence why they practice under the direction of an RN, APN, MD, DO, DMD, or DDS. The supervising/consulting professional does not need to be onsite but available for consultation in person, via phone, email or other messaging system.

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