Pain med PRN ATC

[Nursingluv101]

I'm not a hospice nurse, I'm a float, tonight I was on CCU and, had a newly palliative care pt. He had no wounds, no traumas...he was old and dying. The first nurse before me told me he had Benadryl PRN for insomnia and worked well for him. He also had Ativan and Fentanyl every 2 hours PRN. He had 0 signs of pain and he denied pain, so at night I just gave him his Benadryl when I report off to the oncoming **** the nurse

Asked me why I did not give him his Fentanyl and Ativan, I said" its PRN " he has 0 s/sxs, she replied but he is palliative and needs to be comfortable! So what the heck when there palliative PRN really means OTC ? Seriously I did not seen any sx/s so why should I give it?

[tewdles, RN]

I'm going to trust your clinical judgement in this post. You say that he had no evidence of discomfort per assessment and verbally denied discomfort on interview...so, indeed, it would be appropriate to hold prn meds.

[MissIt]

I agree. You don't have to give meds just because they are there. Some people will even prefer to have a little discomfort over the meds at times. Did he sleep okay, seem restless? If he had a comfortable night, you did a good job.

[FLArn]

If the patient is able to speak, ask him. The pain is as severe as he says it is. If he is not able to speak, look for signs such as grimacing, moaning, guarding, restlessness, agitation, rapid/labored respirations, elevated B.P. etc. Hospice does not mean drugged to unconsciousness. Look back at MARs if meds were not given for a shift, did the patient require large or frequent doses to get comfort? Then he might need small doses more frequently. (This would also show that he needs a "base" or routine dose ATC in addition to the prn dose.

[AtlantaRN, RN]

Thats why it's prn instead of scheduled....you did the right thing.

Did day nurse come into a patient in pain? No? you did the right thing.

some folks just want to tell everyone how to manage the patient.....