PRN meds

[mom-wife-nurse]

Ok, this is mainly geared towards LTC nurses. If you have pt ask you for a PRN and it is too soon for them to have it, do you take it to them when they're eligible to have it? I always tell my pts that I can't just bring them a PRN. They need to tell me what is wrong and I will medicate as ordered. Some nurses I've worked with will just take them the PRN when they are eligible for it if they've already asked. What do you all do?

[LadyFree28, BSN, LPN, RN]

The question is- what does ethnicity have to do with any patient that wants a pain med or anything else, whether the nurse feels or doesn't feel there is a legal reason to give that med?

The answer is, cali was making a figure of speech; meant Mexican standoff:

http://www.thefreedictionary.com/_/dict.aspx?rd=1&word=Mexican+standoff

NOT talking about ethnicity...

[Sam J.]

The answer is, cali was making a figure of speech; meant Mexican standoff:

Mexican standoff - definition of Mexican standoff by the Free Online Dictionary, Thesaurus and Encyclopedia.

NOT talking about ethnicity...

Never heard that phrase- live and learn? (But- the Wicki version claims it is 'confrontation among three opponents armed with guns').

I think your version is bit more tame for the situation above.

[withasmilelpn]

I had a resident who demanded her vicodin when night shift came on. Sometimes she wouldn't even wait for report to end. According to PM shift, she never demanded it from them. As many times as I asked her what was wrong, she would stare at me with the most defiant, hateful look and say nothing. So no assessment of a need, I left the room. The call light went back on. Spanish stand-off. I never was able to get her doctor to change the order to routine. Apparently, he was just fine with things as they were. The PM shift nurses laughed at me, the CNAs complained, and even her neighbors said I should give it to her just "because".

Honestly, this could be determined as neglect. I would've administered the med as long as there were no medical reasons not to, (low blood pressure/or resps) and documented the request, the refusal to answer questions as to why/ or give you an assessment of her pain, along with observed FLACC scale symptoms, keeping it as objective as possible. (of course we don't use refuse any longer, we use decline, or chooses not to, or simply state does not respond when asked - got to love PC nursing language.)

My feeling that this is a trust issue, and your patient has their own reasons for not answering. Perhaps seeing this as a 'power play' on your part and finding it intrusive, or they perceive you as uncaring, or in the past had a bad experience with another nurse, you remind them of their evil stepfather, and on and on, etc etc.

As to needing a reason, you have one I'm sure - the doctors order should state a diagnosis. Which in my view is reason enough, as long as I'm giving it as prescribed, safely - my patient not cooperating with my assessment is not a good enough reason in my book to not give it.

In turn, I would work hard to win this patient's trust and explain how monitoring pain can help them in developing a good plan.

Two good resources about pain:

How to tell if your patient is REALLY in pain. (Or a PIA)

Home

Also for the FLACC scale:

Pain Scales and Pain Assessment

[caliotter3]

The question is- what does ethnicity have to do with any patient that wants a pain med or anything else, whether the nurse feels or doesn't feel there is a legl reason to give that med?

The only person discussing and complaining about ethnicity is you.

[Sam J.]

The only person discussing and complaining about ethnicity is you.

Nobody 'complained'. Somebody did mention that it was not appropriate- me. And somebody else then went further to elaborate the origin of the phrase- and then I went further to research it, out of curiosity. Fact being- ethnicity isn't appropriate to be mentioned, at all, whether the phrase was meant to be ethically based, or not. The issue really is a nurse antagonizing a patient about a pain med- as in a 'stand-off'. Not appropriate. In fact, you are the one that discussed ethicity by mentioning 'Spanish'.

[morte, LPN, LVN]

more than likely the patient wanted it for sleep, and knew she couldn't say that. I have no problem expecting an answer, or waiting for one.