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Discussion

PRN orders

If an order is written for Tylenol 650 mg po PRN headache/fever can the Tylenol be given for pain/menstrual cramps (outside of the order parameters) with "nursing judgment"? I'm a newer nurse (a year) and tried to get a Tylenol order changed so we could give it for pain, but the on coming nurse said we can just give it using our nursing judgment. I know if the situation was say Ativan 2 mg po PRN for seizures we then couldn't give the Ativan for anxiety even though we know this is an indication for it.

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    I would have no problem giving the Tylenol for that but when it comes to narcs I won't give them for anything except for what the indication is.

    I've never once gotten in trouble for giving a pain med for a headache when it states "PRN for surgical pain"'or what not. But if you want to CYA you could always ask to have "pain" added in.

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    • Experts

    I'm surprised they specifically stated "headache" with APAP. Something like Imitrex or

    Flexeril might have a more specific indication, but usually basic non-narc pain relievers (Tylenol, Motrin, naprosen) are ordered for pain in general.

    I agree with PP: would have no problem slipping that Tylenol to a patient for menstrual cramps, but I wouldn't do that with anything that was schedule.

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    I'd give it. Not worth the headache for me to argue with the Resident about changing a tylenol order.

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    • Author

    Thanks for the feedback! I'll be less nit-picky next time :) Ativan was a bad example as narcs are way different than Tylenol. I've just heard horror stories of nurses getting fired for giving a med in any way other than ordered.

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    • Experts
    If an order is written for Tylenol 650 mg po PRN headache/fever can the Tylenol be given for pain/menstrual cramps (outside of the order parameters) with "nursing judgment"? I'm a newer nurse (a year) and tried to get a Tylenol order changed so we could give it for pain, but the on coming nurse said we can just give it using our nursing judgment. I know if the situation was say Ativan 2 mg po PRN for seizures we then couldn't give the Ativan for anxiety even though we know this is an indication for it.
    Technically no.....the order is specific and should be followed. I'd give it but I would leave the doc a note to add pain to the order when they make rounds. I will leave a sitcky on the progress notes/chart.
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