Proper PRN Administration

The worst part of having a job where you have to deal with people? Dealing with people.

Stuff like this is why I prefer to work with patients that have a tube down their throats. The only advice I can offer if this behavior bothers you is to find a different job... preferably one where patients are unconscious/unresponsive. I think that is the only setting where you can truly use judgment about PRNs. Otherwise, if the patients say they need their PRNs and you don't give them, you are just setting yourself up for a really difficult shift and buying yourself an appointment with your manager over patient complaints about you.

With the whole reimbursement/satisfaction thing going on, we are encouraged not to use our judgment and just give the patients whatever they want. Nursing judgment with PRNs isn't welcome anymore.

Each prn order should have the reason for which it may be administered or what sign or symptom you are trying to control or alleviate. Since symptoms are subjective such as pain and anxiety, it it best to believe your patients as long as it safe to administer it. Some nurses want to judge and say I do not think my patient is in pain because they are talking on the phone, eating, or using the internet or whatever the nurse thinks they cannot do while in pain.

Signs are objective such as you can hear the patient coughing and can see what they cough up or you can hear hyperactive bowel sounds or a heart murmur for a few examples.

In your case if you do not hear the patient cough and lungs are clear, etc you do not have to medicate the patient. The problem may be that other nurses are medicating to just keep the patient quite and I admit I have often just given the medication if I know it will not hurt the patient and just chart the patient states he has been coughing and then my assessment. It is best if you are all on the same page especially in your type of setting, but that may be difficult to achieve! That may be part of the problem here and then you are placed in a bind. In terms of the patient and his anxiety I would just believe him and medicate him if he stated he is experiencing it.

Elixirs are alcohol based and some cough suppressants have codeine in them. What is the medication..is it an expectorant or suppressant?

I would be asking the prescriber to d/c the robitussin on the man with no cough obsessing over it.

Suppressant...as for anxiety, that's not my concern as much although we're Supposedly encouraged to redirect them whenever possible and use "our skills" unless the or is too far agitated.

One can say the whole psychiatric field is grey. I was asked by a few colleagues who asked me for my rationale for administering a PRN milk of magnesia (MOM). They claimed that their BM book says this PT went yesterday. First off, this BM book is subjective because we ask the patient for this information. This patient approached staff for "the powder **** that makes me ****." I used to work on this unit for years and this patient never ever asks for PRNs. This PT is further complicated because he has a severely resected bowel. It was about 1500 hours when he asked for this PRN and I gave it to him. My first rationale is that I believe this patient. My second rationale was perhaps the book is fallible, after all the unit had a patient in the last year die from a perforated bowel from an impaction. My third rationale, milk of magnesia is rather benign and won't hurt the patient. My fourth rationale is that the PT is on severely constipating medications like Clozaril. I guess the other nurses on the unit have their own philosophy against the way I practice my psychiatric nursing. However, it is ultimately my license and I can live with giving someone diarrhea versus someone dying of an impaction because I believed a book over the patient. The night shift charge nurse told me I could hurt the patient by giving him the MOM when he doesn't need it. She told me he could have horrible runs and that could lead to a bad outcome. I have never heard of someone dying of milk of magnesia overdose in my 5 years of nursing and 2 years of nursing school. Of course I was unable to articulate my rationales at the time either.