several prn pain med

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hi,

i am a new grad LVN, just got my first job at the LTC.

I'm confused about how to give prn pain medication.

Today, my pt. was requesting Vicodin for pain.

Order was Vicodin q4h prn/ ultram q6h prn.

Last dose for vicodin given at 9pm.

pt. was asking for vicodin at 12pm ( which is 1 hour early.)

So,, I told him that it's not due yet and I can give ultram if he wants.

He took ultram at 12 and at 1240 he was asking for vicodin.

I thought it's too early to give another pain med since I just gave him one. So I asked him if he can wait about 30 minute until the ultram kicks in. I also asked my supervisor about this and she said not to give vicodin yet.

Later, he didn't call me again for the pain pill but, in the morning I found out that he was mad at me b/c i didn't give him the vicodin.

I asked if he wants it now but he refused b/c he was mad.

Later, morning nurse came and told me that I was supposed to give him the vicodin.

I'm so confused.. Can someone tell me what I was supposed to do??

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Specializes in Cardiothoracic ICU.

sounds like a resident who is trying to create drama between nurses. You should tell the patient that you did not administer the vicodin because the pain appeared to be controlled with the ultram.

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Well first, lots of times folks are prescribed different pain meds for different kinds of pain. If this is unclear to you, call for clarification. And lots of times, folks are prescribed different pain meds for different levels of pain. If this is unclear to you, call for clarification. Because sometimes, folks forget to d/c orders they meant to d/c, and you might have run into that. But one thing needs no clarification: if he were in pain when you offered him the med, he'd have taken the pain med.

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Specializes in Developmental Disabilites,.

I have seen orders like this before for the elderly. I have seen it done to prevent confusion that stronger narcotics can cause. The only thing is it is usually written ultram q6, vicodin q 4 for break though pain. If they need the vicodin q4 they get it.

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Specializes in Geriatrics, Home Health.

There should be some parameters to the PRNs, like "Vicodin Q4H PRN pain unrelieved by Tramadol"

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Specializes in LTC.

If the resident stated that they still had pain.. I would have given them the vicodin. 12am is pushing it for q4h.

I would have told him give the Ultram a chance to kick in.. by 1am if your pain is not relieved I will give you a Vicodin.

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Three things: 1 Vicodin is 500mg Tylenol. If he/she gets 2, that's a gram. 4 grams in a 24 hour period is the max r/t acetaminophen max. This means 8 tabs or typically 4 doses of med per patient. Percocet is 325mg a piece of tylenol. Rocicodone (Oxycodone IR) has none.

The order is Q4h. It's NOT Q3h, nor Q3.75h. That said, you used nursing judgement and they were not happy about it. Pt ed on the toxicity of tylenol is sometimes all that is needed for some of these patients.

PO pain med onset of full effect r/t absorption is 45min-1hr. Keeping that in mind, if he asked for another pain medication before that window. IV is 15 - 30 minutes, typically (some get effects sooner, however)

Finally, if the patient is not getting effective pain relief w/ whatever pain scale your institution uses, a call to the MD for a different med may be necessary.

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Specializes in Chemo.
hi,

i am a new grad LVN, just got my first job at the LTC.

I'm confused about how to give prn pain medication.

Today, my pt. was requesting Vicodin for pain.

Order was Vicodin q4h prn/ ultram q6h prn.

Last dose for vicodin given at 9pm.

pt. was asking for vicodin at 12pm ( which is 1 hour early.)

So,, I told him that it's not due yet and I can give ultram if he wants.

He took ultram at 12 and at 1240 he was asking for vicodin.

I thought it's too early to give another pain med since I just gave him one. So I asked him if he can wait about 30 minute until the ultram kicks in. I also asked my supervisor about this and she said not to give vicodin yet.

Later, he didn't call me again for the pain pill but, in the morning I found out that he was mad at me b/c i didn't give him the vicodin.

I asked if he wants it now but he refused b/c he was mad.

Later, morning nurse came and told me that I was supposed to give him the vicodin.

I'm so confused.. Can someone tell me what I was supposed to do??

You were right for with holding the pain med. Remember it is your job to keep this patient safe. You are in charge of this patient and no one else. Know your medications. Things to remember when giving narcotics make sure that they are given an hour apart this includes sleep aids. Then next thing most patients who are sleeping do not need pain meds. Beware of patients who have numerous pain meds ordered, they could be easily over medicated. Pain management is a hard to treat, more so with drug seeking patients because it takes more for him or her to gain relief. On that note, he or she could be in the hospital because they are seeking drugs. Do not be manipulated into not following the MAR.

As far as the patient you described remember, just document everything. When you gave it, the response and when he refused the medication. This will protect you that you did your job. Do not get into game playing like the other nurse did to you. It is not wrong to withhold pain medication, it about safety, judgment and patient care.

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Specializes in Hospital Education Coordinator.

the hospital where I work does not allow MD to write such a vague order. It carries too much responsibility for the nurse and the patient could be overdosed or underdosed. I think you did the right thing, but I believe you ought to bring this to the attention of your DON to prevent further problems.

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thanks everybody for the replies.

I feel much better now b/c some of you said i did the right thing..

and.. Flo., you are right.. my co-worker said it was for the break through pain.. (which i didn't understand what it meant at that time..)

I guess I will get better as I get more experience..

Thanks again for the good advice.;)

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

You did the right thing. Never give ANY pain meds - especially narcotics - earlier than they are intended - you leave yourself open for litigation and can cause serious damage/death to a patient. I know we all give meds a little earlier to get our med rounds done, but you can explain why you can't give too many narcotics - I have actually said to a patient who was demanding narcotics only for pain 'as nothing else worked' that he couldn't have them cos he will possibly stop breathing and die! I made it a bit more technical than that of course, but it pulled him up short a bit and he was given paracetamol instead. Don't forget also that patients get used to narcotics, want more, etc and some have drug-seeking behaviour - even if they aren't aware of it. Patients quite often get institutionalised as well. If a patient is demanding narcotics, get his pain levels, chart it, and report to a supervisor/senior nurse and let them deal with it. They can then decide what to give the patient.

Even if you do report this to your senior nurse, you are ultimately responsible for YOUR practice and can be hauled up in court for questioning. Never give into patient demands, even if they are in agony. Always get further orders from their responsible Dr or senior nurse, and ensure you chart everything.

Unfortunately (or maybe it's a good thing in a way) we live in a legal world and have to be aware of that too.

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It sounded like a prn break thru type order to me.

I know in LTC they are cracking down on assessing pain meds and the results.

Make sure you are rating the pain before the med and after the med.

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