My floor gives an incredible amount of PRN meds. I'd never really seen some of these PRN orders in clinicals before. I'm wondering if I just missed this before, if it's because of the field I'm in, or if PRN use varies amongst facilities overall.
Obviously most specialities will see prn pain meds, tylenol, sleeping pills, and maybe some prn benadryl for itching, topical creams, or prn ativan for anxiety.
But what PRN meds do you see that are unique or unusual?
Some common ones we see are PRN orders to start IV antibiotics if the pt spikes a temp or a cx comes back positive, prn one time doses of antibiotics for a temp, prn growth factor shots for low ANCs, prn Lasix based on I&Os, prn hydralazine or lopressor, prn IV potassium, magnesium, calcium, or phosphorus, FFP for too high of an INR, prn baclofen for hiccups, and everyone has parameters for blood and platlet transfusion.
I've also seen caffiene pills and nicotine inhalers.
So what PRN orders do you see commonly where you work?
What would be the rationale for that? From the rest of that post, it looks like a pretty acute, if not ICU, unit ... do y'all pan-culture, too, or just give the one dose of abx?
We give single doses of Tobra all the time, and single doses of Zosyn quite a bit (though some of our prn Zosyn orders are to start it q6h). BMT docs aren't as concerned with resistance as they are with not letting their patients die of infection in the immediate future.
Lyte replacements are the big ones for me. Potassium, Mag, Phos, & Calcium I give on a regular basis. (I actually gave all of them to my pt last night...)
Lyte replacements are the big ones for me. Potassium, Mag, Phos, & Calcium I give on a regular basis. (I actually gave all of them to my pt last night...)
Does your unit have a protocol they follow for that? We do, and it's fantastic. No more calling over K's of 3.2 or what not.
Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.
Zofran and Dilaudid or Morphine IVP (post surgical floor), percocet or vicodin PO. I have never given demerol PRN although we carry it in our narc cabinet. For those that can't take morphine or dilaudid, we give Toradol IVP or Fentanyl patches.
So funny... I give IV Demerol probably 10 times a shift, mixed with Gravol! I work on a post surgical floor at times too! Almost never give percocet, it's not even always stocked in the narc drawer. Never given Vicodin.. but I'm in Canada so... We use Atasol 30's A LOT! Never heard of Phenergan until I worked in the US a few months ago (never even seen it here under a canadian trade name). We use Gravol, Maxeran and Zofran most of the time. We use Nubain the most in L&D... Funny the regional differences eh???
On a regular basis, I give the following PRN: Phenergan, Zofran, Inapsine, Morphine, Dilaudid, Fentanyl, Ativan, Valium, Xanax, Ambien, KCl, MagSulfate, KPhos, NaPhos, Blood, FFP, Platelets, metoprolol, hydralazine, labetalol, levophed, dopamine, dobutamine, diltiazem, verapamil, etc.
I have one that's pretty specific to my kind of unit;
On some infants MD's will leave orders for PRN surfactant if their FiO2 requirement is above a certain parameter (>30-40%) at so many hours of life. Most of the time we notify the MD/NNP on call of the infant's symptoms that suggest need for it, but with some infants they just know they might need it or may need a repeat dose.
In our NICU, they don't tend to pass out too much pain medication or sedation (frustrating at times), but the PRN's we do see are usually Morphine, Tylenol, Versed & Fentanyl, in that order, morphine is given far more than probably any of the others.
Morphine, Gravol, acetaminophen, Atasol 30, Percocet, oxycodone, Dilaudid, Zofran, Stemetil, Maxeran, Bendadryl, Imovane, and Ativan. I work on a post-surgical floor (majority ortho and GI). We always have to call for abnormal labs (potassium, hemoglobin) and get an order for Slow-K or transfusion.
RobLPN
70 Posts
Ativan, lots of ativan. Morphine, sleep meds
Sleeping pts are good pts!