mixed medication times

Hello, as a new nurse, I have a question for the more experienced staff. I take care of a hospice pt that has a pain pill sched q4h while awake and a breakthrough order of same med prn q4h. Can I medicate in between the last known q4 dose every two hours using the prn while the pt is awake?

Depends on the med- for example, if it's something that contains Tylenol (Pecocet, Vicodin, etc....), then no, you cannot give an extra PRN dose in between the scheduled doses (you'd be overdosing on the Tylenol). I would clarify the order with the ordering physician.

I would clarify as far as max dose in a time period or ask for something else for breakthrough. From my dad experience I say who cares if they want it give it to them I had nurses taking care of my dad (in the hospital the last 2 weeks before he died) who didn't want to give him too much pain med because it might cause constipation SO or he'd get to much SO and had to tell them that too.

I believe the Tylenol is usually written 'Not to Exceed 4000 mg in 24 hours'.

I can say for certain that one patient of mine did have MS04 written like this: 120 mg q. 12; 60mg (or was it 90?) q. 2-3 hours for breaktrhrough pain. Mind you, no Tylenol there. Maybe that will help? :D

Great points about Tylenol within meds. (meds. that end in "cet" usually have Acetaminophen in them like Darvocet and Percocet).

If this patient isn't already on a Fentanyl patch, the doctor might want to do that...then they can be getting pain coverage even when they are asleep and NOT have to wake up in terrible pain!

hchiker wrote:Hello, as a new nurse, I have a question for the more experienced staff. I take care of a hospice pt that has a pain pill sched q4h while awake and a breakthrough order of same med prn q4h. Can I medicate in between the last known q4 dose every two hours using the prn while the pt is awake?

It really depends on the medications. One thing they do here in Western Australia is use Oxycodone and Tramal quite a bit. A patient can get both medications. The Tramal 50 mg to 100 mg is every 6 hours and the Oxycodone 5 to 20 mg every 4 hours. They also use an intravenous form of Panadol (basically the same as Tylenol) called Perfalgan. Damn, this stuff is amazing. It really works well in conjunction to a PCA. Here is a link that provides some information on the drug:

http://www.racgp.org.au/cmi/bqcperfa.pdf

Thanks for that link, kimmie! Perhaps you can post it in the Medication Forum, also? :)

'Cat'

cougarnurse wrote:Thanks for that link, kimmie! Perhaps you can post it in the Medication Forum, also? :)

'Cat'

Sure thing...Anything for a mate.

Cheers :)