Jun 13, 2012, 10:59 am
Last edited Jun 13, 2012, 10:59 am
update #1
You can give PRN but should exercise discretion. Ask if its really required, are there alternative therapies, are we addressing the symptoms and what are side effects and etc. Also when giving sub cut, IMI or IV, one has to check meds with another nurse. If you start using PRN based on what you have suggested, then it would have been better off being written as a standard order. Given this, there must be a reason why doctors have written it as PRN (as and when required).
Example - A patient presented with shortness of breath, was on 2 litre oxygen via NP, is a CO2 retainer. My student nurse was quick to suggest medicating using PRN salbutamol. I disagree because its like assuming the obvious. I got student nurse to auscultate for wheezing or crackles. No wheezing, hence discounting possibility of bronchial constriction = salbutamol would be useless. Pt was also tachy and salbutamol can cause tachycardia as its a beta 2 agonist and may stimulate also beta 1 in the heart to increase heart rate. Ausculation - pt had plueral effusion, x-ray conducted and confirmed the same. Hence, I recommend to undertake obs and use discretion, had we gone with the PRN salbutamol would have delayed discovery and appropriate treatment for patient.
cheers
