Can a LVN/RN or someone who is experience in meds, please help me....

  1. I have some questions about medications that would be greatly appreciated to answer them:

    1. If a patient is out of the room when you bring in his meds what should you do?

    2. If your patient is scheduled for a diagnostic study that requires being NPO and has orals meds ordered what should you do if the meds are to be held? How do you document this on the MAR?

    3. If your patient vomits 15 minutes after you give them their meds - what should you do?

    4. To ensure that a patient takes his meds - what can you do?

    5. What should you do if an adult patient refuses a medication?

    6. What should you do if a drug is omitted?

    7. What medications / classifications of drugs are best taken without water?

    8. What type of oral med forms can be crushed? Which ones cannot?
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  2. 5 Comments

  3. by   weetziebat
    I can tell you what I would do. But that doesn't necessarily mean it is what everyone would do.

    1. If my patient was out of the room when I brought his meds I'd take them back and keep them till I was able to give them myself. Never know what will happen to them otherwise.

    2. If the patient is scheduled for a procedure for which he needs to be NPO, I check with the M.D. if I have any doubts, but most meds can be held and given after the procedure.
    On the MAR I would put my initials and circle them. On the back would write 'meds held. Pt. NPO for procedure. Will give later' - when I gave them later I would again sign my initials under the circled ones, to indicate they'd been given.

    3. If your patient vomits 15 minutes after meds are given you do not re-give the pills - no way of knowing how much had been digested. Leave till next dose due.

    4. Well, if it is someone like a prisoner, or a mentally ill patient, who there is a question about such things, you could make them open their mouth after you watch them 'swallow' the pill and look inside, asking them to lift up their tongue as well.

    5. If I had a adult patient refuse a med, I'd make sure they understood what the med was for and why they should take it. Then I'd ask the reason they don't want to take it. A mentally intact adult cannot be forced to take anything they don't want to. Just be sure to document it and let the charge nurse and doctor know.

    6. If a drug is omitted? As in 'forgotten' to be given? It would depend on how long it was before I realized the error. If it was, say a half-hour, I'd just go ahead and give it. If close to the time for the next dose, I'd wait and make sure you again tell the charge nurse and M.D. - would need to fill out incident report if med not given for any reason.

    7. Suppositories. Nah, just funning with ya! But if you are talking about oral meds what else would you give them with? Maybe I've been out of acute care too long. Are there actually oral meds not given with water? Something new to me.

    8. Generally the enteric coated tabs and the extended-release capsules should not be crushed. Sure there are others but can't think of them at the moment. You can always check a drug handbook if you have any questions about the feasibility of crushing meds.

    Hope this helps.
  4. by   puggymae
    Antacids and cough suppressants should not be taken with water.
  5. by   emllpn2006
    You should never crush a potassium pill even if not enteric coated or labeled as extended release.
  6. by   txspadequeenRN
    Alot of this depends on where you work. I am a alzheimers nurse and work in LTC facilities. You are going to get different responses from nurses that work in hospitals. So I will answer some on these.. Here we go....

    1. My patients wander . I never chase anyone to give them their meds because they will always come back to me. Just saves me time.

    2. I always ask if they want their meds given usually it is yes and they get them with a small amount of water. If not circle the MAR and write on the back Pt NPO this AM or something like that.

    3. I always make a note on the MAR and chart about this. This is a tough situation , you know they need their meds ..some more than others (Pain) However, I dont know how much of the med body has already used so I dont give them again. If the pill comes up whole and i can identify it and they really have to have it .. I may call the Doc to see if he wants to repeat the drug.

    4. I stand there and watch him swallow then ask him/her to open mouth and lift tongue. My patients pocket and then the others try to be sneaky..

    5. Well my paitents are alzheimers and if they refuse i just back away and ask them again in 10 min or so. they ususally forget and take it. In a aware adult i would find out why he/she is refusing . Do some education have them ask some questions . If it is a drug they really need i will either have the drug scheduled at time when the patient is more likely to take it (by this i mean nothing at sundowning time) or give it when the family comes they can usually conveince the patient.

    6. Make a note as to why it was omitted. I omit alot of drugs because of low BP's or pulses. Circle on the MAR and make a note on the back. If you forget a drug and you are out of your window then it becomes a med error.

    7. cough syrup, things like this..

    8. Generally , anything enteric coated cannot be crushed ior anything extended release. However....there is always the exception to the rule .... In LTC facilities you have crush orders on all your meds.With the exception of a few and at every facility I have been at there was a note made on the MAR...Do Not Crush. We try to get liquids of the meds that are EC or extended release but that sometimes does not always gonna happen. You never crush percocet, morphine, oxycontin or any of those type of pain meds.. You can crush vicodin and IR (instant release) morphine or oxycodone.

    These are some very good questions ......I apologize for the mis-spelling ..if any I am way tired....





    Quote from Liz21
    I have some questions about medications that would be greatly appreciated to answer them:

    1. If a patient is out of the room when you bring in his meds what should you do?

    2. If your patient is scheduled for a diagnostic study that requires being NPO and has orals meds ordered what should you do if the meds are to be held? How do you document this on the MAR?

    3. If your patient vomits 15 minutes after you give them their meds - what should you do?

    4. To ensure that a patient takes his meds - what can you do?

    5. What should you do if an adult patient refuses a medication?

    6. What should you do if a drug is omitted?

    7. What medications / classifications of drugs are best taken without water?

    8. What type of oral med forms can be crushed? Which ones cannot?
  7. by   Daytonite
    If a patient is out of the room when you bring in his meds what should you do?
    Discard any medications that you have already poured. They can't be used. It would be bad practice, and dangerous, to attempt to save them. You would never leave any medications unattended either. You would return to the patient's room at a later time and attempt to administer them again.
    If your patient is scheduled for a diagnostic study that requires being NPO and has orals meds ordered what should you do if the meds are to be held? How do you document this on the MAR?
    Hold all the oral medications and do not give them. If there is a question in your mind that the patient should be getting some or any of the medicines, pick up the phone and call the patient's doctor. Discuss the situation with the doctor and let him make any decisions. Most facilities have written policies and procedures in place that will direct you how to document medications that are being held. In most places a circle is placed around the normal way the administration would be documented and a narrative note placed somewhere at the bottom or on the back of the medication sheet explaining the circumstances of why the medication wasn't given.
    If your patient vomits 15 minutes after you give them their meds - what should you do?
    Note the character of the vomitus and if any of the patient's medication seems to be in it. Make sure the patient is made comfortable and given hygiene after vomiting. If antiemetics are ordered, administer them. Notify the doctor and see what the doctor wants to do. Document everything.
    To ensure that a patient takes his meds - what can you do?
    Follow the five "R"s of medication administration.
    What should you do if an adult patient refuses a medication?
    Try to get the patient to tell you why they are refusing the medication. You can attempt to rationalize with them why the medication has been prescribed, but ultimately, the patient does have the right to refuse. Notify the doctor. Document all.
    What should you do if a drug is omitted?
    This is a medication error and must be reported to the patient's physician. When you notify the physician you can ask him whether or not to give the dose that was missed or wait until the next scheduled dose. This all needs to be documented in the patient's chart as well. Most facilities also require an incident report be filed as well.
    What medications / classifications of drugs are best taken without water?
    Off hand, I'm thinking about sub-linqual medications. You want them to dwell under the tongue and have time to melt and absorb into the capillaries. Also, things such as lozenges and thick syrups (such as cough syrups) are designed to coat the throat, so following them with water would obliterate their mode of action.
    What type of oral med forms can be crushed? Which ones cannot?
    I would assume that all oral pills can be crushed unless the name of the drug contains the letters of the alphabet that indicate they are extended release, ie., XR, XL, SR, LA, XT and I'm sure there are others. If you are ever in doubt contact the pharmacist, check the PDR or a drug reference before crushing any medication.

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