Do I give the med or hold?

Nurses Medications

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I work in LTC, my resident is given gabapentin (time release capsule) along with a lot of other tablets. This resident chews all meds and will not listen that gabapentin states "swallow whole, do not chew, or crush". I see all the other nurses give this med and not worry about this.

Specializes in Addiction.

Have your tried giving it in apple sauce or yogurt?

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Specializes in retired LTC.

Brandon - This is a good conversation, and I'm enjoying the back & forth. I pretty much feel as you do that the state of nsg today is XXX and I've just about reached my limit. I agree that some rules are stupid, asinine and expletive. But as Unit Mgr on a LTC unit, I once had to address a med pass error by an RN (usually very good) who punctured a COLACE (YES, a colace) and she squeezed it out for the pt. Oh, she told the State surveyor she'd get the order chg'd to liquid, but AFTER she squished the colace and gave it.

I don't have all medications' actions, peaks, durations, side effects, etc memorized and I don't have Pharm D initials behind my name. I can only pass meds as recommended by the drug company (PI = pharm instructions?) and by the silly R & R estab by those who pull the puppet strings. And that's what's expected of all others who pass meds, do tx, ck VS, work equip, etc. When discordance occurs, it is nsg to correct - that's what we do.

And as I said earlier, just because "we've always done it that way" doesn't make it right. Most of the times, there's no problem, but I think of that lady I first posted about who bit her imdur (and I was giving it correctly). We're reading about all the angst these newbies are experiencing with their med errors. Warnings are written for a reason! My motto has been 'when in doubt, err on the safe side'.

So back to OP - I'd hold the neurontin and get it clarified. I mean, how much time are we talking when it's one dose and there are easy alternatives avail? PIA, yes. But it could be an imdur. And thank you for the dialogue, honest.

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Yes, it can be a slippery slope once you start bending the rules. First you say "I don't need to hold that." then you say "she doesn't really need a 8am dose AND a 1pm dose" then it's "I don't have time to give inhalers or eye drops". I've seen it happen. There's such a thin line....

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You can change them, you just need to get a doc's order to do it. If patient is competent, they get to choose when, so you get that order from doc and write "per patient preference".

Our facility wakes the residents for there 600 - 700 synthroid and prilosecs

the state wouldnt let it get pushed for to long before they noticed

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can the tablet form be chewed? This resident chews any and every medication, from ibuprofen, to vicodin, to atenolol.

I wouldn't really worry about that part of the conversation too much. Just call the dr., explain the situation, and ask if he can give you an order clarification stating either that it is OK to sprinkle the med, or that he would like to use another form of it.

What I usually do, is notify the dr. that the patient is chewing meds and ask for an order to crush any meds possible and give in applesauce, then review the issue of capsules.

It is a very common issue that comes up in nursing, so don't stress about it too much.

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Specializes in Case Management, ICU, Telemetry.

Levothyroxine should ALWAYS be given on an empty stomach because of how it is absorbed. While there are a lot of drugs that are recommended to be taken on an empty stomach and don't really "need" to be, levothyroxinenus is not one of those. I would research that a little bit.

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Specializes in Case Management, ICU, Telemetry.

Very well said. "this is the way we've always done it" is never the right answer. The suggestions in medication books aren't arbitrarily chosen, there is research supporting them.

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Specializes in ortho, hospice volunteer, psych,.

I take the Neurontin capsules which should not be crushed or chewed, however, I found this about

the tablets:

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[/TD]

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[TD=width: 100%, colspan: 2]How should I use this medicine? (Back to top)

Take this medicine by mouth. Swallow it with a drink of water. Follow the directions on the prescription label. If this medicine upsets your stomach, take it with food or milk. Take your medicine at regular intervals. Do not take it more often than directed. If you are directed to break the 600 or 800 mg tablets in half as part of your dose, the extra half tablet should be used for the next dose. If you have not used the extra half tablet within 3 days, it should be thrown away. A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time. Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed. Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

Note: This medicine is only for you. Do not share this medicine with others.

[/TD]

[/TR]

[TR]

[TD=width: 100%, colspan: 2] [/TD]

[/TR]

[/TABLE]

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Levothyroxine should ALWAYS be given on an empty stomach because of how it is absorbed. While there are a lot of drugs that are recommended to be taken on an empty stomach and don't really "need" to be, levothyroxinenus is not one of those. I would research that a little bit.
It absorbs *best* on an empty stomach. It's not like it doesn't absorb at all if given with food. Worst case scenario is the pt needs a slightly higher dose to maintaintherapeutic levels. This is a drug that requires regular blood work, so it must be working. We would *know* if it wasnt. We have not had to adjust a dose of synthroid on my floor in years. If you wake up 20 confused 90 year olds at the crack of dawn to give them a pill it's a recipe for disaster.
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Specializes in Case Management, ICU, Telemetry.

I'm sorry but I believe th

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Specializes in Case Management, ICU, Telemetry.

No offense, but you are wrong. Just because it's the way you've always done it and in "your experience" it's doesn't matter, that is not true. Until you have Pharm D after your name I don't think that you have the expertise to make that judgement call.

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Specializes in Case Management, ICU, Telemetry.

Nor do I find it wise or ethical for you to tell new grads that the drug book shouldn't be followed because common sense supersedes research... I would hope that any new grads reading this post would have the common sense to not listen.

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