Do I give the med or hold? - page 8

by spectrabrite

11,610 Views | 79 Comments

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... Read More


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    yes the theraputic effect is greater on an empty stomach. However, balance this against an increase in falls in this group of demented elderly persons...I think the higher dose with food is going to win that arguement hands down. This is the realistic, real world reality we work with. And meds that need/should be given on an empty stomache don't nec. need to be given before breakfast, could be before lunch or dinner. And Brandon is giving this WHEN it is order to be given.
    Quote from spectrabrite
    we are given orders for a medication but must follow the pharm / drug guides unless specific written orders are given otherwise.

    Sounds like you are bending the rules because you know you are watched by the state like a normal facility.

    It is not bad / strange or harmful to wake them up for synthroid or fosamax that the guide specifies to take on an empty stomach before breakfast. Does you docs 8am orders state does not need to be on an empty stomach? If so I would take that to mean 8am med and breakfast is given between 830 - 9am sometime.
    BrandonLPN likes this.
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    Last time I checked doctors done order meds for a specific time lol the order is written "levothyroxine xmcg PO QAM" sometimes with "ac" after QAM... The time listed on the mars is not the physican's order, it's the time as chosen by the person who transposes meds to mars... VERY rarely does a doc ask for a med to be given at a specific time....
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    And morte, levothyroxine is almost exclusively a QAM drug, so it will only be given before breakfast. Other drugs that designate "on an empty stomach" means 30 minutes before and 2 hours after food.
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    And a final note, if you ask a lot of these people, when they are at home they take their synthroid before breakfast... It's a point that is emphasized by primary care. That being said if a person is at your facility and you are improperly giving their synthroid with breakfast and they go home and take it the way it should be, now their dose will likely need adjustment. Not only does this recommendation improve absorbtion but (assuming everyone follows the same rules) ensures the absorbed dose is consistent despite setting.
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    all the orders we get state time except for prn meds. Must just be my facilities policy with the docs.

    Quote from sarrah
    Last time I checked doctors done order meds for a specific time lol the order is written "levothyroxine xmcg PO QAM" sometimes with "ac" after QAM... The time listed on the mars is not the physican's order, it's the time as chosen by the person who transposes meds to mars... VERY rarely does a doc ask for a med to be given at a specific time....
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    A few points: a) our breakfast is at 730. b) the doctor explicitly changed the med time to first shift, to avoid third shift having to wake people up so early c) in my facility, and many others, nobody is going home. They are here till they die. d) the third shift nurse has upwards of 80 residents some shifts so popping in 30 minutes before breakfast is not as easy as you suggest. It can not be done by any human on the planet. She would have to start giving them at 5 am or earlier.
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    Quote from sarrah
    And morte, levothyroxine is almost exclusively a QAM drug, so it will only be given before breakfast. Other drugs that designate "on an empty stomach" means 30 minutes before and 2 hours after food.
    there in lies the key, in the real world things are not ALWAYS optimal. and AM goes until 12N. Had to change a patient's time to 10 am because she wouldn't take it at 6. It was aborbed quite well, her TSH went from 9 to 1.
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    I am with you brandon. Reality can be daunting, but must be dealt with.
    Quote from BrandonLPN
    A few points: a) our breakfast is at 730. b) the doctor explicitly changed the med time to first shift, to avoid third shift having to wake people up so early c) in my facility, and many others, nobody is going home. They are here till they die. d) the third shift nurse has upwards of 80 residents some shifts so popping in 30 minutes before breakfast is not as easy as you suggest. It can not be done by any human on the planet. She would have to start giving them at 5 am or earlier.
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    Quote from BrandonLPN
    A few points: a) our breakfast is at 730. b) the doctor explicitly changed the med time to first shift, to avoid third shift having to wake people up so early c) in my facility, and many others, nobody is going home. They are here till they die. d) the third shift nurse has upwards of 80 residents some shifts so popping in 30 minutes before breakfast is not as easy as you suggest. It can not be done by any human on the planet. She would have to start giving them at 5 am or earlier.
    Our third shift has 146 residents, there are 2 seatings for all meals, there all here till they die but we manage to wake and give as directed no problem. 56 of our residents are a locked dementia unit third shift covers both sides.
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    and you point is?....
    Quote from spectrabrite
    Our third shift has 146 residents, there are 2 seatings for all meals, there all here till they die but we manage to wake and give as directed no problem. 56 of our residents are a locked dementia unit third shift covers both sides.


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