Help with a prioritizing question please!

[MrsCuoco]

So we were given this take home exam in pharmacology, and anyone who has ever had a take-home knows they make it as hard on you as possible. My class of 26 went through it today to make sure al our answers matched up, but no one could agree on this one, either by having differing opinions or just not having a clue. Any feednack would be appreciated!!

Question is:

Indicate in which order of priority the nburse should administer the medications to these patients:

a. a cardiac patient receiving a daily dose of digoxin

b. an asthmatic patient recieving a daily dose of Singulair

c. a patient receiving an antibiotic FOUR times a day for an infected wound

d. a patient with diabetes receiving a daily dose of insulin

We are always taught AIRWAY first, but in this case, the patient is simply receiving a daily dose of an inhaled med and there is no indications that he is having an ACUTE episode. The rest...we just don't know.

[MrsCuoco]

This is probably why my pharmacology teacher says that nursing is just as much an art as it is a science.

[Esme12, ASN, BSN, RN]

Nursing is an art as well as science. You use your science to develop your art.

These all sound like daily dose drugs except the antibiotic........Depending on the patient and what the glucose was........I'd give the antibiotic first as the timing is crucial and it is an acute infection. Then the insulin for that is also imperative timing with meals and doesn't "stay in the system". Then the singular for it is for the breathing and doesn't have a long half life and "stay in the system" with blood levels. Then the lanoxin as there is a consistent "therapeutic blood level" that is constant and a few minutes late won't alter the blood level and cause the patient harm.

.I hope this helps.....let us know what the "answer" was. I'm always curious.

[sixty3dayswithSarah, BSN, CNA, RN]

second thought.... Digoxin, Antibiotic, Insulin, Singular

rationale: Dig is daily and timed, Anti is why they are in-pat. and this all sounds like its taking place in the morning so if the patient is eating less upset stomach, Insulin must be long acting if only given once per day, Singular and Dig are not friends so Id give that last

[MrsCuoco]

Well...moment of truth.

I consulted MANY professionals on this one and got as many varied perspectives, so I eventually settled on Abx, insulin, digoxin, singulair.

Then I decided I'd ask my med surg teacher (this test is for pharmacology) if she'd feel comfortable weighing in, and after discussing it with HER and deciding her rationales made sense, I changed my order to abx, dig, sing, ins.

Turns out the "correct" order my pharm teacher was looking for was the one I had the first time.

But...we were all worked up into such a state over it that she said she'd throw the question out which I really anticipated.

[Sun0408, ASN, RN]

So which way was correct per the pharm teacher :)

[MrsCuoco]

Per the pharm teacher: abx, ins, dig, sing

[metal_m0nk, BSN, RN]

I knew the insulin would probably have a high priority and it kind of felt like a toss up between the insulin and the abx simply because I was thinking in terms of if it were to be withheld or delayed, which would have the quickest adverse response. Synthetic insulin dependence is one of those fragile instances where the patient's health status can decline rapidly if it is not balanced/treated promptly, consistently and appropriately.

Since this is a pharmacology question, I would think in terms of the short term/immediate effects of missed/late doses in these examples. Whichever has the most immediate consequence is probably going to take priority - unless it's a choice between something that has an immediate consequence and something that has a slightly less immediate but significantly more severe consequence. In that case, I would choose the one with the more severe consequence.

Interesting question.

[PedRN86]

I would do ABX, insulin, digoxin, singulair myself. Maybe ABX, dig, insulin, singulair too.

[nurseprnRN, BSN, RN]

Indicate in which order of priority the nburse should administer the medications to these patients:

a. a cardiac patient receiving a daily dose of digoxin

b. an asthmatic patient recieving a daily dose of Singulair

c. a patient receiving an antibiotic FOUR times a day for an infected wound

d. a patient with diabetes receiving a daily dose of insulin

I'd go for the insulin first, because breakfast is coming. You generally get an hour leeway on antibiotics but you need to keep the serum level up and this one is ordered for QID so its level probably drops comparatively rapidly (as opposed to a BID or even QD antibiotic). Digoxin levels take a comparatively long time to decline (look up its half-life and you'll see what I mean), and airway meds are important but as a daily dose, it's less time-critical. So I go insulin, antibiotic, Singulair, digoxin. Though realistically you'd get them all given within an hour or so, so it wouldn't really make any difference at all.

What did your faculty say and why?