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.

NO! tHE pH of dilantin is 9, The caps are sealed to prevent errosive esophagitis/stomach irritation.

I agree with getting an order clarification, if only to CYA. In the case you mentioned with the Dilantin, isn't the facility checking her serum Dilantin levels regularly? If her blood levels are always therapeutic, isn't it a moot point?
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Where i come from it was communicated from "state" that thyroid was to be given at 0630, ie on an empty stomache, i have had to change it to a different time, on occasion; with a doc's order and rationale. Yes it can be given with food, but a higher dose is likely required.

*sigh*, as I understood the OP's post, this guy has been taking this pill this way for ages. And is fine. What makes you think he's suddenly going to have a "reaction" or something? In this case all "holding" the poor guy's neurontin is going to do is probably result in some unnecessary neuropathy pain! If this were a brand new order or something that would be different.

This reminds me of when a new grad came to my floor and decided that we need to reschedule all our 8am synthroids and prilosecs for 6am because "the drug book says they need to be given on a empty stomach." Give me a break! You really want the night nurse to go around and wake 20 ninety year olds at 5 am to give them a pill they've been taking safely at breakfast for years? Really?? Do people in the "real world" set their alarms for 5am to take their syntroid? No! Do they die of thyroid disease as a result? No! Common sense, people. Common sense.

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NO! tHE pH of dilantin is 9, The caps are sealed to prevent errosive esophagitis/stomach irritation.
I'm sorry, I was thinking of those depakote sprinkles capsules, rather than Dilantin. My bad.
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Specializes in Hospice / Ambulatory Clinic.
I'm sorry, I was thinking of those depakote sprinkles capsules, rather than Dilantin. My bad.

Have you seen the full PI sheet for those. It has directions on how patient caregivers can "hide" the medication in applesauce.

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What's a PI sheet?

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Specializes in retired LTC.
*sigh*, as I understood the OP's post, this guy has been taking this pill this way for ages. And is fine. What makes you think he's suddenly going to have a "reaction" or something? In this case all "holding" the poor guy's neurontin is going to do is probably result in some unnecessary neuropathy pain! If this were a brand new order or something that would be different.

This reminds me of when a new grad came to my floor and decided that we need to reschedule all our 8am synthroids and prilosecs for 6am because "the drug book says they need to be given on a empty stomach." Give me a break! You really want the night nurse to go around and wake 20 ninety year olds at 5 am to give them a pill they've been taking safely at breakfast for years? Really?? Do people in the "real world" set their alarms for 5am to take their syntroid? No! Do they die of thyroid disease as a result? No! Common sense, people. Common sense.

Brandon - I usually agree with what you post, but not this time...YES. We had to reschedule/give all our synthroids for 6:30 am. My facility could not bypass the pharmacy consultant inspection report that required us to follow phramaceutical directions.I'm from a super regulated state in the country. Just because "we've always done it that way" won't cut us any slack with our DOHSS survey inspectors. No way! I agree that it was stupid for a synthroid, but common sense doesn't pass survey.
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the other people administering are med techs not nurses that just give what is ordered and dont think about these things or watch for problems.

You're missing the bigger point that this resident has been taking this med this way for a long time without any apparent adverse reactions. Did you ask the other nurses on the floor about it. I'm betting they'll tell you that everyone (including the doc) knows about it already. If he's NOT aware of the chewing, then I'm sure he'll change it. But don't be suprised if he doesn't. Just because the med book says "do not crush or chew" does NOT mean it's unsafe to do in every case. If this is how the resident gets his therapeutic dose, why on EARTH would you change it?? Trust me, common sense trumps the med handbook every time....
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I have been told that by chewing it realeases all at once, the resident will be fine no pain complaints for about 1 - 2 hours then calls demanding pain meds till the next routine dose and he has no PRNs.

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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

*sigh*, as I understood the OP's post, this guy has been taking this pill this way for ages. And is fine. What makes you think he's suddenly going to have a "reaction" or something? In this case all "holding" the poor guy's neurontin is going to do is probably result in some unnecessary neuropathy pain! If this were a brand new order or something that would be different.

This reminds me of when a new grad came to my floor and decided that we need to reschedule all our 8am synthroids and prilosecs for 6am because "the drug book says they need to be given on a empty stomach." Give me a break! You really want the night nurse to go around and wake 20 ninety year olds at 5 am to give them a pill they've been taking safely at breakfast for years? Really?? Do people in the "real world" set their alarms for 5am to take their syntroid? No! Do they die of thyroid disease as a result? No! Common sense, people. Common sense.

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I have been told that by chewing it realeases all at once, the resident will be fine no pain complaints for about 1 - 2 hours then calls demanding pain meds till the next routine dose and he has no PRNs.
Like I said, I'd put it on sick call for clarification. But, in this case, I don't see the point in holding it. Better he get a "quick release dose" than no dose at all.
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Our facility wakes the residents for there 600 - 700 synthroid and prilosecsthe state wouldnt let it get pushed for to long before they noticed
The ironic part of working at a state facility is that we don't have to worry about state regulations. Maybe that's why I have a hard time understanding those nurses who do. So many of those state rules seem so asinine. Why wake those poor little old people up at the crack of dawn?
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I am mixing it in applesauce till I can get clarification from the MD

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