How to administer meds to patient with SLE

[NURSERUBY1206, LPN, LVN]

I had a problem with a patient. The patient has been newly diagnosed with Systemic Lupus Erythematosus. She's very weak and often needs assistance from her husband. She doesn't eat very well, so her doctor orders supplemental nutrition - you know, a "milk" to aid in her nutrition, plus a gazillion more tablets to take. My problem is, her medications are scheduled rtc, q8h, q12h... and when 6 different meds are supposed to be taken, she refuses at the time of medication and tells me she's too weak and she'll take them later. But I'm worried the effects of the medications will be null if she doesn't take them on time! I want to space out the time of her medications every two hours, but I can't afford to check on her every two hours because I have ten other patients. NGT has been suggested but the patient doesn't want it. What do I do? Do I tell her doctor that the patient's too weak to swallow or convince the patient and the relatives that NGT would work for her?

This also goes for other cases, what do I do when patients don't want to take their important medications? I know I'm supposed to write that the patient refused medication and let them sign it, but aren't we nurses supposed to convince them to let them take it so that they'd get well?

I appreciate your reply! Thanks for taking the time to read!

[Zana2]

I would document this in the MAR sheet. And speak to a doctor.

I never try to persuade anyone, I try to make SURE that the patient knows as much as I know about that medicine, what happens if it's not taken, what happens if it is taken, make sure they understand, ask them to repeat in their own words what I just said, basically, ensure that they had an informed choice. And then it's up to them.I always document in the nursing notes as well, and also write what i have done about it (informed senior sister/doctor etc). if the patient cannot communicate, I go to the person who's responsible for such decisions.

Hope that helps.

[Virgo_RN, BSN, RN]

What I usually say to a person who doesn't want to take their meds is something like "You have the right to refuse treatment, and nobody can force you to take this. But I do want you to understand why these medications are important, and why it's important that you take them on time.". Then, after explaining, leave them to think about it and try again a little later. As for the NGT, you might try a similar approach, saying something like "I can't force you to have an NGT, nor would I ever try to. But just let me explain how it could help you, should you choose to go that route. Putting in an NGT is not a surgical procedure, it just goes down your nose, and while it might be uncomfortable for a few minutes, once it's in, most people tolerate it well. It would only be temporary, just to give you a chance to get stronger so you can eat and take your medicines a lot easier. I wouldn't dream of making that decision for you one way or the other, but it is an option that I think you ought to consider.".

Ultimately, the patient has a choice about every single pill, every single treatment. We can't force or trick them into accepting them. All we can do is educate them and let them decide.

Always be sure to document their refusals, as well as your teaching. If she is consistently refusing her meds, then the doctor needs to know about this.

[ktwlpn, LPN]

I had a problem with a patient. The patient has been newly diagnosed with Systemic Lupus Erythematosus. She's very weak and often needs assistance from her husband. She doesn't eat very well, so her doctor orders supplemental nutrition - you know, a "milk" to aid in her nutrition, plus a gazillion more tablets to take. My problem is, her medications are scheduled rtc, q8h, q12h... and when 6 different meds are supposed to be taken, she refuses at the time of medication and tells me she's too weak and she'll take them later. But I'm worried the effects of the medications will be null if she doesn't take them on time! I want to space out the time of her medications every two hours, but I can't afford to check on her every two hours because I have ten other patients. NGT has been suggested but the patient doesn't want it. What do I do? Do I tell her doctor that the patient's too weak to swallow or convince the patient and the relatives that NGT would work for her?

This also goes for other cases, what do I do when patients don't want to take their important medications? I know I'm supposed to write that the patient refused medication and let them sign it, but aren't we nurses supposed to convince them to let them take it so that they'd get well?

I appreciate your reply! Thanks for taking the time to read!

Sheesh-too weak to swallow? How about a psych consult-I'm sure she is very depressed ( another pill? why not?) I've got several resident that would fool around all day staring at their meds.They get them spoon fed. Good luck-poor gal