Test question, just wanted your thoughts

  1. Pt admitted to unit c T-101.8, cough, and pain rated 7/10. Which med would the nurse anticipate giving first?
    a) antihistamine
    b) antibiotic
    c) Tylenol
    d) Codeine

    I can't remember which antihistamine and antibiotic were listed on the test by brand name.

    I just wondered what you guys would have chosen as your answer.
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    About RNnTrainin'

    Joined: Aug '08; Posts: 93; Likes: 15
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    37 Comments

  3. by   Maliffy
    Personally I'd start bugging our medical director for tylenol with codine (2 birds, 1 stone).

    I'm guessing the right answer is Codine. It addresses BOTH the pain and the cough.

    I'm interested in other people's perspectives.

    Do you have the "right" answer?
  4. by   Daytonite
    pt admitted to unit with t-101.8, cough, and pain rated 7/10. which med would the nurse anticipate giving first?
    a) antihistamine
    b) antibiotic
    c) tylenol
    d) codeine
    you always treat the worst symptoms first. but, with fever, cough and pain you must recognize that the patient is experiencing some sort of infection. fever and pain are symptoms of inflammation (cardinal signs are redness, heat, swelling and pain) which accompany infection. the cough would indicate that the infection is probably respiratory in nature. the doctor will also be doing the same, treating the symptoms. he also has the ability to target the underlying cause of the symptoms--the infection. he is going to order something for this infection and want that started asap. so, as a collaborator in the care of the patient the nurse needs to get the antibiotic started immediately. the medications for the other symptoms of the fever, cough and pain can be given afterward.
  5. by   Maliffy
    Daytonite-

    That makes a lot of sense. I always tend to jump the gun and want to address symptoms first and then treat the underlying cause, ie... stop the coughing, THEN cure the coughing. I doubt that working in hospice has done anything to break me of that habbit.

    I REALLY appreciate your answers. They're always right on, and very informative! You're awesome!
  6. by   Daytonite
    actually, in many of the hospitals that i worked we had to start atbs within 2 hours of admission or the doctor writing the order or the sword of damocles came down on you. it has something to do with medicare guidelines and conditions of participation.
  7. by   qaqueen
    antibiotic! NCLEX is looking for less than 4 hrs door to hang time.
  8. by   cursedandblessed
    thanks
  9. by   RNnTrainin'
    Quote from Maliffy
    Personally I'd start bugging our medical director for tylenol with codine (2 birds, 1 stone).

    I'm guessing the right answer is Codine. It addresses BOTH the pain and the cough.

    I'm interested in other people's perspectives.

    Do you have the "right" answer?
    That was my exact way of thinking. It was wrong though!!! I am still upset about it. We are taught Maslow in Fundamentals, following his theory, shouldn't we address pain? Anyway, I chose codeine, like you said, pain and cough, but the right answer was antibiotic.........
  10. by   RNnTrainin'
    Quote from qaqueen
    antibiotic! NCLEX is looking for less than 4 hrs door to hang time.
    you made that seem so effortless!!! LOL It really got me...I just knew it was codeine. I guess I was thinking the overuse of antibiotics, and that deferred me from that choice. Thanks!!
  11. by   RNnTrainin'
    Quote from daytonite
    pt admitted to unit with t-101.8, cough, and pain rated 7/10. which med would the nurse anticipate giving first?
    a) antihistamine
    b) antibiotic
    c) tylenol
    d) codeine
    you always treat the worst symptoms first. but, with fever, cough and pain you must recognize that the patient is experiencing some sort of infection. fever and pain are symptoms of inflammation (cardinal signs are redness, heat, swelling and pain) which accompany infection. the cough would indicate that the infection is probably respiratory in nature. the doctor will also be doing the same, treating the symptoms. he also has the ability to target the underlying cause of the symptoms--the infection. he is going to order something for this infection and want that started asap. so, as a collaborator in the care of the patient the nurse needs to get the antibiotic started immediately. the medications for the other symptoms of the fever, cough and pain can be given afterward.
    i love your replies. the way you explain the answer helps so much. you really should look into instruction! i know a lot of nsg students who would love an instructor who was a fragment of you! thanks again!!!
  12. by   buttercup99
    I don't know if this is a country specific thing - I am from Australia and i would have thought it was tylenol. That is something you can pretty much give before you even think about what is causing the symptoms. It addresses the fever and pain (ok, it doesn't address the pain, but they always try the tylenol first.)

    I can see how it would be antibiotics but I think if the doctor hasn't seen the pt yet, it is much easier to get them to quickly order tylenol without examining the pt than an antibiotic. In fact in most places, nurses can give tylenol on their own initiative.

    I wouldn't pick the codeine because a) they always try tylenol first and b) you don't want to supress the coughing when you are trying to diagnose the problem.

    And what about looking at it this way: the pain score is 7/10 so shouldn't that be the highest priority to deal with? The cough can wait as long as the other obs are okay.

    In other words, I would chase up the pain relief before the pt got seen by the doctor, but I wouldn't go out of my way chasing the AB until a full assessment had been made.

    I'm glad they don't use NCLEX in Australia. They should let you give your reasoning behind the decision and rate you on critical thinking skills. How can anyone say there is one right way to do things?!
  13. by   NurseLoveJoy88
    Honestly, I would have most likely chose the antibiotic, however I was stuck on the tylenol also. Broad spectrum antibiotics can be given initially. I'm thinking that if tylenol was given it may mask some s/s that the pt. may have that would indicate an infection. So yes, antibiotic seems correct.
  14. by   Daytonite
    Quote from RNnTrainin'
    That was my exact way of thinking. It was wrong though!!! I am still upset about it. We are taught Maslow in Fundamentals, following his theory, shouldn't we address pain? Anyway, I chose codeine, like you said, pain and cough, but the right answer was antibiotic.........
    All the choices were doctor's orders (collaborative interventions, not independent nursing interventions). It's because of critical thinking and following the nursing process. By engaging the nursing process we find the abnormal data in Step #1 of the process. By Step #2 of the process we can determine that the underlying problem is an infection. By Step #3 (Planning) we are thinking about our interventions for the problem. This question then takes a little bit of a bizarre turn and specifically challenges our knowledge of the "medical decision making" process because it is asking us which physician orders should be enacted first. The "medical decision making" process isn't much different from the nursing process except that the doctor works within a medical model of care and is often able to treat the underlying cause of the patient's problem. We assist the doctors in carrying out their orders. This question is really asking, "which order will the doctor will want carried out first?" And, I will tell you now that in the real world of nursing you will get your hands slapped if you don't carry out doctors orders by that way of thinking, especially when you work in an acute hospital. So, you not only need to know nursing priorities, but medical priorities as well! The doctor is the captain of the ship.

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