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.

[katrinairene]

Did you find out what the answer was?

[lagalanurse]

Hm tricky. I would still go with asthma, Digoxin, insulin and then wound patient. The only one I would maybe change up would be Digoxin and Insulin. No clue if this is correct, just my initial thoughts.

[MrsCuoco]

Nope, not yet.

That's my instinct also, lagalanurse, I just am not sure.

[Sun0408, ASN, RN]

I would say the ABT, this is not a daily dose and is time sensitive.

[Sun0408, ASN, RN]

Also singulair is a tablet not INH.

[MrsCuoco]

Right you are, sun0408...how would you prioritize the rest? I'm thinking antibiotic, insulin, dig, sing?

[Sun0408, ASN, RN]

I would say ABT, dig, sing, then insulin.. Which model are you using... ABC's or CAB.. lol, so many different ones..

Anyone else have an idea. Time to get ready for work.. check back tomorrow :)

[Stephalump]

My first thought was that antibiotics should be first, as well. Beyond that,I'm not sure. I'd say antibiotics,asthma, heart, diabetes.

[hodgieRN]

This is a good question. I am thinking the Digoxin is the priority. Cardiac pts who do not receive their digoxin on time are at risk for cardiac arrhythmias. And, Dig increases the contractility of heart, so this could include the circulation aspect. I think this choice is the most important, especially for a cardiac pt. A cardiologist would flip out if a pt went into a-fib and saw that the dig was given late.

2nd and 3rd are a toss up b/c you could argue the two....

The antibiotic is important b/c it is timed. With Q6 hr dosing, you have to stay on schedule. Plus, hospitals get dinged when pts receive antibiotics late, especially with pts at risk for sepsis. JACHO is very serious with antibiotic timing.

Asthma pts are priority due to airway and breathing but Singular is a maintenance med and it's a long-term, daily drug used for prevention. The main treatments for asthmatics are oxygen and short-acting bronchodilators, but Singular is used to prevent bronchospasm, which is important. But, it could be argued that it's more of a chronic, preventative-type drug that doesn't do anything in the short term for hospitalization. Singulair is often used as an add-on with other treatments. If this choice was Albuterol, it would definitely be first, but I am kind of on the fence with this one.

The insulin would be last. I am thinking the "daily dose" is probably a long-acting insulin, so the coverage has already been on-going. But, glucose control is important.

So, I pick dig, antibx, singulair, insulin. Maybe even dig, antibx, insulin, singulair.

[MrsCuoco]

Well netween you all and texting several nurses i know, everyone says they'd give these meds in differing orders of priority, lol. Oh well...if that's the only one I miss on the exam plus one or two others, I'm still in damn fine shape. Thank GAWD for take home tests to boost the old test average!

[hodgieRN]

Interesting enough, you will probably find instructors that will each give you different answers! That's the one thing is nursing....there's always some rationale that can alway be argued.