which med do I give first

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I'm in my first year of school so I don't have a lot of experience with medications.Anyways our class was given a take home quiz (we can use any notes, people ect.) and many of us are stumped with this question because we feel we could rationalize each medication. The question goes like this- a patient who was admitted to the hospital with pneumococcal pneumonia has a temperature of 101.6 F with a frequent cough and is complaining of chest pain rated a 7 on a 10 point scale with deep inspiration. which of these ordered medications should the nurse give first?

A. Azithromycin (Zithromax)

B. Acetaminophen (Tylenol)

C. Codeine phosphate (Codeine)

I would appreciate anybody's input!! I'm really stumped, like I said I feel I could give a good rational for each.

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Specializes in Med/Surg Nurse, Homecare, Visiting Nurse.
I'm in my first year of school so I don't have a lot of experience with medications.Anyways our class was given a take home quiz (we can use any notes, people ect.) and many of us are stumped with this question because we feel we could rationalize each medication. The question goes like this- a patient who was admitted to the hospital with pneumococcal pneumonia has a temperature of 101.6 F with a frequent cough and is complaining of chest pain rated a 7 on a 10 point scale with deep inspiration. which of these ordered medications should the nurse give first?

A. Azithromycin (Zithromax)

B. Acetaminophen (Tylenol)

C. Codeine phosphate (Codeine)

I would appreciate anybody's input!! I'm really stumped, like I said I feel I could give a good rational for each.

I would give a pain med first...then address the fever. Just my two cents.

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codeine.

you want to stop the coughing stat, to prevent transmission.

leslie

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I agree with betterme29. I would give the pain medication first since 7 out of 10 is a significant amount of pain. Then I would give the Tylenol for the fever.:nurse:

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I agree with giving the Codeine first.

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Specializes in Utilization Management.

This is why I hate questions like that. In the real world, you'd make sure blood cultures were done, then pull all three meds. You'd hang the Zithromax, then give the Tylenol and last, give the cough syrup. Reason for giving the Zithro first, is that you attack the source of the cough first. Give Tylenol next for comfort, and the cough syrup last because you'd want to teach the patient to refrain from eating or drinking for about 15 minutes after any cough syrup.

So my answer would be -- all three, asap.

(Now I can't wait to see what the real answer is, darn it.)

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Specializes in Utilization Management.

Oops, just realized that the med is codeine, not a codeine-based cough syrup. That's because no one would prescribe JUST codeine, it usually comes combined with Tylenol, which equals a Tylenol #3.

Or am I completely having a senior moment here?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

a patient who was admitted to the hospital with pneumococcal pneumonia has a temperature of 101.6 f with a frequent cough and is complaining of chest pain rated a 7 on a 10 point scale with deep inspiration. which of these ordered medications should the nurse give first?

a. azithromycin (zithromax)

b. acetaminophen (tylenol)

c. codeine phosphate (codeine)

i hate to be the party pooper here, but i'm thinking about all the years of my practice as a hospital nurse. this patient was admitted for pneumococcal pneumonia. the doctor of this patient is going to come in and his first question to me is going to be, "did you start the zithromax yet?" i'm sure he's a compassionate doctor, but he's not going to be very pleased that the underlying cause of the fever, cough and pain wasn't attended to first.

my answer. . .we better get that antibiotic started first.

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a patient who was admitted to the hospital with pneumococcal pneumonia has a temperature of 101.6 f with a frequent cough and is complaining of chest pain rated a 7 on a 10 point scale with deep inspiration. which of these ordered medications should the nurse give first?

a. azithromycin (zithromax)

b. acetaminophen (tylenol)

c. codeine phosphate (codeine)

i hate to be the party pooper here, but i'm thinking about all the years of my practice as a hospital nurse. this patient was admitted for pneumococcal pneumonia. the doctor of this patient is going to come in and his first question to me is going to be, "did you start the zithromax yet?" i'm sure he's a compassionate doctor, but he's not going to be very pleased that the underlying cause of the fever, cough and pain wasn't attended to first.

my answer. . .we better get that antibiotic started first.

you know, my first instinct is to address the source of all the ills...which would be infection.

but knowing that pneumococcal pneumonia is transmitted via droplets and this pt is coughing, i couldn't help but think about the rest of the vulnerable population in the hospital...

so i put codeine to suppress his cough.

either way, tylenol was the last one i'd give.

leslie

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Oops, just realized that the med is codeine, not a codeine-based cough syrup. That's because no one would prescribe JUST codeine, it usually comes combined with Tylenol, which equals a Tylenol #3.

Or am I completely having a senior moment here?

Oh, you are completely right. I was asking my mom about this because she has worked in a pharmacy for 20+ years and when I read her the question and told her the choices her reply was "codeine with Tylenol!" She said that's how it is usually prescribed.

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Aren't these kinds of questions fun? Actually, they can be. They really make you think and learn... I just hate if they are graded all or nothing because as we can see from the discussion here that oftentimes in the real world, and even in the ideal world, there just aren't always clear cut answers. You could really know a great deal about all aspects of the condition and treatments and have well-grounded rationale's and still get the answer wrong. Oh well, I guess the important thing is learning!!!!!

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I'd go with the pain med. In real world nursing the answers would be different but when in school, its all according to NCLEX and "Ivory Tower" nursing.

Giving the pain med will reduce the pain from deep inspiration. Once the pain is reduced the pt will then be able to cough and deep breath which is important to mobilize the fluid in the lungs.

Tylenol for the fever won't help get rid of the infection and the zithromax will start to get rid of the bacteria causing the pnemnonia but if the patient isn't coughing and deep breathing, the pnemonia will linger. These two meds won't do a lick of good if the patient can't get gas exchange because they aren't coughing out the secretions and moving the "gunk" in the lungs.

Just my :twocents:

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