Ondansetron.... iv or im ..... doctor's prescription....

psu_213, BSN, RN · Jan 31, 2015

I have never given it IM and I can not find anything saying it can be given IM.

It is given somewhat frequently IM by medics when a patient is actively vomiting and IV access is not possible (for example, someone who is a difficult stick).

If, however, a patient has an IV, I see no reason to give it IM rather than IV.

2bNurse_kinjal · Jan 31, 2015

Yesterday i had practical exam.... so might be professor wants to confuse me.... my patient had 2 episod of vomiting in morning between 8 to 8:30 and doctors came in round at 9 o'clock. So i was giving ondansetron at 9 after ordered by MD. i have given the answer that sir we cant change the route but wants me to answer that is it good that if patient has no vomiting at 9.... so whyy should we give patient medication without complain of vomiting at nine....

JustBeachyNurse, LPN · Jan 31, 2015

Yesterday i had practical exam.... so might be professor wants to confuse me.... my patient had 2 episod of vomiting in morning between 8 to 8:30 and doctors came in round at 9 o'clock. So i was giving ondansetron at 9 after ordered by MD. i have given the answer that sir we cant change the route but wants me to answer that is it good that if patient has no vomiting at 9.... so whyy should we give patient medication without complain of vomiting at nine....

Not enough information. Is the patient receiving chemo or narcotics? What is their medical condition? Zofran works better as a preventative antiemetic than once vomiting starts. Do they have choleycystitis or pancreatitis? Conditions known to cause waves of nausea& vomiting.

psu_213, BSN, RN · Jan 31, 2015

Yesterday i had practical exam.... so might be professor wants to confuse me.... my patient had 2 episod of vomiting in morning between 8 to 8:30 and doctors came in round at 9 o'clock. So i was giving ondansetron at 9 after ordered by MD. i have given the answer that sir we cant change the route but wants me to answer that is it good that if patient has no vomiting at 9.... so whyy should we give patient medication without complain of vomiting at nine....

I'm pretty sure your professor is not trying to confuse you; rather, he/she is probably trying to get you to think about the situation and come up with answers on your own. Every med has adverse effects and Zofran is no different. However, compared with some meds we give, Zofran is fairly benign. If the patient was actively vomiting, I don't see it as unreasonable to give a 'scheduled' dose even after the vomiting has stopped. It is much easier to "stay ahead" of N/V (i.e., keep it away) rather than try and catch up after a patient has started a severe episode of projectile vomiting.

2bNurse_kinjal · Jan 31, 2015

Right. If the patient is being given other medications that are likely to cause nausea then it would be indicated but otherwise why give? I'm of the mindset that I wouldn't want medications in me that I don't need and I treat my patients as such.
@nurse_kinjal...This sounds like your instructor is testing your critical thinking skills.

And yeah as i am 3 semester BSN student so i do not have much knowledge about pharmacology.... it was my practical exam and sir asked this question to me in the bed side viva voce.... after showing him procedure of IV administration.... so I got that he wants to confuse me by telling that im or iv route.... :rolleyes:

2bNurse_kinjal · Jan 31, 2015

Not enough information. Is the patient receiving chemo or narcotics? What is their medical condition? Zofran works better as a preventative antiemetic than once vomiting starts. Do they have choleycystitis or pancreatitis? Conditions known to cause waves of nausea& vomiting.

patient has Acute gastro entritis at present and Pulmonary Kochs (Since 4 years)and COPD (2 years) and has completed full 9 months AKT Course of treatment.... patient had abdominal tenderness and pitting edema too

Here.I.Stand, BSN, RN · Jan 31, 2015

I haven't read through the responses, but if it's not needed I'd just have the provider change the order to PRN. But in any case, if the route is specified as IV no, you can't just give it IM. Personally I'd never suggest giving an IM injection when IV access is available, though...OUCH!!

ETA: if the pt still has underlying nausea that the Zofran is keeping under control or if it's being given as a pre-med, then absolutely continue to give it as scheduled. I'd still give it IV though, even if IM was an option.

2bNurse_kinjal · Jan 31, 2015

:thumbup::thumbup::thumbup: thank you all for helping me....

2bNurse_kinjal · Jan 31, 2015

I'm pretty sure your professor is not trying to confuse you; rather, he/she is probably trying to get you to think about the situation and come up with answers on your own. Every med has adverse effects and Zofran is no different. However, compared with some meds we give, Zofran is fairly benign. If the patient was actively vomiting, I don't see it as unreasonable to give a 'scheduled' dose even after the vomiting has stopped. It is much easier to "stay ahead" of N/V (i.e., keep it away) rather than try and catch up after a patient has started a severe episode of projectile vomiting.

you are right.... in fact sir told us that he wanna make our whole batch same as him.... as he is speciality of critical care nursing...... so he always asks us questions that screws our brain....

SN2014 · Jan 31, 2015

Is the order PRN? (as needed)

Is the pt nauseous? It is ok to give for nausea... the pt does not have to be actively vomiting.

The medication is fairly low risk.

The risk your instructor is speaking of is probably referring to the fact that anytime you start an IV or access an IV port you introduce a risk of infection..which if you follow protocol is also low risk..

like many people stated IM would be also unnecessary, and unpleasant.

Maybe a PO route would be more appropriate? Zofran ODT? It's fast acting and less "risk"

In real world, you give it. In NCLEX perfect world, you'd ask if it could be switched to PO.

nurseprnRN, BSN, RN · Jan 31, 2015

He's not screwing your brain, he's asking you to integrate everything you know about this medication, this medical condition, assessing N/V, the likelihood that it will reoccur, and the procedures for prescribing and delivering medications to come to a decision about what you, as a nurse, should do. You'll have to do all that every day of your working life, and that's what you're in school to learn.

And if he wants you to be better critical thinkers (and this does not refer only to "critical care") and thinks you capable of achieving his level of practice, you should be flattered, not resisting. Think out loud with him, and ask him to help you work through the thought processes to make a decision.

chevyv, BSN, RN · Jan 31, 2015

I also have never seen Zofran ordered as an IM injection. Never ever. And an IM is more painful for the patient anyway. Is the professor giving you a trick question maybe? IMs have side effects too and causes a break in the skin, therefore increasing infection risk. If a slower route is preferred, then I'd ask the Dr. for the SL route but in the hospital I've only used the SL route if there is no IV access at the moment. Don't know why you would want a slower route though, it's used for N/V so even without vomiting being present, nausea is certainly not comfortable for the patient.[/quote']
We give Zofran IM all the time on our unit. I work acute mental health and we do not have IV's on our unit (for safety reasons). We do a lot of detoxing and end up using Zofran often IM as PO will be useless.