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

[2bNurse_kinjal]

if patient has no vomiting at present and doctor has prescribed ondansetron IV.... so should we give it to IV or change the route to IM.... my professor said that i'm increasing chances of complications by giving iv.... where patient is not needed rapid action.... should i listen to my professor or follow the doctor's prescription.... please help... i have to answer my professor....

[KelRN215, BSN, RN]

Add me to the list of people who've never, ever given zofran IM. If the patient has an IV, I don't see why you'd give IM anything, unless it was a vaccine or something else that can only be given IM. IV zofran is perfectly safe to administer. OP, your patient had had 2 episodes of vomiting in the past hour. Just because he's not actively vomiting at present doesn't mean that he's not still experiencing nausea. And, as another poster said, it's better to stay ahead of the nausea because, if you don't, it will take much longer to get it under control as you play catch up. When I worked in the hospital, our pharmacy often blocked the use of oral zofran because of the expense. Patients who are vomiting likely have IVs (or need one if they don't have one) and they felt IV zofran was the better option.

[ClaraRedheart, BSN, RN]

Zofran IM is kinda strange. Wasn't aware you could give it that way. Phenergen (also relieves nausea/vomiting), however, can be given IM and IV, and IV has a LOT of complications that can happen with it. I'm kind of wondering if the professor wasn't thinking of Phenergen and wrote odansetron instead. Phenergan is really caustic and can cause burns and necrosis. At my hospital, many of our doctors will specify in the order details for Phenergen that they want it IM, even though it's a linked order and BOTH the IM and IV version show up as available on the chart. If I have the option to combat nausea/vomiting with Zofran or Phenergen, I usually choose Zofran first, THEN Phenergen IM, then Phenergen IV. Just FYI, If you give Phenergen IV, NEVER give it in hand or wrist access and flush with 20cc's of saline just to be safe.

[Tenebrae, BSN, RN]

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....

If I was your professor, I would want you to tell me that you can not change the route of a medication without a doctors signed order.

I'd also want you to tell me why did the MD prescribe this medication? How much and how often?

I'd want you to tell me the patients Hx nausea and vomitting and when this medication was last given?

Your professor is not trying to confuse you, they are just trying to get you to use your critical thinking and assessment

[gonzo1, ASN, RN]

Not to change the subject but you can take the iv zofran and just squirt it in mouth. As nurses we should try to limit IMs for our patients because they are painful and open a possible infection route.

[2bNurse_kinjal]

Not to change the subject but you can take the iv zofran and just squirt it in mouth. As nurses we should try to limit IMs for our patients because they are painful and open a possible infection route.

And what if my professor would fail me in practical exam.....

[cayenne06, MSN, CNM]

Not to change the subject but you can take the iv zofran and just squirt it in mouth. As nurses we should try to limit IMs for our patients because they are painful and open a possible infection route.

Yes, you can do this, but you still need an order to change the route.

[That Guy, BSN, RN, EMT-B]

Im sorry but increasing complications of giving it IV? Is your instructor crazy?

[NurseSpeedy, ADN, LPN, RN]

You have to follow the doctor's order. You cannot change the route without an order. If the patient is not nauseated, then why is it ordered? Have they had nausea recently (Basically, why are you even giving it if they don't need it)? Consider getting an order to change it to PRN. If I were the patient, you would have just gotten refused. I've never given IM Zofran and I've been a nurse for 15 years, 8 of which were in the hospital. Yes, there's a risk of infection with IVs. There's risks with IMs too (like nerve damage if done incorrectly. Though rare, injection sites can become infected too). PLUS IMs HURT! I haven't known of too many nursing students that were allowed to contact the MD to change the order, even with their instructor. Honestly, I think your instructor wants to make sure that you won't do anything illegal, like give the medication a different route than what was ordered.

[NurseSpeedy, ADN, LPN, RN]

And what if my professor would fail me in practical exam.....

You will need to get an order to change the route. I've never seen IV medication used orally in order to change the route. There is such thing as sublingual zofran. I had an order for PO from the ER and when I vomited after taking it at home, my MD told me to take it under the tongue SL instead. There are also other drugs that the MD may choose to order, such as a phenergan suppository. Every drug has side effects and every drug needs an order from a doctor. I get that your teacher is trying to get you to think and this is why he is asking you a bunch of questions. In the real world, we do what is best for the patient (and obtain the MD order). If it doesn't make a difference (like giving IV when they have an IV site) then we give it to them IV (and change to PRN if not needed routinely). You will learn quickly that we contact the doctor when necessary. Calling them for things that will not affect the course of action and can wait until they make rounds next will quickly get you corrected if you make a habit of it (such as asking for IM zofran when they have an IV).

[joe007]

Sounds like you have one of those nutty instructors who is messing with you. I would do what the order says and give it IV unless pt. refuses.

[Tenebrae, BSN, RN]

And what if my professor would fail me in practical exam.....

If your answers are based in evidence based nursing praxis, they would have a hard time doing so.

[VANurse2010]

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.

In which case, for projectile, the patient should be getting phenergan or tigan anyway...