Question

Safe Medication Administration

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A 23-year-old female is admitted to the hospital for treatment of an infected left toe. The patient has a history of spina bifida and has a percutaneous endoscopic gastrostomy (PEG) tube in place due to difficulty swallowing. In addition, the patient is on antibiotics for a recurring urinary tract infection (UTI) and appears dehydrated. The patient states she developed the trouble swallowing about 1 year ago and the PEG tube now provides her primary source of nutrition.

1. Identify the clinical problem(s) in the case study.

2. The nurse prepares to administer antibiotics for the UTI to the patient. The health care provider ordered Bactrim once daily in the morning. The pharmacy has sent Bactrim tablets for the patient. How should the nurse administer this medication?

3. The nurse returns to the patient’s room 15 minutes after administering the medication and finds the patient lying on her left side, complaining of difficulty breathing. What should the nurse’s response be?

4. Discuss potential patient problems that may be encountered in the administration of oral or topical medications (e.g., nausea, skin irritation). Have students identify appropriate nursing interventions for each situation.

Answer 1

Ans) 1) COMPLICATIONS ASSOCIATED WITH PEG PLACEMENT: INCIDENCE AND MANAGEMENT
Peristomal wound infections. Incidence and causes: Peristomal wound infections are the most common complication associated with the PEG procedure, with an incidence ranging from 4%-30%.
Clogged feeding tubes.
Peristomal leakage.
Colonic fistulae.

2)  Health care provider ordered Bactrim once daily in the morning. So, the nurse administers the medication 1 tab of bactrim after breakfast.

3) Perform Initial Assessment of Patients with Dyspnea
Assess airway patency and listen to the lungs. Observe breathing pattern, including use of accessory muscles. Monitor cardiac rhythm. Measure vital signs and pulse oximetry.

4) Adverse oral drug effects include xerostomia, oral ulcerations, gingival hyperplasia, taste alteration, lichenoid drug reaction and mucositis, which are discussed here. Others include dysesthesias (altered sensations), osteonecrosis, malignancy, intraoral pigmentation and angioedema.