Question

Carol Petros (C. P.) is a 77-year-old female admitted to the hospital 4 hours earlier after a fall at home caused by dizziness and weakness. She was initially brought to the emergency department by her daughter, who checked on her after not reaching her by phone. Her medical history includes hypertension, osteoarthritis, and a hysterectomy at age 50. She states that she has an allergy to penicillin, and she is full-code status. The patient has lived alone since the death of her spouse 3 months ago. She brought a small plastic bag with multiple medications in it because, as she said, “I can't open my medication bottles easily because of my arthritis.”

C. P.'s vital signs are: T 36.5° C (97.7° F), P 92 and regular, R 20 and unlabored, BP 172/92, with a pulse oximetry reading of 98% on room air. She reports a pain level of 8 of 10 in her left hip. She also reports a pain level of 5 of 10 in her hands from her arthritis. As the nurse completed the admission assessment, C. P. stated, “I forgot to take my furosemide in the morning, so I took both tablets before bed. I was up and down to the bathroom a lot, and fell because I was dizzy and my legs gave out early this morning. My daughter came to get me. Right now my hip and leg hurt when I move.”

She further reported, “I always have some pain in my hands and have to take medicine for that sometimes, but I don't like to because then I get constipated. I take a tablet of the over-the-counter herb, feverfew, every day to help with my arthritis pain.” The nurse notes a 4 × 5 cm bruise on the left hip. The patient's Braden score is 20, and her Morse Fall score is 40. Her left hip x-ray on admission showed no acute fracture. Serum potassium level is 3.3 mEq/L.

Treatment orders are as follows:

• Vital signs every 4 hours

• No-added-salt diet

• Activity as tolerated with assistance

• Intake and output

• Electrolyte panel in a.m.

Medication orders are as follows:

• Continue home medications of:

• Furosemide 40 mg PO bid

• Hydrocodone 5 mg PO every 4 hours PRN for pain

• K-Lor 8 mEq daily

• Start docusate sodium 50 mg PO daily

• Start intravenous (IV) infusion of 5% dextrose in half normal saline (D₅ NS) with 20 mEq of KCl to run at 75 mL/hr

Question 1:  CP has requested pain medication for her bruised hip. When the nurses accesses the locked narcotic cabinet, there are fewer pills counted than what is listed on the medication administration record. This is indicating there is a discrepancy with the narcotic medication. What action should the nurse take?

Question 2: The nurse accidentally administers CP’s prescribed diuretic, potassium and stool softener to Charlotte Peters, another patient on the unit. First, list at least four safety measures that can help prevent medication administration errors. Then, what actions should a nurse take after a medication error has occurred?

Question 3:  The primary care provider writes an order for CP that states “docusate sodium daily, PRN.” What additional information is needed before the nurse can safely administer this medication?

Question 4: C. P. verbalizes the concern that she will not take her medications correctly when she returns home. What plan can the nurse implement to help the patient safely take her medications?

Answer 1

1)Answer:

-Re check and confirm with second RN

-Report to ward manager/ incharge

- Report to pharmacist

-Complete the datix

2) Following steps are essential  to prevent medication errors

-Read the prescription carefully

-Check the  patient-Identity by name and DOB.

-Check for any medication allergies

- Fllow five rights of medication preparation and administration

: Right patient

: Right drug

: Right route

: Right dose

: Right time

Actions to be taken following a Medication error

-Complete assessment of the patient and necessary actions to maintain patient stability.

-Report immediately to the ward manager/incharge and yhe clinician incharge of the patient care

-Complete the incident report form.

-Explain to the patient as appropriate.

3)Nursing consideration for the safe administration of docusate sodium

-Evaluate the patient respose to the medication(confirm the status of constipation)

-check for side effect like cramping and rectal bleeding

-Check intaje of other drug, antacids or milk

4)Discharge medication

-Explain each medication to the patient,indication and duration of medications.

-Educate the patient

:what to do if a dose is missed

:when to call for concerns

:proper storage

:refill information

-provide written copy of all verbal information

-Arrange medication trial with pharmacists.It helps to make sure that patient can take their medicine before they discharge.

-Discuss with pharmacy outreach services for regular visit and review. Its essential when patient lives alone.

-Consider use of dose administration aids, such as dosage boxes.