Question

Nurse M. is caring for a 71 year old female client R S on the midnight shift (11p-7a 2300-0700) at the local hospital. Client R S has a history of Depression, Chronic obstructive pulmonary disease (COPD), and Congestive Heart Failure(CHF). RS was admitted earlier with shortness of breath, to rule out (R/O) pneumonia, and to rule out acute exacerbation of CHE Client RS is stable at this time. Upon reconciling mediations for RS, the nurse observes that she takes the following medications at home: furosemide (lasix) 20mg by mouth daily fluticasone propionate and salmeterol (advair) I puff Q12H lisinopril (zestril 20mg by mouth Q day clopidogrel (plavix) 75mg by mouth daily It is now 0100 (lam) and RS is scheduled for furosemide (lasix) 20mg IV push and it is not in the medication drawer for RS Nurse M. asks a fellow RN what to do. Busy, the other nurse states "we have extra doses in the cabinet in back, it comes in a brown bottle, use that." Nurse M. locates the brown bottles labeled furosemide (lasix) 40 mg/ml and examines RS's Medication Administration Record (MAR). Nurse M withdraws 2.5ml and prepares to administer it to RS 1. Is there anything you think Nurse M. should have done differently? 2. Did Nurse M. follow the 9 rights of safe medication administration, if not, explain? 3. Are there concerns regarding this particular medication being administered at this time? 4. Any age related concerns regarding this particular medication? 5. What laboratory results should Nurse M. consider prior to administering? 6. In light of the above scenario what may contribute to a medication error? 7. Is there any other resource or personnel involved in safe medication administration that Nurse M can consult regarding medication administration other than her co-worker that is busy, if so, who?

Here is a clearer picture.

Nurse M, is caring for a 71 year old female client R S on the midnight shift (11p-7a 2300-0700) at the local hospital.

Client R S has a history of Depression, Chronic obstructive pulmonary disease (COPD), and Congestive Heart Failure(CHF). R S was admitted earlier with shortness of breath, to rule out (R/O) pneumonia, and to rule out acute exacerbation of CHF. Client R S is stable at this time.

Upon reconciling mediations for R S, the nurse observes that she takes the following medications at home:

furosemide (lasix) 20mg by mouth daily

fluticasone propionate and salmeterol (advair) 1 puff Q12H

lisinopril (zestril) 20mg by mouth Q day

clopidogrel (plavix) 75mg by mouth daily

It is now 0100 (1am) and RS is scheduled for furosemide (lasix) 20mg IV push and it is not in the medication drawer for R S. Nurse M. asks a fellow RN what to do. Busy, the other nurse states “we have extra doses in the cabinet in back, it comes in a brown bottle, use that.” Nurse M. locates the brown bottles labeled furosemide (lasix) 40 mg/5ml and examines R S's Medication Administration Record (MAR). Nurse M withdraws 2.5ml and prepares to administer it to R S.

1. Is there anything you think Nurse M. should have done differently?

2. Did Nurse M. follow the 9 rights of safe medication administration, if not, explain?

3. Are there concerns regarding this particular medication being administered at this time?

4. Any age related concerns regarding this particular medication?

5. What laboratory results should Nurse M. consider prior to administering?

6. In light of the above scenario what may contribute to a medication error?

7. Is there any other resource or personnel involved in safe medication administration that Nurse M can consult regarding medication administration other than her co-worker that is busy, if so, who?

Answer 1

1.The nurse could have probably ordered this medication from the pharmacy and then administered it because as this medication is in order for the patient twice a day. Therefore there will be necessary to ensure that morning doses are there.Second most important thing to consider here is why there is no night dose when the order is for twice a day.Ensure the patient is not overdosed.

2.The time is a concern here,the right response of the medication after being administered at this time for the improvement of the patient existing symptoms

3.Furosenide is a diuretic so it should not be administered in the night time .It is generally administered before evening in case of two doses a day.Giving this in night time will interrupt the patient sleep.

4.The elderly patient have decreased renal and liver function because of age.This medication is mostly eliminated via urine ,so it has to be given after great concern with right dosing to avoid complications