Question

An 80-year-old man “Gus” was 3 days postoperative. He was alert and oriented. A nursing student administered his morning medications in one cup that included clopidogrel (Plavix), carbidopa-levodopa (Sinemet), prednisone, rivastigmine tartrate (Exelon), and risperidone (Risperdal). Unfortunately, this cup of medications belonged to another patient on the unit. The nursing student realized her error when she went to medicate her second patient and the patient noted that the medications in the cup did not look like her medications.

1. What potential side effects might Gus experience from the medications in this cup? Which of these side effects is most concerning to you?
2. What assessments are critical to monitor on this patient for the remainder of your shift due to potential side effects of the administered medications?

Gus became drowsy with mild nausea and hypotension after taking the medication.

1. What interventions could be provided to relieve the patient of these side effects? (name at least one for each side effect)
2. What needs to be monitored with each intervention to prevent further complications? (name at least one for each intervention)

Gus’s symptoms resolve in 24 hours without further incident or adverse event. A meeting was conducted with the nursing student and instructor to debrief the incident. The student provided the following explanation for the error. In an attempt to save time, the student removed and prepared the medications for both of her patients from the Pyxis (automated drug dispensing system) at the same time. She reviewed and checked the medications for both patients in the medication room and then left both cups on the counter. When the student returned to the medication room to retrieve the first patient’s medication she grabbed the wrong cup. The student acknowledged that she did not check the patient’s medication at the bedside because she had already checked them in the medication room.

1. What legal and ethical parameters of medication administration did the student violate with her actions?
2. What workarounds were present in this situation?
3. What steps of the medication administration process did the student fail to perform?
4. If she was a licensed RN, what potential legal ramifications could the student face due to her error?
5. What should the student do the next time to ensure a similar error does not happen again?

6. List the proper steps of the medication administration process. (10 points)

Answer 1

1.As the nurse administered antiplatelet drug, clopilet the patient is at high risk for developing bleeding. Patient may also experience nausea, vomiting, light headedness, loss of appetite and headache due to taking Carbidopa.

2.patient may experience the effects of medication once they have started it. Observe the patient for abdominal pain, bleeding from gums or nose, severe headache and vomiting, change in the excretion of urine.

3.Provide the patient with water or administer intravenous fluids as per doctors order. Provide the patients with dry foods throughout the day to relieve nausea.

4 Monitor the patient vital signs at regular intervals and check BP. Examine the abdomen for auscultation of bowel sounds.