Question

Ms. C.J., a patient on the medical-surgical unit, was admitted 2 days before with a diagnosis of exacerbation of heart failure. This morning her blood pressure is 175/80 mm Hg. She denies chest pain but states that she has been experiencing shortness of breath. She tells the nurse she uses three pillows to be able to breathe at night while sleeping. Her baseline weight at admission was 170 lb, but this morning’s scale indicates a 4-lb weight gain, and +3 pitting edema to the lower extremities is evident. The nurse telephones the doctor and receives an order for furosemide 40 mg by mouth (PO) twice daily and metoprolol 25 mg PO daily to start immediately.

1. How will the nurse identify Ms. C.J. prior to administering medications?

2. Which labs should the nurse review prior to administering furosemide and metoprolol?

3. What safety measures should the nurse use when obtaining the medications from the Pyxis system and administering the drugs to Ms. C.J.?

4. The nurse scans the medications in the electronic health record (EHR) and medication administration record (MAR) and administers the metoprolol. When she attempts to administer the furosemide, the patient states, “I don’t want the water pill.” What is the nurse’s next action?

5. What important information should the nurse document into Ms. C.J.’s medical record 30 minutes after administering the medications?

Answer 1

1. Identification of patient

Use atleast two patient identifiers before the medication ( such as Full name and In patient number,IP Number).Always follow agency policy for patient identification and compare against the MAR ( Medication Administration Record).

2. The nurse has to review the lab reports especially for electrolyte alterations.There is a chance of hypokalemia and decreased excreation of lithium , may cause litbium toxicity after furosemide administration. She should also check for hypoprotienimia, inturn cause ototoxicity. She has to check for the presence of Diabetes mellitus and Thyrotoxicosis, metoprolol may mask the the complications of both. It may become a danger for patient's life.

3. Pyxis system is the automated medication dispensary system supports decentralised medication management with various features for safety and efficiency. Eventhough it is safe nurse has to be responsible for entering the correct data for obtaining drug. Check the drug for the name, expiry date etc.

4. If a patient questions a medication, stop and explore the patient's concerns. Explain the action of drugs.review the physician's order and if necessary notify the practitioner.

5. After administering the medication she has to document in Ms.C.J's medical document regarding any variation in blood pressure, urinary output, presnce of any allergic symptoms, blood glucose level. Also should mention about any tinnitus or confusion.