Question

Use the following scenario and client data to answer the question. A nurse is preparing to administer medications to a client for whom the nurse has the following data: Diagnosis Major depressive disorder Medications to Administer Vital signs Diazepam 5 mg oral twice daily BP 152/78 mm Hg Pulse rate 92/min Respiratory rate 18/min Oral temperature 36.7° C (98.1°F) O2 saturation 97% on room air Weight 97.7 kg (215 lb) Gabapentin 300 mg oral three times daily Atropine 0.4 mg IM 1 dose 30 min preprocedure Lisinopril 20 mg oral once daily Allergies Gentamicin Furosemide 40 mg oral once daily Medical history Panic disorder Fibromyalgia Posttraumatic stress disorder Congestive heart failure Hypertension Succinylcholine 0.6 mg/kg iv during procedure Laboratory Test Results Potassium 3.7 mEq/L Sodium 146 mEq/L BUN 18 mg/dL Hgb 15 g/dL Hct 54% ECG: normal sinus rhythm Diet LOW-sodium Electroconvulsive therapy (ECT) in 1 hr Scheduled Procedures Which three medications require clarification prior to administration? (Complete the following sentences by choosing from the dro not use the same medication selection more than once.) . - . The nurse should clarify the prescription for Select an option because The nurse should clarify the prescription for Select an option because Select an option Select an option the client is scheduled for ECT administering the medication is outside the nurse's scope of practice of the client's blood pressure of the client's allergy the client has a history of congestive heart failure. of the client's sodium level. The nurse should clarify the prescription for Select an option because PREVIOUS

Answer 1

Which 3 medications need clarification prior to the administration?

Answer:

Introduction:The standard patient guidelines for the ECT procedure:

The common instructions given to the patient scheduled for ECT are nil by mouth from midnight to the morning of the treatment without anything to eat or drink .They have to take the blood pressure medication with small sips of water in the morning before the procedure{here lisinopril to be given with water sips ,hence no clarification needed) .The inhaler for patients of COPD,asthma and chronic bronchitis can be used 1 hour before the procedure. .Lithium which is a mood stabilizer has to be stopped 24 hours before the treatment. Antidiabetic Drugs like metformin glucophage should not be taken 12 hours before the treatment to prevent hypoglycemia as the patient has to stay starving /fasting. The drugs like benzodiazepines (hence diazepam withheld here} lamictal, .(neurocontin)/ gabapentin (hence gabapentin withheld here) and other antiepileptic drugs affect the ECT treatment and decrease its efficacy..Hence the night time dose and the morning dose of these drugs should be skipped before the treatment .The patient should be accompanied by a family person/guardian/ responsible adult for the treatment session. The patient must empty his bladder or pass urine prior to the procedure (hence furosemide withheld).The patient is premedicated with atropine(hence no clarification needed) to prevent vasovagal attack and administered relaxation using thiopentone and succinylcholine,(hence no clarification needed) during the procedure.

answer1:

The nurse should clarify the prescription for diazepam because the client is scheduled for ECT.

Explanation:

The electroconvulsive therapy works by the induction of a generalised seizure using electric current stimulus.Drugs like benzodiazepines [diazepam] raise the seizure threshold and decrease the potential efficacy of the ECT. So the benzodiazepine drugs like diazepam should be stopped before the scheduled electroconvulsive therapy.

Preferably the patient has to skip the night dose and the morning dose before the scheduled day of electroconvulsive therapy as diazepam has a long half life .Since this client has been ordered diazepam and is also scheduled for electroconvulsive therapy in one hour ,the nurse must seek the clarification from the physician regarding the administration of diazepam as the drug is normally withheld or not administered prior to electroconvulsive therapy.

The reason why the other options as the reasoning are not correct:

The diazepam medication administration is not outside the nursing scope of practice and is not related to the client's blood pressure or History of allergy/ congestive cardiac failure or sodium levelc(here hypernatremia). Hence these are not the correct answer options.

answer 2:

The nurse should clarify the prescription for furosemide because the client is  scheduled for ECT

Explanation:

The nurse should seek clarification regarding the furosemide because the patient is scheduled for electroconvulsive therapy in one hour and it is a loop diuretic drug which increases the the amount of urine,fills the bladder  and so increases the risk of urinary incontinence/urine overflow during the seizure. Hence this drug is generally withheld just prior to ECT procedure (Prerequisite of ECT is empty bladder) and administered post ECT procedure once patient is stable. So the nurse must clarify from the physician whether it can be given before the procedure as the client is scheduled for ECT in one hour.

The reason why the other options as the reasoning are not correct:

Furosemide medication administration is not outside the nursing scope of practice and does not need clarification with relation to the client blood pressure/ history of allergy/ congestive cardiac failure /sodium level [here hypernatremia]. Loop diuretics like furosemide cause hyponatremia,Hence these are not the correct answer options.

answer 3

The nurse should clarify the prescription for gabapentin because the client is a scheduled for ECT

Explanation: Gabapentin is a mood stabilizer/anticonvulsant drug.Its administration prior to ECT decrease the quality of seizure in ECT and potentially decreases the  efficacy of the treatment.So the nurse  must clarify from the physician whether it can be given before the procedure as the client is scheduled for ECT in one hour.

The reason why the other options as the reasoning are not correct

Gabapentin medication administration is not outside the nursing scope of practice and is not related to the client blood pressure /history of allergy/ congestive cardiac failure or sodium level [here hypernatremia]. Gabapentin use causes hyponatremia.Hence these are not the correct answer options.

Reason why the drugs atropine ,lisinopril and succinylcholine are not the  clarification options:

Atropine is a premedication given 30mins prior to ECT to prevent vasovagal attack  and succinylcholine  is given for muscular relaxation during the procedure.The antihypertensive drug lisinopril  should be given prior to the procedure with sips of water in order to prevent hypertension from occurring during seizure. Since all the three drugs are indicated for the ECT procedure , they do not require any clarification .hence these drugs are not chosen for the answer options for seeking clarification.