Medication Safety and Patient Assessment: Responding to Mrs. Bell’s Case

QUESTION

Scenario Naomi Bell, age 90, was admitted to the hospital yesterday after experiencing chest pain. She wears a hearing aid in her left ear. In the report you were told that she is "confused" and "doesn’t answer questions appropriately." Her vital signs overnight were as follows: temperature, 98.0 F; pulse, 62 beats/min; respiration, 18 breaths/min; blood pressure, 132/86 mm Hg. She is due for her morning medications. You review her medication administration record: Digoxin 0.125 mg PO every morning Famotidine 20 mg PO BID Enteric-coated aspirin 81 mg PO every day Potassium chloride 10 mEq PO every morning Furosemide 20 mg PO every morning Captopril 50 mg PO TID As you inform Mrs. Bell of her ordered medications and state their purpose, she points to the digoxin and says, "Honey, I don’t take that pill." Initial Post Questions (Refer to Discussion Grading Rubric Before Posting) 1. What are the safety checks to perform in order to administer medications safely? 2. How would you respond to Mrs. Bell’s statement? 3. Should the nurse administer the medication? Why or why not? Provide a rationale 4. Research digoxin on Lippincott advisor. What assessments are required before administration? 5. If Mrs. Bell has a low pulse rate, low blood pressure, or a toxic laboratory value, what is the nurses action? Reply to a Peer Instructions (Refer to grading rubric before posting) After you have posted, read through the postings of your peers. Read the 2023 Joint Commissions Hospital Patient Safety Goal NPSG.03.06.01 In response to at least one other student, based on your knowledge of medication administration and the NPSG

ANSWER

Medication Safety and Patient Assessment: Responding to Mrs. Bell’s Case

Introduction

Medication administration is a critical nursing responsibility that requires adherence to safety checks and thorough patient assessments to prevent adverse events. In this case, we discuss the safety checks needed for medication administration, how to respond to a patient’s statement regarding medication refusal, and the considerations related to administering digoxin.

Safety Checks for Medication Administration

1. Right Patient: Ensure you have the correct patient by verifying their identity using two unique identifiers (e.g., name and date of birth).

2. Right Medication: Confirm that the medication matches the physician’s order and the medication administration record (MAR).

3. Right Dose:Check that the prescribed dose is accurate for the patient.

4.Right Route: Verify the intended route of administration (e.g., oral, IV) and ensure it matches the physician’s order.

5. Right Time: Administer the medication at the scheduled time, adhering to institutional policies for time-critical medications.

6. Right Documentation: Accurately document the administration, including the time, dose, route, and any patient responses or refusals.

Response to Mrs. Bell’s Statement

When Mrs. Bell expresses her unwillingness to take digoxin, the nurse should respond as follows:

1. Listen Actively:Give Mrs. Bell your full attention and listen to her concerns without interruption.

2. Clarify and Reassure: Politely ask Mrs. Bell why she doesn’t want to take the medication. It is essential to address her concerns and provide information about the medication’s purpose and benefits.

3. Document the Refusal: If Mrs. Bell insists on not taking the medication after a discussion, document her refusal in the medical record. Ensure her decision is well-documented to prevent misunderstandings or potential issues later.

Should the Nurse Administer the Medication?

In this case, the nurse should not administer the digoxin without addressing Mrs. Bell’s concerns and ensuring her safety. The rationale for this decision is as follows:

1. Informed Consent: Patients have the right to refuse medication. Administering a medication against the patient’s will is a breach of their autonomy and informed consent.

2. Patient Safety: Digoxin has a narrow therapeutic range, and its administration should be based on accurate indications and patient tolerance. Administering it without Mrs. Bell’s consent may pose a safety risk.

Digoxin Assessment Requirements

Before administering digoxin, the nurse should assess the following:

1. Heart Rate: Ensure the patient’s heart rate is within an acceptable range (usually above 60 beats/min for most patients). If the heart rate is below this threshold, withhold the digoxin and consult the healthcare provider.

2. Potassium Levels: Check the patient’s serum potassium levels. Low potassium levels can increase the risk of digoxin toxicity. If potassium levels are low, consult the healthcare provider.

3. Blood Pressure: Monitor blood pressure for any significant changes. Low blood pressure may be a concern when administering digoxin.

Action for Abnormal Values

If Mrs. Bell exhibits a low pulse rate, low blood pressure, or toxic laboratory values, the nurse’s action should be as follows:

1. Low Pulse Rate: Withhold the digoxin and consult the healthcare provider. Reassess the patient’s vital signs and continue monitoring.

2. Low Blood Pressure: Assess the patient’s overall condition, administer fluids as appropriate, and consult the healthcare provider.

3. Toxic Laboratory Values: If laboratory values indicate digoxin toxicity, withhold the medication, and immediately inform the healthcare provider. Continue monitoring the patient’s vital signs and symptoms.

In conclusion, medication administration involves multiple safety checks and a patient-centered approach. In response to Mrs. Bell’s refusal of digoxin, the nurse should prioritize her autonomy and safety, ensuring that her concerns are addressed before proceeding with administration. Additionally, close monitoring and consultation with healthcare providers are essential when dealing with critical medications like digoxin.