Online Companion: Fundamentals of Nursing Standards and Practice 2E

Frequently Asked Questions

The nurse prepares 5 scheduled medications for a client. He refuses to take the drugs saying "Those pills aren’t helping me; they are making me sicker than I was." How does the nurse proceed in this situation?

There are several reasons why clients choose not to take ordered medications. If the client is asymptomatic, it may be difficult for the client to understand the need to take the medications. Medications are expensive and the client may not be able to afford the medications. If the medication does not provide prompt relief, the client may consider the drug useless and discontinue it. If the client experiences undesirable side effects from the drug, he may decide to stop taking it. In the example in the question, this client is not getting relief from the drugs and is having undesirable side effects. The nurse begins by exploring and clarifying what the client means when he says "sicker that I was". Assess what specific symptoms he is having at the present time. Clarify what he means when he says "aren't helping me". Assess the concerns and symptoms he expected to be relieved by the drug regimen. The client's thoughts and feelings are the basis for the nurse's response. The nurse may identify that the client needs information about his medical problem and the expected effects of the ordered medications. The interaction may assist the nurse to identify that the client is experiencing side effects of one of the drugs and decide to collaborate with the physician about the client's response. At the bedside, the nurse explains to the client the expected effects of the drugs and the consequences of not taking the medicine. The client can then make an informed decision about taking the medicine. This is a right of the competent adult client. The nurse then documents the interaction and notifies the physician or other health care provider who wrote the drug order of the situation.

The nurse on the previous shift documented that a stat dose of Lasix 40 mg po was given to Mr. Robert Jones when it was ordered to be given to Mr. Herbert Jones. You discover the error; what steps should be taken?

The first step to be taken is to assess Mr. Robert Jones for effects and side effects of the drug Lasix; his health condition, the drugs he usually receives, his age are all important factors to consider and evaluate. The assessment data is reported to Mr. Robert Jones' physician and documented. An incident report is completed. Mr. Robert Jones is monitored closely for the next 24 hours. The matter of the correct order for Herbert Jones has to be addressed as a priority of care. This client also needs careful assessment to determine what effects of the delay in receiving the Lasix drug have had on him. The nurse assesses specifically for evidence of fluid overload. If there has been a delay of more than four hours since the stat order was written, Mr. Herbert Jones' health care provider should be notified and data on his current condition shared to decide the next step in his care. An incident report may be prepared for this incident of delay in implementing a stat order. The nurse and the administrators of the nursing service in the agency should plan a time to problem solve this situation, what factors led to this error and what measures will be taken to prevent this occurrence in the future.