Problem 10 - Clinical Nursing Skills and Techniques

Question

During the admission history the nurse determines that his 80 -yearold patient is currently taking a salmon-colored blood pressure pill, a yellow "muscle relaxing" pill, a pink liquid to calm his stomach, and a green and yellow "joint" pill. Which action should the nurse take first? 1 Ask the patient if he brought the medications with him 2 Check the patient's armband before administering any medications 3 Try to identify the medications by the patient's descriptions 4 Call the pharmacist to see if she can figure out what the medications are

Step-by-Step Solution

Answer

The nurse should first ask the patient if he brought the medications with him.

Step 1: Assess the Patient's Resources

Begin by checking if the patient has brought his medications to the facility. This involves directly asking the patient if he has the medications with him, as this can provide immediate and accurate identification of what the patient is taking. Selecting this action ensures that you utilize any information the patient already possesses.

Step 2: Confirm Patient Identification

It's critical to confirm the identity of the patient by checking the armband before proceeding with administering or verifying medications. However, this is more pertinent when you have medications to administer, rather than identifying them, which is the current issue.

Step 3: Accurate Identification of Medications

Attempt to identify the medications based on the patient's descriptions. This step involves using the patient's color-based description of their pills to determine what they are.

Step 4: Consult with a Professional

If identification based on the patient's description fails or proves insufficient, calling the pharmacist can provide professional assistance in identifying the medications the patient is taking based on their description and other known factors.

Key Concepts

Patient Safety

Ensuring the safety of a patient is the foremost responsibility in healthcare settings. Patient safety revolves around preventing harm to those being treated, making it a critical component during medication reconciliation. In scenarios where a patient cannot accurately describe their medications, evaluating potential risks is crucial.

Mistakes in medication administration can result in adverse drug interactions or overdose, particularly among elderly patients who often take multiple medications. Therefore, it is vital to confirm what a patient is taking before providing new treatments.

• Prevent medication errors by verifying patient details and medication specifics.
• Establish clear communication with patients to reduce misunderstandings.
• Double-check any medication details through reliable sources like pharmacists or medical records.

Nursing Assessment

The nursing assessment is an essential phase in evaluating a patient’s health status. It involves collecting and analyzing information about a patient’s conditions and needs, which informs further medical actions. During this evaluation, the nurse assesses not just physical health but also the patient’s understanding of their medication.

By asking questions such as: "Do you have your medications with you?" a nurse gathers critical information for accurate medication reconciliation. This process also includes observing nonverbal cues and considering the reliability of the available information.

• Assess the patient's understanding and capacity to manage their medications.
• Use the patient's med descriptions as an initial step, complementing it with other identification strategies.
• Ensure thorough documentation of findings to inform the healthcare team.

Medication Identification

Properly identifying a patient's medications is pivotal for effective treatment planning. Patients may refer to their medications by color, shape, or purpose. Thus, healthcare providers need a systematic approach to decode these descriptions accurately.

Often, patients might forget exact names or doses, making color descriptions vital clues. However, these are subjective and can lead to misunderstandings.

• Use the patient's medication containers, if available, to confirm drug identity visually.
• Access pharmaceutical databases or contact a pharmacy to aid in identifying unknown medications.
• Document every step of the identification process clearly.

Pharmacist Consultation

Pharmacists are invaluable in the medication reconciliation process. They possess detailed knowledge about medications, including appearances and common uses. When uncertainty arises about a patient's drug regimen, reaching out to a pharmacist for consultation can resolve many ambiguities.

Pharmacists can cross-reference pill descriptions with their databases to identify the exact medications and contraindications. This collaboration ensures the patient's safety and aids in avoiding potential drug-related problems.

• Leverage the pharmacist's expertise for issues beyond color or shape descriptions.
• Ensure that the pharmacist has access to all relevant patient information to provide effective guidance.
• Incorporate recommendations from the pharmacist into the patient’s treatment plan.