(uplifting music)
- Hi I'm Sarah, and today I'm going to demonstrate
the administration of oral medications.
So I'm going to go over here to my computer
and look up my patient.
(scanner beeps)
Okay, our patient is Morgan Brown.
Date of birth, August 4th, 1970.
He has no known allergies.
So now I'm going to look at my orders
and see what medications I have to administer today.
Okay, I see that he has an order for docusate,
100 milligrams, to be given today orally.
Also an order for digoxin, .25 milligrams to be given today.
Furosemide, 20 milligrams, to be given today.
And potassium chloride, 20 mil equivalence
to be given twice a day, once this morning,
and later this evening.
So, I've already been in the room to see the patient,
I've done all my appropriate assessments.
One thing you have to make sure when you're giving
digoxin, the heart rate, checking the patient's heart rate
is really important.
His heart rate was above 60,
so it's safe to give the medication.
Things to consider is if his heart rate is below 60,
you would want to consider holding the medication
and notifying the physician.
He's getting furosemide.
Furosemide's considered a water pill.
We need to make sure that we are checking
for adequate I and O.
We also want to make sure that we look at our labs,
such as our potassium level.
I looked at all of that today, and it looked good.
He is going to get some extra supplementation
with the potassium, and then the docusate,
that's a stool softener, which you want to tell the patient
how that works, bringing water into the bowel,
and we want to know when was his last bowel movement.
And after I looked in the chart,
it looks like his last bowel movement was today.
Okay, so after I've done all my proper assessments,
I now need to think about what are my adverse reactions
and other patient teaching that I want to do.
So of course, I want to explain to him all the reasons
that he's getting this medications,
why he will be getting furosemide.
I saw that he has a history of heart failure, CHF.
So that's important to keep fluid off the body.
Again, like I said, potassium is a supplementation.
Digoxin, that's to help the heart work better.
That's going to give the heart a better pumping ability.
And then the stool softener,
to help him move his bowels a little bit easier, okay?
So, any adverse effects that I want to look for.
So here in the drug book,
I'm going to start with docusate sodium.
With docusate, you want to make sure that you're
monitoring the patient's stool,
and that they're not going to frequently,
or that the stool isn't too liquidy.
With digoxin, like I said, we have to track the heart rate.
We want to make sure that the heart rate
is not dropping, okay?
So after we give the medication we want to keep
an assessment of how the patient's heart rate's looking,
that's not going to low and that the patient's
not exhibiting any dizziness or lightheadedness.
We also have to monitor for something called digtoxicity.
You could check a patient's level with that,
but you also want to assess for if they're seeing
any yellow or green floaters,
if they're exhibiting any confusion.
And then with potassium, since we are giving the supplement,
but if a patient's potassium was too low,
they might be experiencing some weakness,
some cramping when the potassium is too high.
That's why we have to be very cautious.
That can cause some lethal arrhythmias.
And furosemide.
Like I said, we have to monitor here for I and O, okay,
and then watching our electrolytes
because we don't want those electrolytes to be too depleted.
If sodium gets depleted, they get neurologic effects,
and then with the potassium, cardiac effects.
Now I'm going to go to the medication cart
and gather my supplies and my medications.
I'm going to perform my first check.
So I have right patient, Morgan Brown.
Right drug, docusate, 100 milligram tablets
to be given orally today at 10:00 am.
The medication is not expired and I will document correctly.
Next medication's digoxin.
I have the right patient, Morgan Brown.
The right medication, digoxin, the right dose,
.25 milligrams to be given orally today at 10:00 am.
The medication is not expired and I will document correctly.
My next medication is furosemide.
So I have the right patient, for Morgan Brown.
Right drug, furosemide.
Right dose, 20 milligrams.
Right route, to be given orally.
To be given today at 10:00 am, the right time.
And medication's not expired and I will document correctly.
Lastly, I have potassium for the right patient,
Morgan Brown.
The right drug, potassium chloride.
The right dose, 20 mil equivalence.
The right route, to be given orally.
The right time, today at 10:00 am.
And the medication is not expired
and I will document correctly.
So that completes my first check.
Now I'm going to do my second check.
Okay, I have the right patient, Morgan Brown.
The right drug, docusate, 100 milligrams.
To be given right route, orally.
To be given today, the time 10:00 am.
The medication is not expired and I will document correctly.
Digoxin.
I have the right patient, Morgan Brown.
The right drug, digoxin.
The right dose, .25 milligrams.
To be given at the right time, 10:00 am today.
The correct route is oral.
The medication is not expired and I will document correctly.
Then I have furosemide.
Again, the right patient, Morgan Brown.
The correct drug, furosemide.
The correct dose, 20 milligrams.
To be given at the right time, today at 10:00 am.
To be given the route orally.
The medication is not expired and I will document correctly.
And then, potassium.
For the right patient, Morgan Brown.
The right drug, potassium chloride.
The right dose, 20 mil equivalence.
The right time, to be given today at 10:00 am.
The right route, to be given orally.
The medication's not expired and I will document correctly.
Now I'm ready to go to my patient's room.
(door knocking sound)
Hi Morgan, it's Sarah, your nurse.
I'm here to give him your medications.
- [Patient] Hi Sarah.
- How are you doing?
- [Patient] I'm okay.
- All right, I'm gonna put the head of the bed up here
so you can swallow properly.
All your medications are going to be given orally
and I don't want you to choke.
And if you remember, I was in the room earlier
and completed all my assessments.
Okay.
(scanner beeps)
I'm gonna get to your chart here, Morgan.
Okay, can you tell me your name and date of birth?
- [Patient] Morgan Brown.
August 4th, 1970.
- Okay, good, that's what I have here.
Okay, so one thing to keep in mind is
I'm performing my third check in the room right now
and that is because I have an electronic medical record.
When you have an electronic medical record
in unit dose medication, you need to bring that medication
in the room with you to do your third check,
to be able to scan the medication,
because that's when you are going to document.
If you're in a facility that does not have
an electronic medical record, such as a long term care
or a skilled nursing facility, you will be performing
that third check outside the room at the med cart
prior to coming into the patient's room.
Okay, Morgan, do you have any allergies?
- [Patient] No.
- All right, great.
All right, so let's see here.
All right, our first medication is going to be docusate.
That's a stool softener.
Okay, so I have the right patient, Morgan Brown.
The right drug, docusate.
The right dose, 100 milligrams.
I have for the right time, today at 10:00 am.
I have the right route, orally.
I am going to document now,
and the medication is not expired.
Okay, documenting.
Okay now,
our next medication is digoxin.
This is for your heart.
Okay, I have the right patient, Morgan Brown.
I have the right drug, digoxin.
I have the right dose, .25 milligrams.
I have the right time, to be given today at 10:00 am.
The right route, to be given orally.
The medication is not expired, and I will document now.
Okay, and our next medication is
furosemide.
Okay, I have the right patient, Morgan Brown.
I have the right drug, furosemide.
I have the right dose, 20 milligrams.
I have the right time, today at 10:00 am.
I have the right route, to be given orally.
The medication's not expired and I will document now.
Okay, and lastly, oh Morgan, that furosemide,
that's your water pill to help get the extra water
out of your body, so you're gonna urinate a lot today, okay?
- [Patient] Okay.
- All right, and then we have potassium chloride.
This is a potassium supplement.
We don't want your potassium get too low.
So we have the right patient, Morgan Brown.
We have the right medication, potassium chloride.
I have the correct dose, 20 mil equivalence.
I have the correct time, to be given today at 10:00 am.
I have the correct route, orally.
And the medication's not expired and I will document now.
Okay.
Okay, Morgan and now you said
you could swallow these all at once?
- [Patient] Yeah, I can.
- Okay, all right, good.
Now I can't, I'm going to give you
just enough water to swallow these.
You're on a fluid restriction of 1,000 milliliters
and we have to monitor very closely what you're taking in.
So, I've got some water and your medications here.
Okay, there you go.
Okay, here's some water.
All right, good.
Did those go down okay?
- [Patient] Yep.
- All right, just want to make sure
there's nothing left in your mouth.
Okay, good.
Morgan, I'll be back in about an hour to check on you.
Here's your call light.
If you need anything, go ahead and push the red button.
My side rails are up, my bed's in the lowest position.
Are you comfortable in this position?
- [Patient] Yeah.
- Okay.
Morgan, feel free to call me sooner if you need anything
or if you start to feel dizzy or any palpitations.
But like I said, I will be in in about an hour
to check on you again.
- [Patient] Okay, thank you.
- That now completes our demonstration
of oral medication administration.
(uplifting music)