# Medication Directions



## DFW333 (Feb 26, 2011)

Ok they really need to come up with a better way to tell the nurses how to administer meds on the patient's medication list.

The directions "Nitroglycerin, PRN for Chest Pain, Give Up To 3" is kinda vague.

Ran a call on a patient at a NH who complained of CP, nurse told us she gave him two nitro and his BP was 112. First thing I asked, "Was that BP before or after the nitro?" It was before. So Im just thinkin "Awh sh*t, this guys gonna be unconscious & unresponsive w/ BP in the crapper" cause just a week prior another crew had run to this same NH and had that happen.

Surprisingly enough he was A&Ox4 and talkin to us. So we asked him what happened and he said he woke up from chest pain and "the nurse came in, took my blood pressure and gave me two little pills and told me to hold them both under my tongue."

I looked up at my partner and he's lookin back at me with this look of 'Did he just say what I think he said?' on his face. Just to verify I asked the nurse how many doses of nitro he had. "I gave him one dose of two pills, I figured three would be too many."

His BP was in the forties when we checked it. How he was still awake and conversing like normal I dont know.

This is also the same nursing home where the diabetic fell out of bed, they checked his sugar and it was 19. We arrived to find him seizing in the bed covered in vomit while they gave him orange juice and oral glucose by mouth.


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## tao (Mar 1, 2011)

Some of the nursing homes I've run could score a movie deal-- "The Three Stooges Provide Patient Care" or something rather.


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## TransportJockey (Mar 1, 2011)

That's not a complete med order. It should say something like "NTG, 0.3mg SL q15 x3. PRN w/ chest pain." So they just need to learn out to either read a MAR properly or chart better.


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## M3dicDO (Mar 5, 2011)

DFW333 said:


> His BP was in the forties when we checked it. How he was still awake and conversing like normal I dont know.



How in the world did you check his BP? CVP???? :glare:


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## mycrofft (Mar 5, 2011)

*The nurse is not supposed to accept a bad order like that.*

However, at some nursing homes to stand up to the MD (who may also be the medical director) is tatamount to volunteering for night shifts, weekends, and the morst assaultive patients until you quit.

Try this one:
Order written "Drug ABC, 500 mg, give tab III po BID X 10 d". (Order presumes a nurse can't divide total dose by strength of tablets or capsules).

I've seen the order like this noted as "ABC tab III po BIDX 10d", or "ABC, 500mg po, BID X 10", etc etc. (four total iterations).

Correct order: "ABC, 1500 mg, po, BID X" a date ten days in the future, or better yet, "X 20 doses" THEN a stop date.

ANYTIME an order is unclear, the receiver HAS to clarify, then transcribe as given, whether a med "usually" comes in a given dose concentration. If it doesn't sound right, check it with another practitioner.


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## Bon-Tech (Mar 6, 2011)

I've worked at nursing homes and, although as stupid as the nurse was in the scenario given, it's not pretty for them either. In the one facility, they had 40+ patients per RN per shift. That's a lot of charting and a lot of fires to put out, for one person. 

They make money most of us wish we made, but it is a :censored::censored::censored::censored: job. Just wanted to add that perspective.


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