Question

The nurse is preparing to administer four medications to the client with dysphagia. Which medication should be administered first? A. Conjugated estrogen (Premarin) B. Furosemide (Lasix) C. Ceclor (cephaclor) D. Diphenhydramine (Benadryl)

Short answer

Short Answer: Ceclor (cephaclor) should be administered first. This antibiotic can address potential infections that may worsen dysphagia or pose a serious health risk if not treated promptly.

Step-by-step solution

Understand the condition of dysphagia

Dysphagia refers to difficulty in swallowing, which can result in challenges when taking medications orally. It's important to prioritize the medications that have a direct impact on the client's dysphagia or have a higher risk if not administered promptly.

Analyze each medication's purpose and effect

A. Conjugated estrogen (Premarin): This medication is typically used for hormone replacement therapy in menopausal women. It has no direct impact on dysphagia. B. Furosemide (Lasix): This is a diuretic used to treat fluid retention (edema) and high blood pressure. While it may not directly affect dysphagia, a delay in administering this medication can lead to an increase in edema and potential respiratory issues. C. Ceclor (cephaclor): This is an antibiotic, typically prescribed for bacterial infections. It's unclear whether the client's dysphagia is caused by an infection, but administering antibiotics first can prevent the spread or worsening of infection. D. Diphenhydramine (Benadryl): This is an antihistamine used for allergy relief. It also has some side effects, like drowsiness, which may not be ideal before administering other medications.

Prioritize the medications

Based on the analysis of each medication's purpose and effect, the priority for administration should be: 1. C. Ceclor (cephaclor): Administer the antibiotic first to address potential infections that may worsen dysphagia or pose a serious health risk if not treated promptly. 2. B. Furosemide (Lasix): Administer the diuretic to avoid fluid retention issues that could lead to respiratory difficulties. The remaining two medications, Premarin and Benadryl, have no direct relation to the client's dysphagia, so they can be administered later in any order.

Answer

The medication that should be administered first is C. Ceclor (cephaclor).

Key concepts

Dysphagia Management

When managing dysphagia, an understanding of its implications on medication administration is crucial. Dysphagia presents a challenge not only for eating but also for swallowing oral medications. Nurses must assess the physical form of medications (liquid, pill, or crushable tablet) and consider alternative routes of administration if necessary.

For instance, liquid medications or dissolvable tablets are often preferable for patients with swallowing difficulties. If a medication is only available in pill form, checking if the tablet can be safely crushed and mixed with food or a thickening agent may be an option. This practice should always follow pharmacist consultation to ensure medication efficacy is not compromised.

Administering medications in a controlled environment, where the patient is sitting upright and not rushed, can also reduce the risk of aspiration. It is important to monitor the patient during and after swallowing to confirm that the medication has been successfully ingested and to check for any signs of discomfort or aspiration.

Pharmacological Prioritization

In the context of pharmacological prioritization, nursing judgment plays a pivotal role in determining the order of medication administration. Critical factors include the patient's condition, the action and urgency of the medication, and potential interactions.

With dysphagia, medications that can alleviate the condition or are essential to the patient's immediate health, such as antibiotics to tackle an underlying infection, should be given precedence. Following this, medications for conditions that could exacerbate symptoms or lead to complications, like diuretics in the case of fluid retention, should be prioritized.

Medications for chronic conditions that are not immediately life-threatening, such as hormone replacement, may be scheduled subsequently. Lastly, medications with effects that could hinder later treatments or cause discomfort, like sedatives, should be considered carefully. It is essential to evaluate the risk versus benefit for each medication, always considering the patient's current health status.

Nursing Interventions

Nursing interventions are actions taken by nurses to improve patient outcomes. In medication administration, especially with conditions like dysphagia, these interventions extend beyond mere delivery of drugs.

For safe medication administration, nurses should review the patient's medication profile, identify any potential drug interactions, and assess the patient's ability to swallow. Educating the patient about the purpose, expected effects, and potential side effects of their medications is also part of comprehensive nursing care.

When administering medications to a dysphagic patient, nurses should use appropriate positioning, support the jaw as needed, and offer medications in forms that the patient can safely swallow. Monitoring after administration is crucial to observe for any adverse reactions or signs of aspiration. Documentation of all steps taken during medication administration is essential for continuity of care and legal purposes.

If the patient has difficulty swallowing even modified forms, nurses may coordinate with physicians, pharmacists, and speech therapists for alternative medication routes or additional swallow therapy, demonstrating the collaborative nature of patient-centered care.