Question

Fill in the blank: Robert’s initial medication orders include famotidine (Pepcid) 20 mg IV every 12 hours. Th e nurse reviews the medication orders with Robert prior to administering. Robert asks “why am I taking that heartburn medicine? I don’t have any heartburn and I never had stomach problems.” How should the nurse respond to Robert’s question?

Short answer

While famotidine is typically used to treat heartburn and other stomach issues, it's also used as a preventive measure in certain treatments to protect the stomach. In this case, Robert is being prescribed famotidine as a preventive measure during his treatment course.

Step-by-step solution

Understand the Medication

Famotidine (Pepcid) is a type of medication commonly associated with treating stomach conditions such as ulcers and gastroesophageal reflux disease (GERD). It works by decreasing the amount of acid the stomach produces, thus preventing and treating heartburn.

Ascertain Patient's Medical Condition

In this case, Robert does not have any stomach problems or heartburn. However, he has been prescribed famotidine. This could mean that the medication is being used to prevent any potential stomach issues or acid reflux that may result from other treatments or conditions Robert may be undergoing or representing.

Formulate an Appropriate Response

Given what we know about Famotidine, and Robert's current condition, the nurse might respond with something like: 'Robert, while it's true that famotidine is often used to manage heartburn, it is also used in many different scenarios, such as the prevention of stomach issues. In your case, it's been prescribed to protect your stomach and ensure your comfort during the course of your treatment.'

Key concepts

Famotidine Administration

When administering medications like famotidine, a nurse must understand both the pharmacology of the drug and the specific needs of the patient. Famotidine belongs to a class of medications called H2 blockers, which reduce stomach acid production. It's crucial to adhere to the prescribed dosing schedule, which in Robert’s case is 20 mg intravenously every 12 hours.

During administration, the nurse should ensure the IV line is patent, monitor for adverse effects, and document the administration accordingly. It's also important to consider the patient's overall medication regimen to prevent potential drug interactions. For instance, drugs that require an acidic environment for absorption may not work as well if stomach acid is significantly reduced by famotidine.

Key Administration Points:

• Verify doctor's orders and check the medication's dosage and route.
• Assess the IV line for proper function.
• Administer the medication slowly, as per guidelines, to prevent complications.
• Monitor the patient for any adverse reactions.
• Educate the patient on the purpose of the medication, even if they are not currently exhibiting expected symptoms.

Patient Education

Effective patient education is a cornerstone of nursing care, ensuring the patient remains well-informed and engaged in their treatment plan. When Robert questions the need for famotidine, since he doesn't experience heartburn, it opens an opportunity for educational dialogue.

Patient education should address the medication's purpose, how it works, and why it's being prescribed in the patient’s specific scenario. For famotidine, the nurse should explain that it is not only for active symptoms but is also used prophylactically to prevent potential stomach issues, especially if the patient is taking other medications that may irritate the stomach lining or is at risk of stress-related mucosal damage.

Education Tips:

• Speak in terms the patient can easily understand, avoiding medical jargon.
• Explain the preventative role of famotidine in the treatment plan.
• Discuss possible side effects and what the patient should do if they occur.
• Validate the patient’s concerns and encourage questions to ensure understanding.

Clinical Reasoning

Clinical reasoning allows healthcare professionals to integrate and apply different types of knowledge, to weigh evidence, to critically think about arguments and to reflect upon the process used to arrive at a diagnosis. In the context of Robert’s situation, the nurse must use clinical reasoning to understand why famotidine has been prescribed and to effectively communicate this to the patient.

Through clinical reasoning, the nurse discerns that famotidine, while typically used for GERD, is administered as a preventative measure. This could be due to various reasons, such as the presence of other medications that may cause gastric irritation or as a prophylactic measure against the stress ulcers often seen in hospitalized patients.

Steps for Sound Clinical Reasoning:

• Assess the patient holistically, considering all aspects of their health.
• Analyze the prescribed medications in the context of the patient's full medical history.
• Communicate clearly with the patient, addressing their concerns with evidence-based knowledge.
• Reflect on the patient's response to the medication and the explanation to continue providing tailored care.