NUR 2407 Module 2 Discussion Question
NUR 2407 Module 2 Discussion Question
NUR 2407 Module 2 Discussion Question
Ethical dilemmas in medication administration
Choose a medication type from the following list, note why the medication is used, and consider adverse effects. Invent a scenario where giving this medication could result in an ethical or legally charged situation. Try not to choose a category that has been well addressed by your peers.
- Bethanaechol / cholinergics: Consider risks of inducing urgency or bradycardia in a clients with dementia issues
We examined the health care records of more than 1.4 million older adults using a case-time-control design, allowing each individual to serve as his or her own control. Case patients were residents of Ontario, Canada, aged 67 y or older hospitalized for bradycardia between January 1, 2003 and March 31, 2008. Control patients (3∶1) were not hospitalized for bradycardia, and were matched to the corresponding case on age, sex, and a disease risk index. All patients had received cholinesterase inhibitor therapy in the 9 mo preceding the index hospitalization. We identified 1,009 community-dwelling older persons hospitalized for bradycardia within 9 mo of using a cholinesterase inhibitor. Of these, 161 cases informed the matched analysis of discordant pairs. Of these, 17 (11%) required a pacemaker during hospitalization, and six (4%) died prior to discharge. After adjusting for temporal changes in drug utilization, hospitalization for bradycardia was associated with recent initiation of a cholinesterase inhibitor (adjusted odds ratio [OR] 2.13, 95% confidence interval [CI] 1.29–3.51). The risk was similar among individuals with pre-existing cardiac disease (adjusted OR 2.25, 95% CI 1.18–4.28) and those receiving negative chronotropic drugs (adjusted OR 2.34, 95% CI 1.16–4.71). We found no such association when we replicated the analysis using proton pump inhibitors as a neutral exposure.
Despite hospitalization for bradycardia, more than half of the patients (78 of 138 cases [57%]) who survived to discharge subsequently resumed cholinesterase inhibitor therapy.
- Benztropine /anticholinergics: Consider harms that can occur with comorbidities like glaucoma or BPH
- Albuterol /adrenergics: Consider harms that can occur is asthmatic children are in charge of their own inhalers
- Atenolol/ beta blockers: Consider harms that could occur if heart rate was low or patient was asthmatic
- Lorazepam /benzodiazepines: Consider vulnerability issues related to sedation and induction of memory loss
- Oxycodone / opiates: Consider addiction, drug seeking and patient vulnerability in impaired nurses
- Amitriptylline /tricyclics: Consider vulnerability issues with risk of suicidal overdose given anticholinergic effects
- Phenelzine /MAOIs: Consider consequences of nonadherence to dietary restrictions on these medications
- Haloperidol / neuroleptics: Consider risks of chemical sedation, especially long term risks
- Lithium: Consider risks of mismanagement by clients whose behaviors are unpredictable
- Phenytoin / antiepileptics: Consider risks of Class D in young women vs risks of going without anti-epileptics
- Secobarbital / barbituates: Consider risks related to availability of barbituates to teens via the internet
- Kava or Valerian: Consider risks of availability of compounding poorly controlled over the counter sedatives
- Sumatriptan / triptans: Consider risks of cerebral ischemia when giving vasoconstrictors for migraine control
- Cyclobenzaprine for back spasms: Consider risks of impaired function when nurses take muscle relaxants
- Prednisone / steroids: Consider long term effects, when other immune suppressors are too expensive to access.
- Aspirin / NSAIDs: Consider vulnerability of elders due to over the counter, affordable nature of this analgesic
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