231 OSCE Medication Administration Introduction: • Hand hygiene, introduce self • There will be a family member accompanying the child, ask what the guardian’s relationship towards the patient. Instructor told us not to assume that guardian is related to Pt, ask what’s the appropriate title to be referred by. • Make sure nursing orders are emplaced. “Okay mom, before I start I just gotta make sure everything’s in place.” Ensure HOB is elevated, Pt has CHF may have trouble breathing d/t edema (not written on steps but instructor told us to do so). Ensure O2 nasal cannula is on Pt and at the right liters. • State purpose of visit (giving meds). Do a verbal assessment: Able to void, how many diapers? N/V? Trouble feeding? Trouble breathing? Being fussy/sleeping more than usual? • State to instructor you’ve done a complete set of V/S. State now you’re going to assess lung sounds (may have crackles in lungs d/t worsening of condition: CHF). State you’re now going to take the Pt’s apical pulse (explain to guardian why it’s done). State you’re going to assess bowel sounds (explain to mom: absent = obstruction, meds not to be given). • State you’re now going to med room to pick up the Pt’s medicine. Everything’s WNL and BB will be getting their meds. Medicine Administration: • Keep in mind there will be 3 meds checks. • 1st Med Check = Taking medication out of cabinet. Going through every step of 6 rights of medication administration. • 2nd Med Check = Preparing the meds. Going through every step of 6 rights of medication administration. Take out 3 mL syringe (why 3 mL? Able to be precise w/ dosing since it goes by 0.1 intervals compared to 6 mL where it goes by 0.2 intervals). Take out medicine cup, pour medication in cup, draw out 2.1 mL. Ask another RN (show instructor) to verify that dosage is right. • Verbalize to instructor you’re now leaving the medicine room and going into the Pt’s room w/ the medication. The same machine used to retrieve medication will be your pretend med cart. • Assess Pt’s name and DOB — tell mom you’re now going to give the medicine • Go to computer, scan Pt, scan med, give med • Verbalize: Pt is now receiving medication, sat on lap. Pt’s arm that’s closes to me goes behind my back while I hold the Pt’s left arm. Syringe inserted in Pt’s mouth closest to the cheek, pushing med slowly. = return Pt to bed • Educate Pt’s mom about side effects of Digoxin: N/V and anorexia (refusal to eat). Tell mom to call right away when Pt is exhibiting toxicity. • Document: Pt tolerated well, no signs of N/V, educated mom about side effects. Put in what Apical was • Bed lowest, side rails x2, call bell w/in reach. Last Step — SBAR MD about why Enalapril was not given: BP too low (normal: 95/55; Pt’s BP: 82/41)
