On Giving Meds

Taking medications, for most of us, is a fairly simple thing. Open mouth, take pills, swallow pills, perhaps accompanied by water. In long term care, and also in mental health, the situation can call for a great deal of creativity. On some occasions, it requires deception. In other cases, regrettably, it requires a strange decision. I’ll get to that in a minute.

First of all, how do they take pills safely? Do you need to crush them? What can be crushed? How finely do you need to crush them? What do we put them in? Usually pudding sent up from the kitchen for this purpose, but applesauce is also used, as well as yogurt, or thickened water or juice. Adding some sort of thickener to the liquid is another problem. Have you ever tasted thickener? It isn’t fun. Imagine if all your liquids were thick. Water wouldn’t be wet anymore; instead it is a sort of plastic gel.

About this point, I have to address the issue of narcotics.

I don’t like narcotics. They are annoying to count, for one thing. At the beginning and end of every shift, every single narcotic must be counted. Ativan, oxycodone, Klonopin, Percocet, Vicodin, Tramadol – those are the ones which I commonly have to deal with. One pill off, and everything stops until the supervisor comes up and the issue is resolved.There is nothing more annoying than something holding up count. Except for perhaps a fall. I have a whole series planned around falls. Again, more on that later.

I found out yesterday that pharmacy can’t send 200 narcotics. It is against the law. I still haven’t fathomed all the rules and regulations around narcotics. And that’s for where I work, where we count the narcs by hand. I don’t know how it works in a place with a Pixus.

So you are a good nurse, and you know what you can crush and what you can’t. There are times that no matter what you put it in, the resident isn’t going to take their meds, unless you hide it in their food. I don’t like doing this either, but we hide broccoli in children’s chicken nuggets, so….

You’ve got the meds prepared in whatever medium you need, and now you need to get it into the resident. And they object. They don’t want any meds. And they don’t want whatever innocuous thing you put the meds into. No ice cream, pudding etc. So you may lie, and assure them that there is nothing in it but a few quick things for simple problems. That may or may not work. Perhaps they still refuse.

Say that they really need this drug, for whatever reason. When I was a teenager, I worked in a vet’s office. How do you administer meds to a dog? If the dog won’t eat something with the meds in it, you squirt it into their mouth.

If necessary, one can also do that to a person.

This is psych nursing.  This requires that you, as the nurse, knows what is best for them. They are legally incompetent. They have no freedom, no right to choose their own destiny. You decide what is best for them. By virtue of your license, and the laws of the state, and the country, the nurse can and must decide their path.  It is a heavy responsibility. This, like many of the other things I do, weighs upon me.

Nursing judgement is both a privilege and a heavy burden.

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