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Difficulty: Very hardAccident, Error, and Injury Prevention

A nurse is reviewing the medication administration record for a client receiving continuous enteral nutrition via a nasogastric tube. The morning prescriptions include liquid acetaminophen, an immediate-release carvedilol tablet, and an extended-release nifedipine tablet. The provider's prescription states to crush all solid medications and administer them via the tube. Which action is the highest priority for the nurse to prevent a critical adverse event?

  1. Withhold the extended-release nifedipine and contact the healthcare provider to request a non-sustained-release alternative.Answer
  2. B
    Elevate the head of the client's bed to 15∘15^\circ during and immediately after the medication administration.
  3. C
    Pause the continuous enteral feeding for 30 minutes30\text{ minutes} prior to administering the medications.
  4. D
    Delegate the administration of the liquid acetaminophen to the unlicensed assistive personnel (UAP).

Answer

The nurse must withhold the extended-release nifedipine and contact the provider for an alternative prescription.
Extended-release (ER, XL, SR, CR) medications are specifically formulated to release their active ingredients slowly over an extended period. Crushing an extended-release antihypertensive like nifedipine destroys this controlled-release mechanism, causing a rapid 'dose dump.' This floods the systemic circulation with the medication, leading to profound, life-threatening hypotension and potential cardiovascular collapse. The nurse's highest priority is to recognize this prescribed medical error, withhold the medication, and collaborate with the provider for a safe alternative.

Step-by-Step Solution

1
Analyze the prescribed medications and the route of administration.
The prescription calls for crushing an extended-release (ER/XL) medication for nasogastric tube administration.
Identifying contraindications in medication preparation is the first line of defense in error prevention.
2
Evaluate the physiological consequences of the prescribed action.
Crushing extended-release nifedipine will cause immediate release of a dose meant for 24 hours, leading to severe cardiovascular collapse.
Understanding the pharmacodynamics of dose dumping is required to recognize the severity of the error.
3
Prioritize nursing interventions among the available options.
Preventing a fatal medication error is a higher priority than adjusting bed angles, pausing tube feeds, or delegating tasks.
According to Maslow's hierarchy and basic safety principles, avoiding an immediate, life-threatening iatrogenic injury takes ultimate precedence.

Key Concept

Prevention of Medication Administration Errors: Contraindications for Crushing Medications
Estimated Time:1m 30s
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Topics

Accident, Error, and Injury Prevention

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