A nurse cares for a client with a tracheostomy who is experiencing frequent coughing and increased shortness of breath. What action should the nurse take?

Rationale:

A. The client chewing their enteric-coated aspirin requires follow-up. Enteric-coated medications are specially formulated to dissolve in the intestine rather than the stomach to prevent gastric irritation and protect the medication from stomach acid. Chewing or crushing enteric-coated tablets destroys the protective coating, increasing the risk of stomach irritation, ulcers, or reduced effectiveness. The nurse should intervene and provide education on alternative options, such as discussing a different formulation with the healthcare provider.

B. Waiting for sublingual nitroglycerin to dissolve in the buccal cheek does not necessarily require follow-up. Although sublingual medications are typically placed under the tongue, allowing nitroglycerin to dissolve in the buccal area can still allow absorption through the oral mucosa. The key point is that the medication is not swallowed but allowed to dissolve for mucosal absorption.

C. Reviewing new prescription bottles to verify dosages is an appropriate and safe practice. This demonstrates medication awareness and helps prevent errors. No follow-up is required for this finding.

D. Taking each pill one at a time until finished is a safe medication practice. It reduces the risk of choking and helps ensure each medication is swallowed properly. This does not require intervention.

Rationale:
A. Addressing client questions about medications after administration is not ideal because clients may need information before taking their medications to ensure understanding, adherence, and informed consent.

B. Crushing all medications for a client with difficulty swallowing is unsafe. Some medications are extended-release, enteric-coated, or otherwise formulated to prevent irritation or ensure proper absorption. Crushing these can alter their effectiveness or cause harm. Medications should only be crushed if verified as safe by a pharmacist or prescriber.

C. Performing medication calculations to verify the correct dosages is the correct action. Older adults are at higher risk for adverse drug events due to age-related changes in metabolism, renal and hepatic function, and polypharmacy. Accurate calculation ensures the client receives the correct dose, preventing toxicity or subtherapeutic effects.

D. Scanning prescribed medications before entering the client’s room is a helpful safety step for barcode-assisted medication administration, but it is not specifically focused on the older adult population or on verifying dose accuracy. It complements but does not replace careful dose calculation and assessment.