The client is prescribed aspirin and warfarin. Based on side effects of both medications, the nurse identifies "Risk for bleeding" as a nursing diagnosis for this client. What outcome is appropriate for this nursing diagnosis?

A) Planning: The planning phase involves setting goals and determining the actions needed to achieve those goals. While the nurse may have planned to administer the medications through the nasogastric tube, the specific actions of crushing the tablets, mixing them with fluid, and administering them fall under a different phase. Therefore, planning is not the correct phase for the actions described.

B) Diagnosis: The diagnosis phase is when the nurse identifies and formulates nursing diagnoses based on data collected about the patient’s health status. The actions of preparing and administering medication do not fall under this phase, as diagnosis pertains to assessing health problems or needs.

C) Evaluation: Evaluation is the phase where the nurse assesses whether the goals or outcomes of the care plan have been met. The nurse would evaluate the effectiveness of the medication administration after it has been done, but the actual action of giving the medication is part of implementation, not evaluation.

D) Implementation: Implementation is the phase where the nurse carries out the planned interventions, including administering medications. In this case, the nurse is taking specific steps to prepare and administer the crushed tablets down the nasogastric tube, which is a direct action related to the care plan. This phase involves performing the tasks necessary to carry out the interventions that were decided during the
planning phase.

E) Assessment: Assessment involves collecting data about the client’s health status, such as physical examination, history, and vital signs. The actions taken to crush and administer medications are not part of the assessment phase, which focuses on gathering information, not delivering care.

A) Failed communication: While communication errors can lead to medication mistakes, in this specific scenario, there is no mention of poor communication. The prescription is clear, and the issue is more likely related to the accuracy of the prescribed dose or the nurse’s understanding of it, making "failed communication" a less likely source of error in this case.

B) Dose miscalculation: This is the most likely source of potential error. The medication is ordered as 0.9 mg of ondansetron IV, which is an unusual dosage because the typical dose of ondansetron IV for nausea is usually 4 mg or 8 mg. A dose of 0.9 mg is very specific and could easily be miscalculated, especially if the nurse is not familiar with this specific dosage form or if there’s any confusion regarding the intended dose. This could lead to an error either in preparation or administration of the medication.

C) Lack of client education: While client education is important for many aspects of treatment, it’s not directly related to the potential medication error in this scenario. The nurse’s concern should focus on the accuracy of administering the prescribed dose correctly, not the client’s understanding of the medication.

D) Poor distribution practices: Poor distribution practices may affect the availability or storage of medications, but this is not the likely source of error in this case. The concern here is more about the correct dosage and potential for miscalculation, rather than issues related to drug distribution or storage.