Medication Warning Signs for Caregivers
Recognize side effects, adverse reactions and overdose signs in common home medications, and know when to call the nurse or 911.
Table of contents
Medicines help people live at home, but they also cause falls, bleeding, confusion and hospital stays. Because you see a client regularly, you may be the first person to notice a problem. You do not need to know everything about these drugs. You do need to know which changes to report, and which are emergencies. You never decide to change or stop a medicine yourself.
What You Will Be Able to Do
- Tell the difference between a side effect and an adverse reaction.
- Watch for warning signs linked to common medication groups.
- Explain why taking many medicines raises risk.
- Spot dangerous over-the-counter combinations.
- Respond to low blood sugar, an allergic reaction and an opioid overdose.
Side Effects and Adverse Reactions
A side effect is an expected, usually mild effect, such as dry mouth or mild nausea. An adverse reaction is an unexpected, harmful one, such as a rash, swelling, fainting or heavy bleeding. Both need to be reported. The difference is how fast. An adverse reaction needs an immediate call.
What to Watch For
| Medicine group | Examples | What to report |
|---|---|---|
| Blood pressure medicines | Lisinopril, amlodipine, metoprolol | Dizziness on standing, fainting, slow pulse, swollen ankles, a lasting dry cough |
| Water pills (diuretics) | Furosemide (Lasix), hydrochlorothiazide | Dizziness, leg cramps, weakness, signs of dehydration |
| Blood thinners | Warfarin, apixaban | New bruises, bleeding gums, nosebleeds, blood in urine or stool |
| Diabetes medicines | Insulin, glipizide, metformin | Shakiness, sweating, confusion, nausea or diarrhea |
| Opioid pain medicines | Oxycodone, morphine | Heavy sleepiness, slow breathing, constipation, confusion |
| Sleep and anxiety medicines | Lorazepam, zolpidem | Unsteady walking, confusion, heavy sleepiness |
| Antibiotics | Amoxicillin | Rash, severe diarrhea |
The examples above are not a complete list. If something changes after a new medicine or a dose change, report it.
Medicines That Raise Fall Risk
Blood pressure medicines and diuretics are the classic cause of orthostatic hypotension. That means a sudden drop in blood pressure when a person stands up, which causes dizziness or lightheadedness. Someone on furosemide who feels dizzy after standing may be having this. Also watch people on sedatives, opioids, some allergy medicines (anticholinergics) and anything that lowers blood sugar.
To help, have them sit at the edge of the bed for a minute before standing, stay close, and report any new dizziness, unsteady walking, confusion, blood sugar under 70, fall or near-fall.
Taking Many Medicines
Polypharmacy means taking many medicines at once. Older adults are especially at risk because their bodies clear drugs more slowly and because more drugs mean more chances for interactions and side effects. Clients often see several doctors who may not know what the others prescribed. Tell the nurse about any new prescription, any new doctor and any supplement you see.
Over-the-Counter Dangers
Drugstore medicines can be as risky as prescriptions. Report what you see, and do not tell the client to stop or start anything.
- Blood thinners and NSAIDs. Ibuprofen (Advil), naproxen (Aleve) and aspirin can raise the risk of bleeding when combined with warfarin. If you find them in the home of someone on a blood thinner, document it and report it to the nurse.
- Double acetaminophen. Tylenol is acetaminophen, and so are many cold, flu and sleep products. Taking two of these can exceed the safe daily limit and cause liver damage. Limits differ by person, so the nurse or provider decides what is safe.
- Herbals and supplements. St. John's wort, ginkgo and others can interact with prescriptions.
- Alcohol. It is dangerous with opioids, sedatives and many other medicines.
Controlled Substances
Opioids and some sedatives are controlled, which means they are tracked closely and can be misused by anyone in the home. If the count drops faster than the schedule would explain, report the facts to the nurse. Do not accuse anyone, and do not try to investigate. Never touch or count them unless your job requires it.
Emergencies
Low Blood Sugar
Signs include shakiness, sweating, confusion and irritability. If the person is awake and can swallow:
- Offer 4 ounces of juice or regular soda, or 3 to 4 glucose tablets.
- Recheck in 15 minutes if a check is allowed in the care plan.
- Call the nurse.
If they cannot swallow safely or will not wake up, do not put anything in their mouth. Call 911.
Severe Allergic Reaction
Call 911 for swelling of the lips, tongue or throat, trouble breathing, or widespread hives. If the person has a prescribed epinephrine auto-injector, help them use it if your training and care plan allow, on the outer thigh.
Opioid Overdose
Signs include unusual sleepiness, difficulty waking, slow or shallow breathing, gurgling sounds, blue lips and pinpoint pupils.
- Call 911 immediately.
- Give naloxone if it is available in the home and you have been trained.
- Start CPR if they are not breathing normally.
- Stay with them, and tell your supervisor as soon as you can.
Warning: Do not let a very drowsy person on opioids "sleep it off." Slow breathing can stop.
Other Times to Call 911
Call 911 for chest pain, trouble breathing, signs of stroke, fainting that does not resolve, heavy bleeding that does not stop, or a person you cannot wake up. If someone swallowed something and is not in danger, you can reach Poison Control at 1-800-222-1222 while you contact the nurse.
Reporting and Documenting
Report in the SBAR format, or the format your agency uses. Include:
- What you saw, and when it started.
- Which medicines the person takes, if you can check.
- Vital signs, if you took them.
- Any recent change, such as a new pill or a missed dose.
Then document what you saw, who you told and when.
Common Mistakes
| Mistake | What it costs |
|---|---|
| Assuming dizziness is "just old age" | A fall, or a missed medicine problem |
| Telling a client to stop a pill | You are outside your scope, and stopping can be dangerous |
| Ignoring vitamins and drugstore products | Hidden interactions |
| Waiting to report a nosebleed in someone on a blood thinner | Serious blood loss |
| Letting a very sleepy client on opioids stay in bed alone | A missed overdose |
Check Your Understanding
1. A client on a blood thinner wakes up with blood on her pillow and says her nose bled for half an hour. What do you do?
Report it to the nurse right away. Call 911 if the bleeding is heavy or will not stop, or if she looks ill.
2. A client gets dizzy every time he stands up after starting a new water pill. Why might that be, and what should you do?
It may be orthostatic hypotension. Have him rise slowly, stay close, and report it to the nurse. Do not tell him to skip the pill.
3. A client takes Tylenol and a nighttime cold medicine. Why is this a concern?
Many cold products also contain acetaminophen, so she could take too much and damage her liver. Report it to the nurse.
4. Your client's prescribed oxycodone seems to be going down faster than it should. What do you do?
Report the facts to the nurse without accusing anyone.
Key Takeaways
- Side effects are expected and usually mild. Adverse reactions are unexpected and harmful.
- Blood pressure medicines and diuretics can cause dizziness on standing.
- Polypharmacy raises the risk of interactions and side effects.
- Report NSAIDs with blood thinners, and doubled-up acetaminophen.
- Slow breathing and pinpoint pupils in someone on opioids means call 911.
- Report changes, and never change a medicine yourself.