A nurse reviews codeine prescriptions for a 10-year-old child after tonsillectomy and for the child's breastfeeding parent. Which action is most appropriate?
1Give both prescriptions at the lowest dose and teach the family to monitor for excessive sleepiness.
2Give the child's prescription but hold the breastfeeding parent's prescription until lactation has ended.
3Reduce both prescribed doses by half and dispense them with home pulse oximetry instructions.
4Hold both prescriptions and contact the prescribers for alternatives because of serious respiratory depression risks.✓ Correct answer
Explanation
Codeine is contraindicated in children younger than 12 years and for postoperative pain after tonsillectomy or adenoidectomy in clients younger than 18 years. Breastfeeding is also not recommended during codeine therapy because variable CYP2D6 metabolism can expose an infant to excessive morphine and respiratory depression. The nurse should hold both prescriptions and contact the prescribers for safer alternatives. Dose reduction and home monitoring do not remove these risks.
Clinical reasoning summary Do not administer codeine to a child younger than 12 or after tonsillectomy in a client younger than 18. Codeine is also not recommended during breastfeeding because rapid conversion to morphine can cause severe infant respiratory depression. Contact the prescribers for alternatives.