The Processed Related to IVI Antibiotic Administration - Assignment Example

Topic A: The case of Kylie Thomas 1. Issues Surrounding Swab technique The swab techniques most commonly used are swabs taken using a broad Z-stroke over the entire wound bed and swabs using the technique described by Levine and colleagues. Specimens obtained in this manner sample micro organisms on the surface and are not congruent with the first or second key elements of inspection (Baranoski and Ayello, 2007). Wound cleaning is advocated prior to obtaining swabs. Moistening the swab with normal saline or transport medium is also recommended prior to specimen collection. Because a large portion of the wound surface is sampled, the specimen collected may reflect surface contamination rather than tissue bio-burden. The factors to be kept under consideration in IVI administration are as follows (IVI management): 1. The nurse has to note the patient allergies 2. The drug and solution compatibilities have to be checked. 3. the amount of dilutent needed and the type of dilutent is to be specified 4. The patient’s general status for the establishment of a baseline for medicine administration is to be assessed 5. Patency of infusion set to be assessed. The advantage of the IVI technique is the ability to maximize intraocular levels of medications and to avoid the toxicities associated with systemic treatment.  2. The processed related to IVI antibiotic administration : This has to be initiated with the antibiotic choice based on the patient’s age and medical status. It allows for total medicine absorption and hence the dose that is administrated has to be calculated precisely (Doti, 2010). There is every chance that the patient would show symptoms of speed shock given the fact that the medicine reacts fast is often characterized by insufficient control of administration. Infusion practices change continuously. Each nurse in a given organization has to be able to be cognizant of the policies and procedures relevant to infusion therapy and familiar with the responsibilities in this context-assessment and monitoring, appropriate site selection. Proper body substance isolation needs to be maintained throughout the therapy process. Metoclopramide is absorbed well after oral administration, but a significant first-pass effect in some patients may reduce systemic bioavailability to 30%. The drug is well distributed in the body and enters the CNS. Metoclopramide is only weakly bound to 13-22% of plasma proteins. The drug also crosses the placenta and enters the milk in concentrations approximately twice those of the plasma. It is primarily excreted through urine (Mikota and Plumb, 2006) 3. Steps involved in administration of Pethidine and Metoclopramide For intravenous medication, like Pethidine and Metoclopramide administration there are a certain number of things that the health care professional would have to take into consideration. Pethidine mimics the action of natural endorphins by combining with the opioid receptors in the brain and spinal cord. This blocks the transmission of pain signals sent by the nerves to the brain. Therefore, even though the cause of the pain may remain, less pain is actually felt (Netdoctor.com). Piperacillin would be used because of its antipseudomonal activity. It helps in the optimization of bactericidal exposure given the fact that penicillins require to eradicate bacteria (Sutherland, Kuti, Pharm and Nicolau). The first thing to be kept under consideration is with respect to the administration of the drugs themselves i.e. the processes and the safety measures (QLD, Online). This would then mean that it is the duty of the nurse to ensure that the correct medicine in the corrected dilution is being used, that the medicine has not expired and retains its correct color at the time of use. Beside this, there are legal issues that one would have to place under consideration (MIMS online). It is also required that the nurse is aware of and capable of monitoring the air pressure within the syringe and is capable of medicine administration in the correct muscle area (DeSimone , 2009). These would include the issues of consent, ensuring the standards of the duty of care are met and the factors of confidentiality are respected (Taylor and Taylor, 1994). Finally most intravenous medication are invasive, hence it is the ethical duties of the nurse to ensure that the human rights are protected. Given the fact that this patient has epilepsy, and abuse issues, patient care assumes significant importance. 4. Drip Rate IV therapy of normal saline = 1000 ml Time = 6 hours x 60 minutes = 360 minutes Calibration = 10 Drip rate = 28 gtt/min or 7 gtt/ 15 seconds   5. Health Teaching Plan There are several areas that the patient training on insulin injection would have to consider and incorporate within its program. 1. 2. It is also important that the patient knows that reactions to insulin could at times be adverse, and that a quick drop in sugar levels is possible making hypoglycemia a reality. The patient would thus have to take few minutes after insulin injection to be certain the body is responding appropriately is a good idea. Glucose tablets, biscuits may have to be kept handy in case this were to happen. The best indicators of this are symptoms like paleness, dizziness, hunger and excess perspiration Carbamazepine (Tegretol), being an anticonvulsant medication (Barett, 1998). Should be used 300 mg twice a day and Amoxicillin would have to used 250 mg twice a day. 3. Sideffects: Medication: Piperacillin- The medication could have side effects such as dizziness, nausea, stomach upset, or loose stools (Medicine Net.com). Where Metoclopramide is the side effects could range from extrapyrimidal effects, nausea, diarrhea, transient hypertension and elevated prolactin levels. Finally, pethidine usage could result in nausea, vomiting, sedation, dizziness, urinary retention and constipation among others.  4. The plasma clearance of pethidine is 8.9±1.8ml·kg·min-1 while the Volume of distribution (Vd) is not really influenced, being 4.25±1.72 l·kg-1peroperatively. Finally, the bioavailability, 50–60%. protein binding, 65–75% Topic B: Issue of Mr Pappas 1. Drugs administration via nebulizer Aerosol drug administration is also called inhalation therapy-in most instances commonly known as nebulized drug therapy. It is the method by which the medication is administered directly into the lungs or bronchial airways of the patient (MIMS online). The nebulized inhalation system is an aqueous formulation that would have to be aerosolized with the aid of external energy (QLD, Nursing Council, 2001). The process converts water droplets into the vapor phase, inhaled by the patient. The pump is to produce a fine mist within which the medicine is dispersed via an appropriate along with a compatible face mask-this is then inhaled by the patient. The two primary issues here are that these are not compact like MDIs (Adjei and Gupta, 1997). In the case of this patient, nebulizer usage is recommended because of the fact in patients with pneumonia, the airways feel dried out and in need of moisture, the nebulizer helps in medication administration. It must be remembered that water cannot be used alone (MIMS online). 2. Oxygen to patient Oxygen administration enables the patient to reduce his ventillatory effort. As is the case with this patient suffering from acute coronary syndrome, which impairs diffusion the procedure in essence helps in boosting alveolar oxygen levels. In most cases, the nurse has to ensure that the procedures listed on the mask are followed and that the mask fits snugly and that the valves are secure and functioning (Williams and Wilkins, 2007). The deflation of the mask has to be monitored continuously because abnormal deflation could mean an accumulation of carbon dioxide. The nurse has to ensure that the patency of the patient’s nostrils with a flashlight. Humidification is a process that has to be considered a necessity where the usage of nasal prongs are concerned because the moisture that accumulates during the passage of the air into the lungs is normally sufficient to prevent irritation of the internal mucous membranes (Harman, 2002). However, wearing prongs for long periods could also cause the patient dry nasal passages, soreness and encrustation. Humidification is therefore a process that is a safety must where the administration of oxygen is concerned. 3. Ethical and legal issues in oral medication Ethically, there are five principles to consider. These are the issues of consent, respect for human life and dignity-given the fact that Mr. Pappas is old there would automatically be issues of human dignity at stake, beneficence, honesty, and justice. Data relate to patient information may be disclosed to a third party by Council’s freedom of information decision maker under the Right to Information Act 2009 (Queensland Nursing Council, 2009). Professionally, it is required that the nurse takes care to open the medicine only when at the client’s side, the package has to opened as directed and the medication has to be administered without it being touched. The patient should be at a resting position when the medicine is administered, the side rails should be raised and the procedure would have to be documented (Rice, 2002). Finally, the disposable items need to be disposed carefully, unused supplies are to be returned to designated area and the reusable materials are to be stored. The medical asepsis hand wash has to be performed. The legal issues would to ensure that the duty of care and confidentiality are respected. 4. Drip Rate IV therapy of normal saline = 1000 ml Time = 12 hours x 60 minutes = 720 minutes Calibration = 20 Drip rate = 28 gtt/min or 7 gtt/ 15 seconds 5. Health Teaching plan: Mr. Pappas would have to eat one metoprolol daily, but would have to be on the look out for heart seizure as this is one the major side effects of the medicine-it may worsen the symptoms of heart failure. It must be remembered that the effect of age on the pharmacokinetics of metoprolol and its metabolites is less pronounced than that observed for other drugs (Quaterman, Kendall and Jack, 1981). In such an instance, the patient is advised to immediately check with the doctor if there is chest pain. Ramipril is needed in most susceptible patients over the age of 55. One 5mg tablet of Ramipril would have to be taken everyday. is advised not to take potassium supplements. Where Rampril is concerned, no clinically significant pharmacokinetic interactions with other drugs have been reported. The drug has been generally well tolerated with the most prevalent adverse effects being dizziness (3.4%), headache (3.2%), weakness (1.9%) and nausea (1.7%). The pharmacokinetics of Ramipril and its active metabolite ramipril demonstrate it is rapidly absorbed and reached a peak concentration after 1–2 h. Cmax. Simvastatin would have to be used so that cholesterol levels and hence chances of a repeated coronary congestion could be avoided. It is most effective at lowering LDL-cholesterol concentration therefore reducing cardiovascular disease events and total mortality irrespective of the initial cholesterol concentration. Mr Pappas needs one tablet, 40 mg daily. Glycerin Trinitrate is also used medically as a vasodilator to treat heart conditions, such as angina and chronic heart failure (Mittal, 2005). This can be applied locally in case Mr Pappas feels another heart attack (sever chest pains). References: Adjei, A.,L., and Gupta, P., K., (1997). Inhalation delivery of therapeutic peptides and proteins. Informa Health Care. p219 Harman, R., J., (2002). Patient care in community practice: a handbook of non-medicinal healthcare. Pharmaceutical Press. P120 Williams, L., and Wilkins, (2007). Best practices: evidence-based nursing procedures. Wolters Kluwerth. p343 Baranoski, S., and Ayello, E., A., (2007). Wound care essentials: practice principles. Wolters Kluwer Health. p103 IVI management, accessed February 16, 2010, < http://www.vincesaliba.com/EN_Conversion_Course/preceptors/IVI_Management.pdf> Taylor, R., J., and Taylor, S., B., (1994). The AUPHA manual of health services management. Jones and Bartlett Publications. p261   What is insulin injection, accessed February 16, 2010, Barett, R., P., (1998). Treatment of self-injury and disruptive behavior with carbamazepine (Tegretol) and behavior therapy. Journal of Developmental and Physical Disabilities. 1(2). Pp79-91 Rice, J., (2002). Medications and mathematics for the nurse. CengageBrain. p126 Mittal, S., (2005). Coronary heart disease in clinical practice. Springer Books. p157 Quarterman, C, P., Kendall, M., J., and Jack, D., B., (1981). The effect of age on the pharmacokinetics of metoprolol and its metabolites. British Journal of Clinical Pharmacoly; 11(3). pp287–294 Queensland Nursing Council, (2009). Setting the Standards. Retrieved February 24, 2010, MIMS Online, accessed February 24, 2010, Piperacillin. Retrieved March 5, 2010, DeSimone , E., M., (2009). Restless Legs Syndrome: A Common, Underdiagnosed Disorder. US Pharmacist. 34(1). pp24-29 Sutherland, B.S.; Joseph L. Kuti, Pharm.D.; David P. Nicolau (2007). Optimal Dosing of Piperacillin-Tazobactam for the Treatment of Pseudomonas aeruginosa Infections: Prolonged or Continuous Infusion?. Pharmacotherapy. 27(11). pp1490-1497 Mikota, S., K., and Plumb, D., C., (2006). Metoclopramide HCl. Elephant Care International Doti, C., I., (2010). Medication Management to Prevent Contrast-Induced Nephropathy in the Emergency Department. Retrieved March 5, 2010, < http://www.medscape.com/viewarticle/717526> Read More