Medications in Work Environment - Assignment Example

Nursing Definition of Terms Pharmacokinetics Pharmacokinetics refers to the study of drug absorption, distribution, metabolism and excretion. Its key principle is the drug clearance which is the elimination of drugs from the body, analogous to the principle of creatinine clearance (Crisp & Taylor, 2009). Pharmacodynamics Pharmacodynamics is the study of the effects of a particular drug into the body. It entails both study of physiological effects of drugs as well as the mechanisms of such action incorporating the correlation between the actions and effects within their chemical structures. Pharmacotherapeutics Pharmacotherapeutics is the study of the uses therapeutics as well as the effects of drugs. It entails the study of both beneficial and desired effects and uses. Toxicology Toxicology is compromises the study of the nature, effects as well as the detection of toxins and the treatment of those identified poisoning in the body. Question 2 DRUG Major drug group/class Common routes for administration Mode of action (how they work) Common side effects. Possible adverse interactions with other drugs Nursing Considerations (what you need to know as a nurse administering this drug, both for you and the client) Citation Glyceryl Trinitrate Nitrate Vasodilators Tablets Relaxing the body vessels of the heart. Reduce the heart strain making it easier to pump blood. Chest pain, angina symptoms, breathing difficulty, blue colouring of lips, eye blindness, speaking difficulty, slurred speech. Reacts with apormorphine, sildenafil and n-acetyl cysteine. Not taken against sugar intolerance, alcoholic, effects on pregnancy. Ask whether on is under other drugs as acetylcysteine. Crisp & Taylor, 2009 Warfarin Vitamin K Antagonists Tablets and oral Liquids An anticoagulant hence reduce blood clot formation in veins and arteries through the blocking the formation of Vitamin K-dependent clotting factor Hives, breathing difficulty, swelling of face, lips, tongue or throat, pain, dizziness, nausea, vomiting, bloating, altered sense of taste. Reacts with citalopram, paroxetine, vilazodone, venlafaxine Should not be taken under pregnancy unless the doctor measures Prothrombin frequently, ask if patient is under other drugs for treatment of TB, prevent blood clots, supplements containing vitamin K and antidepressant Crisp& Taylor, 2009 Actrapid Insulin Drug used in diabetes Oral Liquid Binding to insulin receptors on cells in the body by making cells in liver, muscles and fat tissues to raise the uptake of glucose from the bloodstream and reduce the production of glucose by the liver hence controlling the glucose level Hypoglycaemia (common), skin thickening or pitting, redness, swelling at injection site, Excessive fluid retention (oedema), visual challenges and skin reactions such as itching, hives or rash. May be affected by ACE inhibitors like captopril, anabolic steroids e.g. stanozol, disopyramide, fibrates e.g. germfibrozil Not used in hypertensive to human insulin, pregnancy and breastfeeding Crisp& Taylor,2009 Question 3 a. Most important aspects of the drug administration process Checking the order As a medical administrator I have to be certain that the physician’s order is complete and correct. I understand a compete order as a composition of the drugs’ name, dosage, frequency and route administration. An incomplete and unclear order should never be assumed and hence I have to consult with the ordering physician before proceeding (Bullock, & Galbraith, 2007). Check the medication I have to be certain of the expiry date of drugs and ascertain that it is yet to expire. I always scrutinize the labels against the order. I ensure that I have proactively scrutinized medication features. I always discard the unclear medication that always found to appear cloudy and replace effectively (Bullock, & Galbraith, 2007). I should ensure that drugs that appear in single dose are sealed as required without tempering and not to store excess medications from single doses. Scrutinize drug interactions I will always be keen to note that patients are prescribed a range of drugs simultaneously. Before I administer a particular I will check the drug interactions for each medication and validate with the patient’s chart to gauge contraindications or special precautions to be altered (Crisp & Taylor, 2009). In addition I do note the history of patient previous anaphylactic reactions. Correct computation of Dosage I have proactively prevented the occurrence of errors arising from miscomputation of incorrect dosages by ensuring that I double check my computations. I always infer from the dosage information of the drug and where it is extreme I open up for consultation with a colleague (Crisp & Taylor, 2009). In addition, I always brush up my dosing knowledge and skills to achieve competency. Minimize Conversation Attentiveness during administration of drugs is key. I always pay much attention when I administer medications as this help me concentrated on my tasks and hence an important aspect of safety. Right of medication administration The safety of medication administration is embedded on the ability of the administrator to know by heart and follow the Rights of medication administration. 3b. The Unit Ultimately Responsible for Correct Drug Administration The National Board is responsible to ensure correct drug administration. The board puts the ultimate responsibility to only the enrolled nurse without a notation to administer the drugs. Enrolled nurse only administer medicines upon completion of relevant medicine administration education units ((Crisp & Taylor, 2009)). Enrolled nurses without a notation and have expanded the scope of their practice to incorporate IV medicine administration upon successfully completing a course designed to provide the enrolled nurses with the relevant skills, knowledge as well as competence for administering IV medicines besides enrolled nurse having been assessed as qualified by the board to administers IV medicine is ultimately responsible for administration of medication. Question 4: Case Study Mrs. A a) Mode of action for digoxin Inhibits the Na-K-ATPase membrane pump culminating into an increase in intracellular sodium. The Sodium calcium exchange subsequently extrude the sodium hence pump in more calcium which then triggers the activation of contractile proteins. b) Side effects of digoxin and Mrs A’s history related to side effects Blurry or yellowish vision, nausea, anorexia, vomiting and mental alterations. Also Cardiac PR interval prolongation, ST depression, ventricular fibrillation and heart block. Mrs A’s could have suffered from the side effects of digoxin based on digoxin based her mental changes and blurry vision. c) Mode of action and the rationale for administering Frusemide Inhibits water reabsorption within the nephron through blocking the sodium-potassium-chloride contransmiter (NKCC2) in the thick acceding loop of Henle. This function is achieved by competitive inhibition within the chloride binding site on the contransmiter hence preventing the transition of Sodium to loop of Henle into basolateral interstitium from the loop of Henle. Subsequently, the lumen becomes hypertonic compared to interstitium and hence osmotic gradient is diminished for absorption of water within the nephron. As the thick ascending limb accounts for 25% of sodium reabsorption, furosemide is key potent diuretic. d) Mrs A’s prescription medications and interactions Digoxin may not function well alongside Furosemide possibly interacting as electrolyte variations and arrhythmias. e) Absorption, distribution, metabolism, excretion of drugs for older client i. Absorption Absorption rates for drug reduce due to ageing effects. Notably, vitamin B12, calcium and iron absorption via active transport frameworks is declining with levodopa absorption rates rising. ii. Distribution Polar drugs (water soluble) distribution have reduced leading due to body composition changes hence high levels of serum. Such drugs as digoxin are victims. Non-polar drugs distribution (lipid-soluble) have risen which leads to prolongation of half-life. Such drugs as thiopentone fall in this category. iii. Metabolism The first-pass metabolism reduction is associated to ageing due reduction in liver mass and blood flow. The bioavailability of drugs associated with first-pass metabolism like propranolol significantly need increased while ACE inhibitors like perindopril that are pro-drugs should be activated in the liver due to reduced first-pass activation with increasing age. iv. Excretion Renal function with respect to metabolism increases drug half-life with a reduction of renal function. Renal declines with ageing leading to alteration in physiological status such as reduced blood flow into the kidney, kidney mass reduced as well reduction in number and size of functioning nephron. Kidney performs major drug excretion renally through glomerular filtrate and hence a reduction in glomerular filtrate impairs rates of drug excretion in ageing population. Question 5: Case Study Mr. B a) Adverse Drug Reaction Adverse Drug Reaction refers to an appreciably harmful reaction arising from an intervention associated with the utilization of a medicinal substance that depicts hazard from future administration and calls for specific treatment or prevention and/or dosage alteration regimen and sometimes warrants withdrawal of the drug product (Crisp & Taylor, 2009). b) My role as EN The immediate course of action will involve cession of the drug through immediate emergency treatment with Epinephrine, Oxygen, Intravenous steroids. I will consult with those enrolled nurse without a notation and the have complete the required competence in administering Intravenous IV. I will frequently assess the patient’s reactions to the altered intervention to note the progress. The nurse will documents the patient’s new allergies and adverse drug reaction. c) Education for New Allergy The patient and the family members will be educated on the generic name of the drug a patient is allergic to besides other possible cross-reacting drugs. The patient will be issued with a medical Alert card to prevent future accidental dispensing. d) Evaluating Mr. B’s New Allergy Understanding The nurse will evaluate the patient’s understanding of new allergy through asking relevant questions based on the education that had given to gauge whether the patient really understood. e) Changes in Medication Chart There will be an inclusion of the new allergy and the adverse drug reaction. Question 6: group of drugs to: A.P.I.N.C.H.S A: Anti-infective P: Potassium and other electrolytes I: Insulin N: Narcotics and other Sedatives C: Chemotherapeutics agents H: Heparin and Other anticoagulants S: Systems Question 7: Case Study Amelia Bling a. Calculate; Input =50+60+100+150+100+120=580 Output=100+200+400=700 Balance=580-700= -120, Hence Negative Fluid Balance b. Assessing Fluid Overload Clinical assessment is done through asking the patients if they are thirsty. Observing vital signs such as pulse, blood pressure and respiratory rate. Capillary refill time where the nurse holds patient hand at heart level and pressing the pad of middle finger for five seconds (Brown, & Edwards, 2012). Skin elasticity or turgor measure through pitching a fold of skin. c. Completing assessment Ask the patients on his past history, Diagnosis to get the cause of the pain and document the findings. d. 3 complementary therapies Massage, physical therapy (walking, stretching and aerobic exercise) and acupuncture (Crisp & Taylor, 2009) e. Schedule and Storage for Endone Schedule 8-stored a cool, dry place at 30 degrees Celsius temperature f. Nursing notes Severity of the pain, ADR and allergies g. Traditional Medicine According to Aboriginal and Torres Strait Islander healthcare means how deeply the two groups believes in indigenous drugs and show laxity to seek medication (Crisp & Taylor, 2009). Question 8 Legislative and organisational perspective: Marshall Refusal Despite the patient’s right to treatment refusal, the treatment is necessary for safety and recovery (Crisp & Taylor, 2009). Besides all efforts at voluntary treatment will be exhausted and I will use family members to persuade the patient and ensure that if the benefits outweighs risks will administer the drug. Question 9 a. essential elements Dose Hourly frequency Route Dose and hourly frequency Maximum daily dose Indication Prescriber signature, printed name and contact detail b. Errors Hourly frequency-missing Dose and hourly frequency should be in 24 hours-6/24 Missing indication Missing maximum daily dose Missing contact details Route left out in the last prescription Question 10 a. risk factors and complications of IV therapy The complications are phlebitis, infiltration, thrombophlebitis and infections (Crisp & Taylor, 2009). b. care of a peripheral Intravenous cannula Administration of loading doses or bolus. Administration of intravenous fluid, blood products and drug infusions via IV device. Monitoring and evaluation of patients on fluid therapy help prevent fluid overload (Brown & Edwards, 2012). Changing cannulas to prevent re-cannulation which leads to family distress. Elimination of cannulas and prevent infections. c. removal of a peripheral Intravenous cannula With clean hand, wear non-sterile glove and remove the dressing holding in place the cannula. Hold a piece of sterile gauze over the exit site with no pressure Withdraw the cannula maintaining a neutral angle with skin d. indications for the administration of Intravenous therapy Intravenous fluids, blood and blood products, limited parenteral nutrition, drug administration and prophylactic use before procedures. e. medication for; S2 (Dextromethorphan), S3 (pseudoephedrine) and S4 (Ergotamine) Question 11: Mr. John 50 x 1.52= 76 mgs Reference Brown, D., & Edwards, H. (Eds.). (2012). Lewis’s Medical-Surgical Nursing: Assessment and management of clinical problems (3rd ed.). Marrickville, Australia: Elsevier -‘Intravenous fluid and electrolyte replacement, p. 375 - 376 Bullock, S., Manias, E. & Galbraith, A. (2007). Fundamentals of Pharmacology, (5th ed.). Sydney, Australia: Pearson Education. Read „Shelf Life of Preparations‟, Table 7.19, p 76 Crisp, J & Taylor C. (2009), "Complications of Intravenous Therapy", p. 1049 & 1056. (P.1242-1243. 2013 version) Crisp, J & Taylor C. (2009), “Medication Legislation and Standards” pp.728-730. (p.818 – 820 2013 version) Crisp, J & Taylor C. (2009). Pharmacokinetics as the basis of medication actions‟ pp. 730-731. (p. 821 – 823. 2013 version) Crisp, J., & Taylor, C. (2009). Aboriginal and Torres Strait islander health. Pp. 20. Crisp, J., & Taylor, C. (2009). Non-pharmacological pain-relief interventions to Cancer pain management. (p.1342 – 1345 & 1359 – 1361. 2013 version) Crisp, J & Taylor C. (2009). Types of medication actions‟ through to the end of „Medication dose responses‟, pp. 732-734.(p. 823 – 824. 2013 version) Read More