Nursing and Social Care - Essay Example

Health and Social Care Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Instructor Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Introduction The essay herein expounds on the role of health care professionals and their responsibilities in administering drugs in the group of penicillin particularly in the Accident and Emergency Department in a reflective manner. Reflective practice is what refers to the personal capacity of a learning individual to assess their actions in order to determine the knowledge and experience that they have gained during a learning process (Barber & Robertson, 2009). An example here is ear infections. As an associate practitioner, I need to pay critical attention to my everyday practicals that will inform my general practice as a nurse. The developing role of an Associate Practitioner (AP) within the hospital setting is also discussed throughout this assignment. AP’s must have undergone the necessary training as set out in the policies and protocols of the local health authority by which they are employed and signed off as competent, by registered nurses before they can second check any medication. Whilst assisting in the administering of drugs it is also expected that they have an awareness of the pharmacotherapeutic values of all the medication given to every patient (Mallett & Dougherty 2001). Two medicines will be discussed further in this assignment; these being Co-careldopa used in the care of Parkinson’s disease and Paracetamol for pain relief. (Harvey, Champe & Mycek, 2009). The greater variety of health care professionals deal with the general tasks of helping patients with care, medication and management of their conditions. Most of the individuals have immediate, severe, not so severe, or long term needs (Barber & Robertson, 2009). As an associate practitioner working in the emergency rooms and the accident faculty, the case is very different for me. I am charged with examining and treating people who come to the hospital with immediate life-threatening illnesses. Most of the casualties are suffering from the severe bleeding and fresh injuries (McGavock, 2011). The patients therefore require immediate attention and prescription of drugs. Adams, Holland & Bostwick (2010), assert that there are five rights to drug administration. The five rights of medication involves a nurse looking up all the necessary information before administering the medication to the patient, making sure that the patient receives the right dose in correct amounts to avoid being held responsible for any adverse reactions on the part of the patient (MacDonald, 2010). Moreover, the drugs must be administered at the right time, using the right route and to the right patient. This ensures patient safety and shows the patient that as a nurse, I am concerned about their health. Here are the reasons why: Right dose: includes the number of tablets to be taken at one time, how many times a day and for how long (MacDonald, 2010). The right dose must always be indicated on the chart. I got to understand that in most adult patients, the right dose is usually determined by the weight of the patients and the general status of the patients as well. Right drug: this aspect of patient safety requires that as a nursing practitioner, i will be able to ascertain the type of drug that am giving the patient that is the correct one. Confusions and errors in this area may be avoided by comparing the exact spelling of the drug as well as the concentration with the instructions given. Many of the drugs may have names that are almost similar. It is therefore important to read out the name over and over again and to ensure it is the appropriate drug prescribed for the patient. The right time: is the time of the day when the medication should be taken and whether it should be taken before, with, after a meal or with a snack. The schedule to be followed in the administration of such penicillin drugs must be well laid out by the practitioner in charge. As an associate practitioner, I learnt that the schedule must be well planned and this helps in maintaining the blood levels of the patient in a consistent manner. In order to ensure that i give the medication at the right time, i must ensure that the time is correctly indicated on the drug chart. This will help me as an associate practitioner to avoid a lot of errors. Scott and McGrath (2009), asserted that it is acceptable for a drug to be given within half an hour of the prescribed time. Once the patient has taken the medication as prescribed the chart is then signed by the associate practitioner or the nurse in charge and kept as record and as proof. When it comes to the right route, the nurse must ensure that the medication is given in the right manner. Here, considerations include whether the drug should be swallowed or chewed, crushed, taken with or without water (MacDonald, 2010). More importantly it must be considered whether it is an injection, an intramuscular or subcutaneous drug. I also learnt that if I am not very sure about how I should administer the drug to the patient, then it is advisable that I inquire from the qualified professionals. The Intravenous, Oral and Sublingual must not be mixed and must always be done separately. The right patient: this generally requires of me as an associate practitioner to identify the right patient before I administer the drugs. In most of the hospitals, the patients are usually identified using an attached wrist band with a tag. It is also good to verbally inquire of their names. The patient should be wearing two wrist bands which give Name, Date of Birth, Hospital Number, NHS number. The next important thing here is to also consider if the patient suffers from any allergies after taking the drugs of penicillin. This will help me in avoiding errors that nurses make. (MacDonald, 2010) In general, as an associate practitioner, I have a collective responsibility to show care and caution when administering drugs that fall into the group of penicillin to patients (Downie, MacKenzie & Williams, 2008), (McGavock, 2011). As an AP I have a duty of care and a legal liability with regard to the patient. My role as an AP is here to stay and numbers will swell as the predicted fall in numbers of RNs will impact on the workforce. As the numbers of RN’s fall and AP’s rises the impact can be seen as a positive. AP’s will be delegated their own case load of non-complex patients they, may also take the lead in health promotion activities and assist with the teaching of nursing students and other team members (McGavock, 2011). In the ward, all patients have bedside lockers with a locked compartment for medication, the nurse in charge has responsibilities for the keys to the lockers, however some areas now have coded cupboards for drug storage, it is the responsibility of the last person using the last medicine in a packet or bottle to ensure it is replaced/reordered if still required by the patient. The patients’ medicine charts are kept at the bottom of their beds, however checking that the right chart is for that patient is essential as they can be moved either by mistake or by confused patients. Moreover, some of the patients may react by exhibiting some bizarre behaviour. This mostly occurs in extreme cases of allergic reactions to penicillin drugs. In essence, the patient may start to faint or have seizures. Extreme cases can even result to long hours of fainting and coma (McGavock, 2011). Other reactions that may occur from this group of penicillin drugs include swelling of the mouth, lips and tongue, chills, chest pains, pain in the muscles, paling of the skin, hallucinations, stomach and pain cramps, vaginal irritation and blood in the stool and urine just but to mention a few (Page, Curtis, Sutter et al, 2006). It is therefore very necessary that the professional health practitioners, their associates and their assistants working in the accident and emergency department be armoured with the full knowledge and skills to reverse any of the above reactions. As health care providers, this requires very quality training and dedicated practice. I learnt that I must also be able to provide the required medical advice about any potential side effects before the patients are subjected to the drugs in this group (British journal of nursing: BJN 1992). There is also penicillin G potassium which has the same side effects as penicillin G Sodium. The difference between the side effects of the two drugs is almost insignificant. The doctors are warned to be aware of allergic reactions from the patients such as skin rashes, tightness in the chest, light-headedness and fainting and even vaginal itching and irritation (McCance & Huether, 2006). The drugs must immediately be discontinued if the patients complain of such allergic reactions. Muscle pain and paling skin are also associated with such drugs. There might also be reactions such as rapid breathing, heavy pounding in the chest and swelling of the skins (McGavock, 2011). Therefore, for this and other reasons, pre-medication care must be taken to avoid any complications that may arise. It is also important for the doctors to inform the patients of the necessary precautions that they are supposed to take even when taking the medication on their own (Page, Curtis, Sutter et al, 2006). The health care provider can measure the effectiveness of the side effects of the patient’s treatment before administering the drugs. This can be achieved faster through quick laboratory tests and physical examinations. The length of the treatment period will depend on how fast the patient can be able to respond to the penicillin medications that he/she has been given (Harvey, Champe & Mycek, 2009). Moreover, in my practice, I must know that most of the drugs in the group of penicillin are usually associated with hypersensitive reactions (Crouch & Chapelhow, 2008). In most of emergency patient cases, the reactions are more severe and more serious when intravenous therapy procedures are used (McGavock, 2011). Moreover, they have at times been attributed also to oral therapy. For expertise and knowledge to deal with such cases, I am supposed to have the necessary knowledge at the tips of their fingers. For such cases, an associate practitioner must, I must have the basic knowledge of sensitizing exposure which enhances the stimulation and production of antigens, specifically igE (Barber & Robertson, 2009). This chemical reverses the hypersensitive reactions and prevents any second risks. There are other environmental types of exposures of penicillin drugs (Downie, MacKenzie & Williams, 2008). These include the breast milk exposure, the occupational exposure and the utero exposure. Significantly, the side effects of hypersensitivity include skin rashes, conditions such as oedema and fever, severe and fatal anaphylaxis, eosinophilia and even shock which may result to death (Downie, MacKenzie & Williams, 2008 pp.40). With adequate and sufficient care however, such reactions can be easily avoided in treatment and care for emergency and accident cases. Penicillin drugs have high chances of affecting the nervous system of the patients in a very negative way. In my course as a professional I learnt that the drugs have had severe neurologic side effects especially when administered in high doses. This mostly occurs in patients with renal dysfunctions (Crouch & Chapelhow, 2008). It is therefore paramount for the health practitioner to minimise such reactions associated with penicillin administration. Both therapeutical and parenteral administration of the drugs has been associated with the reactions (British Medical Journal, 1947 pp.1399 as cited in Crouch & Chapelhow, 2008). In most cases, the nervous systems react by seizures, both visual and auditory hallucinations and decreased mental ability (Barber & Robertson, 2009). For parentetal administration, symptoms such as extreme numbness of the body, general damage to the nervous system and cyanosis may be experienced. It is required of the nurse to reduce the amounts of penicillin administration to the patient such reactions occur (McCance & Huether, 2006). Notably, this is because severe reactions of the nervous system are associated with high doses of penicillin of up to 18 to 80 million units a day (Huether & McCance, 2008). The intervention here is to restart the dose at a considerably lower dose that is not likely to affect the patient negatively. After complete healing, the reactions will then completely abate (Barber & Robertson, 2009). There are other minor yet significant side effects of penicillin drugs that as an associate practitioner, I must take note of. First, I learnt that there are psychiatric side effects that are temporarily associated with class parenteral penicillin G benzathine (Harvey, Champe & Mycek, 2009). Some of the patients may experience nervousness and anxiety. They are also associated with confusion and euphoria. Second, there are hematologic side effects such as anaemia, leukopenia, lymphadenopathy and thrombocytopenia (McGavock, 2011). I must take a lot of caution to avoid any errors. Third, I must be aware of cardiovascular reactions that are associated with the administration of penicillin (Huether & McCance, 2008). In such cases first aid procedures are necessary if the patient’s life is to be saved. In addition, any caregiver in this sector must be aware of other accompanying reactions such as vasodilatation, cerebrovascular attacks, vasovagal reactions and syncope (Page, Curtis, Sutter et al, 2006). As an associate practitioner, I must also put in check the possibility that penicillin could interact with other drugs (Barber & Robertson, 2009). In order to avoid such complications, the five R’s in the administration of drugs need to be put into consideration. These are the right medication, the right dose, the right patient, the right route and the right time (Crouch & Chapelhow, 2008). It is very important for me as a nurse to importantly these rules in patient medication so as to allow medication errors. I also learnt that in the practice of penicillin administration, there are also ethical issues. These include patient consent as one of them. Consent involves the nurse and the patients making decisions together. As a doctor, I must be satisfied that I have the consent of my patient before making any decision regarding their health (Crouch & Chapelhow, 2008). In addition, there are also other professional issues such as the rights of the patient, communication, confidentiality, the right to health care and other legal principles in medicine. Conclusion Conclusively, all health care professionals, their assistants and associates in any hospital setting must possess the necessary knowledge and skills of the precautions that are required in the administration of the drugs in the group of penicillin (Huether & McCance, 2008). During my period of learning, I observed that it is not easy at all to administer medication to patients. Basically, it is because these drugs are administered as antibiotics and can be associated with very severe and even life-threatening allergies as indicated above. Precautions measures to avoid the reactions should thus be every professional medical practitioner’s priority. Whilst undertaking this medication module, I feel that the knowledge I have gained will help me to support the RN’s within my role as an AP. By gaining understanding of certain medications and how they are administered, I feel that I can transfer this knowledge and become more confident within my role. Although within my role at this present time I am unable to administer medications. It has been suggested that in the future if the necessary training has been completed, according to local and trust policies then the AP’s may become second checkers. So this module will then have given me the basic knowledge to build upon. Moreover, it is of crucial importance that nurses and other associate practitioners must avoid any possible errors in the administration of drugs in the group of penicillin by being extra-careful. If any emergencies occur, then the nurse should be held professionally responsible for the same. It is important that the patients be assessed using a defined and systematic approach so as to ensure that the administration of drugs is safe. This will ensure that maximum and effective care is given to the patients. References Barber P, Robertson D (2009) Essentials of Pharmacology for Nurses. Berkshire Maidenhead: Open University Press.pp. 11-25 Crouch S, Chapelhow C. (2008) Medicines Management a nursing perspective. Essex Pearson Education Limited. pp.67-76 Downie, G., Mackenzie, J. and Williams, A. (2008) Pharmacology and medicines management for nurses. 4th edn. London: Churchill Livingstone.pp. 33-40 Harvey, R.A., Champe, P.C. and Mycek, M.J. (2009) Lippincott’s Illustrated Review of Pharmacology. 4th ed. Philadelphia: Lippincott, Williams and Wilkins.pp. 378 Huether, S.E. and McCance, K.L. (2008) Understanding pathophysiology. 4th edn. London: Mosby.pp.12-56 Macdonald M. (2010). Patient safety: examining the adequacy of the 5 rights of medication administration. Clinical Nurse Specialist CNS. 24. McGavock H. (2011) How drugs work: basic pharmacology for health care professionals. 3rd edn. Abingdon Radcliffe.pp.8-32 McCance, K. L and Huether, S.E. (2006) Pathophysiology: the biologic basis for disease in adults and children. 5th edn. London: Mosby.pp.1169 NURSING AND MIDWIFERY COUNCIL (GREAT BRITAIN). (2007). Standards for medicines management. London, NMC. Page, C., Curtis, M., Sutter, M., Walker, M. and Hoffman, B. (2006) Integrated Pharmacology. 3rd edn. London: Mosby.pp. 15-23 (1992). British journal of nursing: BJN. London, Mark Allen. (1987). Journal of clinical pharmacy and therapeutics. Oxford, Blackwell Scientific Publications.Vol. 1 pp.1274-83 (1992). Journal of interprofessional care. [Abingdon, Oxfordshire], Carfax International Publishers. http://www.informaworld.com/1469-9567. Read More