Nu2003 Flashcards
Discuss drug admin under code of conduct 2014
Ensure medication administered safely and effectively. Nurses must have appropriate knowledge, skills, competence and up to date knowledge. Responsible for assessing the patients condition and monitoring their response as well as identifying and reporting any ADR’s
Discuss drug admin under scope of practice 2015
Responsibilities include assessing patient’s medication history, ensuring its prescribed correctly and checking medication for accuracy and suitability. Ensure patient understands the purpose, dose, and side effects.
Discuss drug admin under guidelines to medication management 2020
Provides detailed guidelines on medication admin including storage, handling and prep. Including medication errors, reporting ADR’s and managing medication related incidents
Drug admin procedure
Check prescription, question cardex, quiet clean space, wash hands, check time of last admin, check pt name, get from double locked press, stock count w register, check label, dose, expiry, record in CD register, prescription dose against container, correct pt, admin, correct route, dose, time, patient. Record in register and medication notes, patient comfort, assess for ADR or effectiveness, dispose sharps
Importance of pain assessment
Vital to ensure patient receives appropriate pain relief, prevents under/over treated pain, develops effective pain management plan incl pharma and non pharma, improves patient outcomes, and quality of life
Discuss comprehensive pain assessment
P: provoking factors; causes/ what increased pain, Q: quality; characteristics, throbbing, stabbing, dull, burning, helps identify causes R: radiating/region; where it’s located, is it radiating, S: severity; how severe it is 1-10, numeric scaled, visual analogue scales, improving/disimproving, T: time; what were they doing at the time, time since last pain, how long pain lasts, associated symptoms
Medication adherence discuss
extent to which patients take their meds. Essential for achieving optimal therapeutic outcomes in many chronic conditions like HIV, DM, hypertension
Importance of highlighting drug errors
Essential aspect of medication management and patient safety. Identifies system failures, implement preventative measures to reduce risk of similar errors occurring again. Duty to report medication errors accurately and promptly.
Importance of highlighting errors under code of conduct 2014
Responsibility for quality of care including management of medications. Importance of continuous learning and improvements.
Importance of highlighting errors under scope of practice 2014
Professional responsibilities include need to report med errors promptly and accurately. Including cause of error, in medical record and to appropriate person.
Importance of highlighting errors under guidelines to medication management 2020
reporting both near misses and errors, regardless of if they caused harm. Non-punitive culture
Learning opportunities for highlighting errors
Continuously learn and improve, strategies for preventing future errors. 1) Continuing professional development and need to maintain up to date info, knowledge and skills by attending workshops and educational programmes. Professional development including clinical supervision, mentoring and reflective practice. Medication safety committees or working groups, med safety training and using incident reporting forms
Factors effecting medication adherence
Patient: poor knowledge or illness/med, administering and dosage of drugs, independent pausing and stopping, lack of competence in self management, hiding drug info, fear towards drugs, media source of info, lifestyle changes, poor control no symptoms, replacing prescription with self administered drugs
GP: reviewing full med info challenging and time consuming, accurate knowledge of home meds difficult to attain, too authorative for doctors, no teaching skills
Drug therapies: complex meds, polypharmacy, duration of meds/ withholding, ADR
Healthcare system: shortage of GP appointments, poor access, meds list not up to date, poor IT and communication
Advice for better med adherence
Patient: focus on health outcomes of self-management and therapies, support to understand, pharmacists as coaches for drug therapies, medication counselling, peer groups
GP: interprofessional practices to update drug lists, continuity of care and patient relationships
Drug therapies: interprofessional interventions, medication reconciliation, combination of products to reduce number of meds, checking and teaching medication devices
HC: interprofessional practices and interventions, HC shared patient info and better IT
Discuss storage and admin of schedule 2 drugs
Double locked press, keys with nurse in charge, checked daily, environment, controlled drug register kept for 2 years, different page for each class, signed by person giving and checking drugs, counter signed.
Process of admin IM injections
Prep: clean area, assemble equipment, sterile single use needles and syringes, reconstitution solution, alcohol swab, sharps container, hand hygiene, single use ppe, skin prep.
Needle: SC 25/26 G, IM 21/23 G
Vial/ ampoule
Deltoid, dorsogluteal, ventrogluteal, vastus lateralis- away from large blood vessels, nerves, bone
Procedure: infection control, medication checks 10R’s, identity and consent, cover ampoule when opening avoid injury, inspect solution- cloudiness, prep injection before going to patient, aspirate ampoule to expel air, 2 needle approach, dispose in sharps, select and locate site, positioned correctly, 90 degrees stretching skin, 1ml/10 seconds
Discuss interventions to reduce admin errors
Training and education - develop knowledge and skills for safe admin, recognize potential errors, occurs in variety of settings, implement best practices and stay up to date, automated delivery system such as automated dispensing cabinets reduce errors as correct med, person, time, dose also reduce risk of illegible handwriting of med, dose, interactions. Barcode med admin prevents errors, scan wristband to barcode, verifies patient identity, med, dose, route
describe nurses role in assessment and mgmt of pain post-surgery
critical to ensuring comfort and recovery, assess pain frequently - assessment tool, before and after meds and frequently, educating patient- re pain mgmt, importance of reporting pain, pain relief available and side effects, admin pain med- ADR, resp depression, sedation, nausea, nonpharma techniques, monitoring and documenting- pain and intervention and response, collab w HC team
Discuss nurse’s role in med concordance
Assess patients understanding of med regime, name, purpose, how to take, when to take, side effects. Provide education and support- importance of med concordance, how to manage side effects, provide resources. Encourage patient involvement, report concerns/ issues
Two strategies to improve med concordance
motivational interviewing, explore and resolve ambivalence about meds, barriers to adherence etc. , medication reconcilliation, comparing patients med regime at admission, transfer and discharge, ensure accurate and up to date and identify potential issues
Monitoring and documentation importance in med mgmt including assessing, planning, implementing and evaluating, communicating- discuss
Ensures safe and effective med mgmt, communication ensures appropriate info is shared among HC team and patients.
Assessing- communicate effectively with patient to assess medical Hx, current meds, allergies, ADR, communicate w MDT ensure med regime is appropriate and safe.
Planning- communication necessary to develop med plan tailored to patients needs, ensure they understand regime, how to take, when to take, side effects.
Implementing- ensure meds admin correctly, communicate w patients to ensure they understand
Evaluating- w patients ensure response if effective or any ADR
Documenting- accurate and complete records maintained
Affinity - drug-receptor actions
Attractive forces between the drug and receptor, causes drug to bind to receptor
Efficacy- drug-receptor actions
ability of drug when bound to initiate change, determines what happens once drug is bound, extent of which the drug can produce a response when all available receptors or binding sites are occupied, max effect drug can have regardless of dose
Potency
Amount of drug necessary to have an effect, measure of the concentration of a drug at which it is effective, determined by affinity of a drug for receptor and no. of receptors available
Specificity
Ability of receptor to recognise specific chemical configurations, lower potency and specificity, greater chance of side effects
Enzyme induction
increase in enzyme activity caused by a foreign compound, requires repeated exposure to compound and important role in drug interactions , consequences: accelerated clearance, reduced action, increased formation of toxic metabolites
Enzyme inhibition
decrease in enzyme activity caused by a foreign compound, requires only a single dose , consequences: impaired clearance, prolonged action
Clinical implications of enzyme induction
increased drug metabolism and elimination leading to reduced drug efficacy and toxicity, reduced plasma concentration of drugs leading to potential treatment failure, increased risk of drug interactions due to altered metabolism or other drugs
Clinical implications of enzyme inhibition
decreases rate of metabolism, increasing systemic exposure of a substrate drug, increasing propensity for side effects and potential toxicity, drug interactions due to changes in metabolism in other drugs, reduced metabolism and elimination of toxic substances increasing toxicity, changes in drug efficacy due to altered drug metabolism and elimination
Principal drugs in anaphylaxis treatment and description
Epinephrine- first line drug, constricts blood vessels, increases HR, relaxes airways which counteract severe allergic reaction, injection into thigh muscle
Antihistamines- block effects of histamine, a chemical released during rxn causing itching, swelling, e.g. cetirizine
Corticosteroids- reduce inflammation and swelling, conjunction w other meds above, prevent reoccurrence of anaphylaxis, e.g. prednisone
Bronchodilators- relax airways, easier to breath, relieve resp symptoms SOB, wheezing, e.g. albuterol
Vasopressors- increase BP and HR, counteract drop in BP, e.g. dopamine
What clinical situations should NSAID be avoided
history of peptic ulcers, GI bleed- irritate lining of stomach causing bleeding/ ulcers
CVD- increase risk of MI or stroke esp w hypertension/ high cholsterol
Chronic kidney disease - impair kidney function and worsen disease
Allergy or hypersensitivity- develop allergic rxn’s
Bleeding disorders- increase risk of bleeding if on anticoag
Why are elderly more susceptible to drug reactions
Age- body composition, higher fat lower muscle, affects distribution of drug and elimination from body, higher drug conc. and increased risk of toxicity
Organ function- declining, esp liver and kidneys, affects drug metabolism and elimination, higher drug conc. and toxicity
Polypharmacy- multiple meds, increase risk of drug interactions and ADR, difficult to identify cause of ADR
Medical conditions- multiple chronic conditions more likely, affects metabolism , absorptions, elimination and distribution of drugs, increase drug interaction and ADR
Cognitive and physical impairments- affect ability to adhere to meds or report symptoms, hard to manage and identify
Reduced physiological reserve- less ability to compensate for effects of drugs or other stressors, increase risk of ADR
Principal drugs used in treatment of hypertension
Younger than 55 A, older/black- D or D
A+C/D
A+C+D
further diuretic therapy or BB
ACEI- angiotensin converting enzyme inhibitor, inhibit ACE reduce total peripheral resistance and stroke volume
ARB- angiotensin receptor blockers, reduce TPR and SR
Beta blockers- reduce HR and SV
CCB- calcium channel blockers, reduce TPR
Diuretics- reduce SR
ACEI
Block formation of Angiotensin II, inhibit aldosterone release, reduce BP, block breakdown of bradykinin, reduce proteinurea in diabetics e.g. Catopril
Side effects-
Cough- bradykinin and substance P
Angioedema
Proteinuria
Taste changes
Pregnancy
Rash
Increased renin and lower angiotensin II
Lytes- hyperkalemia, decreased aldosterone secretion
ARB
Block angiotensin II receptors, bind to angiotensin receptor and block vasoconstriction e.g. losartan
Side effects- fatigue, hyperkalemia, renal failure, syncope
Beta blockers
Reduce force of contraction, block beta receptors e.g. metoprolol
Side effects- bradycardia, conduction, heart failure, bronchospasm, vasoconstriction
Contraindications- asthma, bradycardia, cardiac failure, diabetes
CCB
Block calcium channels, reduce calcium available to contractile proteins, reduce cardiac contractility, vascular smooth muscle tone and BP e.g. nicardipine
Side effects- headache, oedema, flushing
Diuretics
Facilitate diuresis - Thiazides, loop diuretics, potassium-sparing diuretics e.g. furosemide
Side effects- ototoxic, hypocalcemia, hypovolemia, blood disorders
