nursing care 3 Flashcards
Legal concerns for drug admin
- A nurse must
- have knowledge of the laws that direct, define and limit your scope
- be able to recognise the limits of your own knowledge and scope
- have knowledge of the medicines and poisons act 2014 and medicines and poisons regulations 2016
Medication safety
- standard 4
- health service organisations have mechanisms for the safe prescribing, dispensing, supplying, administering, storing, manufacturing, compounding and monitoring of the effects of medicine.
- clinical workforce accurately records a pts med history and that the history is available through out the episode of care.
- clinician provides a complete list of pts medication to the receiving clinician and pt handover care
- clinical workforce informs pts about their options, risks and responsibilities for an agreed medication management plan
hight risk meds: APINCH
A - antimicrobials P - potassium and other electrolytes, psychotropic medications I - insulin N - narcotics/ opioids C - chemotherapeutic agents H - heparin and other anticoagulants
Poisons schedules
- 1-9
SCHEDULE 2 - (pharmacy meds) - available to public from pharmacies
SCHEDULE 3 - (pharmacist meds) - sold by retailer under supervision of a pharmacist or supplied by medical practitioner
SCHEDULE 4 - (prescription meds) - supplied on prescription from a pharmacy or medical practitioner
SCHEDULE 5 - (caution) - poisons of a hazardous nature, readily available to public but require caution in handling, storage and use
SCHEDULE 6 - (poison) - poisons that must be available to public but are more hazardous/ poisonous nature than S5
SCHEDULE 7 - (dangerous poison) - poison that require special prescriptions in manufacturing, handling, storage and use
SCHEDULE 8 - ( controlled drugs) - prescription only meds which require restrictions of manufacture, supply, possession
and use to reduce abuse/misuse
SCHEDULE 9 - (prohibited substances) - poisons that are drugs of abuse
What is the schedule 8 process
- S8s are kept in a double locked cupboard
- red keys and register book - for stock amounts
- 2 nurses must be present through whole process
- 2 rns count total at end of every shift
- errors beed to be ruled and initialed
- is any portion is to be discarded, 2nd nurse must witness and sign
what is the nurses role in drug admin
- to be administered appropriately and accurately
- responsible for assessing the effectiveness of meds and observing any reactions to drugs
different forms of drugs
AEROSOL SPRAY - liquid or powder form
AQUEOUS SOLUTION - one or more drugs dissolved in water
AQUEOUS SUSPENSION - one or more drugs finally divided in liquid
CAPLET - solid form, coated
CAPSULE - in a container, powder, liquid or oil
CREAM - non greasy, semi solid
ELIXER - sweetened aromatic sol’n with medication
GEL - semisolid that liquifies when applied to skin
LINIMENT- med mixed with alcohol, oil or emollient and applied to skin
LOZENGE - dissolving med for mouth
LOTION - med in a liquid suspension for the skin
OINTMENT - semisolid prep for one or more meds for skin and mucus membrane
PASTE - like a ointment but thicker
POWDER - internal or external use
SUPPOSITORY - one or more meds shaped for insertion and melts at body temp to release drug
TABLET - compressed powder
TINCTURE - an alcoholic or water-and-alcohole solution prepared from drugs derived from plants
Routs of admin
- oral
- sublingual
- buccul
- rectal
- vaginal
- topical
- subcutaneous
- iv
- im
- intradermal
- inhalation
- epidural
- intrathecal (around spinal chord)
TERMINOLOGY: prn stat bd/bid tds/tid qid mane nocte pv pr ng mdi po neb picc peg cvc pca
PRN - pro re nata ( as needed) STAT - statim ( give immediately) BD/BID - twice a day TDS/TID - three times a day QID - four times a day MANE - morning NOCTE - night PV - per vagina PR - per rectum NG - nasogastic MDI - metered dose inhaler PO - per oral NEB - nebuliser PICC - peripherally inserted central catherter PEG - percutaneous enteral gastrostomy CVC - central venous catheter PCA - pt controlled analgesia
6 RIGHTS
person, drug, dose, route, date/time, documentation
subcut injection sites
upper arm
abdomen
anterior and lateral thighs
sub scapular area of back
subcut angle of injection
- inject on a 45 degree angle and 16mm needle is less than 25mm of tissue can be grasped
- inject on 90 degree angle is 50mm or more tissue can be grasped with skin hold taught
5 main types o insulin in aus
RAPID ONSET FAST ACTING INSULIN - clear in colour - 1-20 min action - pt must eat immediately after - eg. novorapid SHORT ACTING - clear in colour - 30 min acting - have injection 30 mins before eating - eg. actrapid INTERMEDIATE - cloudy in colour due to zinc or protamine to delay action - works 1 1/2 hrs after injection - gently shake to mix - eg. protaphase MIXED - cloudy in colour - rapid and intermediate mixed (505/50 or 30/70) - eg. novomix LONG ACTING - once or twice a day dose - lasts up to 24 hrs - eg. lantus
INSULIN
can be given by?
considerations for nurse
CAN BE GIVEN BY: syringe, insulin vile or pen device with pre filled insulin cartridge and disposable needle
NURSNG COSIDERATIONS:
- always alternate injection site
- become familiar with documentation and flow chard
- always check BGLs prior to giving insulin
- check local policies
intramuscular injection sites and how to locate them
DORSOGLUTEAL: dorsogluteal muscle is located in upper outer region of buttocks, draw imaginary line from greater trochanter to illiac spin. injection site is upper right corner
VACTUS LATERALIS: one hand space above knee and one hand space bellow greater trochanter, middle 3rd of muscle is best site
VENTROGLUTEAL: place palm of hand over greater trochanter, index finger palpating illiac spine and iddle finger pointing towards illiac crest. V formed in injection site.
respiratory rates throughout lifespan
INFANT: 40-80bpm (abdominal breathing)
CHILDREN: 25bpm
LATE ADOLESENCE - ADULTS: 12-18bpm
factors affecting respiratory function
- AGE: older adults have less elasticity of airways, decreased cough reflex and decreased lung expansion
- ENVIROMENT: heat, cold, pollution, inhalation of certain dusts
LIFESTYLE: can predispose lung disease, dusts/asbestosis eg. farmers - BEHAVIOURAL ISSUES: smoking, alcohol, exercise
- MEDICATIOS: can decrease rate and depths of respiration eg. narcotics
- STRESS: psychological and physiological responses (hypreventilation)
hypoxia causes
- HYPOVENTILATION: inadequate alveolar ventilation due to resp conditons, CNS disorders and drugs
- IMPAIRED DIFFUSION: of O2 from alvioli to arterial blood resulting in hypoxemia
- REDUCED HAEMOGLOBIN: O2 saturation due to sever anaemia
sigs and symptoms of hypoxia (low oxygen)
- rapid luse
- tachypnoea
- intercostal retraction
- increased restlessness
- nasal flaring
- cyanosis
appearance of hypoxia
- face is drawn and anxious/tired
- sitting position = tripod
- fatigued and lethargic
- clubbed fingers and toes
differnt O2 delivery devices
- nasal cannula/prongs
- hudson mask (simple face mask)
- venturi mask
- non rebreather mask
- partial re breather
- tent mask
- non-invasive ventilation (NIV)
what are nasal cannula/ prong?
benefits?
disadvantages?
- delivers a low concentration at flow rates of 2-4L per min
- used in non-critical situations and long term use
- prongs sit in the nose with tubing tucked behind ears
BENEFITS: improved comfort, less claustrophobia, can eat, drink and talk
DISADVANTAGES: nasal dryness and discomfort
what is a Hudson mask?
- maintains flow above 5L to prevent re-breathing of exerted CO2
- concentration of 45-70% O2
- side ports on mask allow room air to enter mask and allow CO2 to leave
- long term use can lead to pressure injuries to nose and face
What is a venturi mask?
- provides oxygen concentration of 24-50%
- colour coded nozzels enable varied concentrations of O2
- nozzel have prescribed amount of O2 flow written on device
what is a non-rebreather mask
- has an attached reservoir bag with a one way valve, which does not allow exhaled gases to enter bag
- exhaled air is directed through a one way valve which prevents the inhalation of room air and re-inhaled exhaled air
- delivers higher oxygen concentrations of 85-90% with flow rates between 10-15L per min
what is a partial re-breather mask
partial and non-rebreather nursing considerations
- only have one valves rather than 2 - allows for air entrainment resulting in lower oxygen concentration delivery
- Co2 is exhaled through side ports
- used for emergency situations
NURSING CONCIDERATIONS
- dont let bag totally deflate or oxygen tubing disconnect - pt may be at risk of rebreathing their Co2
- close monitoring of pt and system to ensure adequate ventilation and that connections are secure
what is a tent mask
- can replace o2 mask when pt cannot tolerate face mask
- varying levels of o2 is supplied: 30-50% concentration at 4-8L per min
- skin needs assessing as it can become damp or chafed
- can be humidified
what is non-invasive ventilation (NIV)
- delivers positive breaths to the spontaneously breathing pt
- specific intranasal cannula/mask
- indications can include: COPD, asthma
types of chest tubes - where they are inserted
rationals for use
INTERCOSTAL CATHETER (ICCs) - inserted into upper anterior thorax SUBCOSTAL CATHETER (SCCs) - inserted into mediastinal space bellow rib cage UNDERWATER SEAL DRAINS (UWSD)
RATIONAL FOR USE: to drain
- air (pneumothorax)
- blood (haemothorax)
- pleural effusions (accumulation of pleural fluid)
- pus (empyema)
chest drains are inserted following?
3 main components of chest drainage systems
inserted following:
- cardiothoracic surgery
- after chest trauma
- a spontaneous pneumothorax
- any condition resulting in accumulation of content in pleural space
3 main components:
- collection chamber: collects fluid drained
- suction control source and/or vent: allows air to excape
- a water seal (one way valve): prevents air from re-entering the chest on inspiration
what is a nurses role in chest drains
WHILE INSERTED: base line obs, offer prescribed meds, x-ray to ensure position, ensure dressing and connections secure
POST INSERTION: documenting, observations, educating pt/family
chest drain complications and what to do
ACCIDENTAL DISCONNECTION: avoid clamping and try to reconnect drainage system immediately
OCCLUSION/ BLOCKAGE: check for kinking if tube, review for clots or blockage of tube, try tapping or pinching tube to remove occlusion, may need to change tube or drainage set, monitor pt closely - may lead to tension pneumo
AIR LEAKAGE: secure all connections of drainage tube, secure dressing site (airtight dressing), note for surgical emphysema
ACCIDENTAL REMOVAL: cover insertion sit, call for urgent help, closely monitor pt
EXCESSIVE DRAINAGE: drainage may increase significantly in amount, if acute - urgent dr review, if slow bleed - monitor pt closely with strict FBC (full blood count)
INFECTION: may get local or systemic infection
SUBCUTANEOUS EMPHYSEMA: collection of air under skin, can indicate a leak in drainage system, may need to re-suture drain at site
factors that affect cardiac output
HEART RATE:
- influenced by autonomic nervous system, bp, hormones and meds
- chronotropes drug effects change the HR: positive chronotropes increase HR and negative decrease HR
CONTRACTILITY:
- intrpoic state of the heart - strength of contractions
- infulenced by autonomic nervous system and meds
- postive intropic drugs increase contractility and negative decrease contractility
how do beta blockers affect cardiac output
they decrease arterial blood pressure
