Week 10 Content Flashcards
what are OTC meds
over the counter medication
four main things to NOT do when assisting with meds
- monitor outcome of any drug therapy
- purchase ANY meds (incl. OTC + herbal)
- fill pill boxes
- assist with meds not in care plan
what are defining characteristics of elixirs
-dissolved in liquid
containing alcohol or water and flavouring
what are defining characteristics of syrups
-dissolved in a concentrated sugar solution (liquid)
drugs and other substances used to prevent or treat disease or illness.
medications
administer vs assist
administer = to give assist = means to help
true or false - a psw can never administer medication
False, medication can be administered by a PSW if:
- you have been formally trained, supervised, and monitored
- it is in your job description
9 Roles of the PSW for medication
- remind
- check dosage
- bring to client
- loosen lid/container
- provide
- supervise
- assist
- observe
- report
alternative remedies
herbal or natural products that do not require a prescription
prescription medication
medication that requires a physician’s prescription and dispensed by a pharmacist
small gelatin containers that hold solid medication
capsules
flat discs containing medication in a flavoured base, to be dissolved slowly in mouth
lozenges
dry, powdered medications that have been formed into hard discs or cylinders
tablets
what is the only solid medication that can be cut in half
scored tablets
solid medications placed under the tongue and dissolved or absorbed into the body
sublingual
what are suspensions
medication suspended in a liquid that should be shaken or stirred before use
semi-solid material containing medication that stay within area they are applied
ointments or creams
medication on a small disc or patch that is applied to unbroken skin; absorbed into the bloodstream through the skin over a 24-hour period
transdermal discs or patches
solid form of meds inserted into rectum or vagina; dissolves via body heat and released/absorbed by mucous membranes
suppositories
liquid form of medication in a special container that allows one drop at a time to be administer (typically for eyes, ears, nose)
drops
injections
liquid form of medication that is injected using a syringe
device consisting of a plastic tube filled with medication, plunger, and a needle attached
syringe
three types of injections
intramuscular (in muscle)
intravenous (in vein)
subcutaneous (under skin)
medication particles suspended in air or gas that are inhaled into the lungs using a metered dose inhaler
aerosols
MDI + definition
metered dose inhaler - small cylinder combined with a special delivery system (aka puffer or inhaler)
unwanted response to a medication that occurs with the intended response
side effect
Why is it important to know your client’s normal behaviour?
You must know your client’s “normal” to recognize the “abnormal”.
Adverse drug reactions may go unnoticed in seniors because people think they are a “normal” part of aging.
drug synergism
combined effect of drugs amplifies effects
drug antagonism
combined effect of drugs counteracts effects
polypharmacy
taking more than prescribed dose or too many medications
generic name of drug
chemical name of drug (acetaminophen)
trade name of drug
trademarked, packaged name given by manufacturer (tylenol)
5 reasons why clients may not follow med directions
- complex medication dosage
- failing memory
- do not understand why they are taking the drugs
- afraid to ask questions
- poor eyesight – difficulty reading the medication labels
what are 3 changes in body composition that impacts drug effect
increase in body fat tissue
decrease in lean body tissue
decrease in water in body
holding chamber
device used with MDI that prevents medication from landing on user’s tongue (typically used by young, elderly, frail)
dangerous or unwanted side effect
adverse effect
antigen
substance that is attacked or fought by the body via antibodies
severe sensitivity to antigen that occurs rapidly and causes life threatening response involving whole body
anaphylaxis
ana= without
phylaxis = protection
MAR
medication administration record
9 Rights of Assisting w/ Meds
- Right Medication
- Right Person
- Right Dose
- Right Route
- Right Time
- Right Day
- Right Reason
- Right Expiry Date
- Right Documentation
what are 3 ways changes in GI function impacts drug effects
- decrease in gastric acid – slower breakdown of drug
- decrease in GI mobility possibly due to less fluids, eating less fruits/fibre
- decrease in blood flow to the kidneys = decrease filtering capacity
true or false: psw’s can teach client about medication
FALSE - nurse or pharmacist are the ones that teach client about medication, if the client does not understand their medication then notify your supervisor
5 Rights of Delegation
- Right Task
- Right Circumstances
- Right Person
- Right Directions & Communications
- Right Supervision & Evaluation
6 Roles of PSW in delegation
- Know your scope of practice
- Skills are not transferable to another client!
- As a PSW you should be able to demonstrate knowledge of theory and practice
- Written authorization should be given for the specific act for a specific client
- If you refuse a task you must have a good reason, never ignore a request to do provide care
- Know your agency’s/facility’s policies & procedures
Examples of delegated tasks
Injections Catheter insertion Bowel routine ROM Tube feedings Trachea suctioning Oxygen therapy Dressing changes
true/false: delegated tasks from one client can be transferred to another client
false, each delegated task is specific to that client with written authorization for each client.
6 DO’s of assisting meds
- Review the care plan and follow employer policies
- Bring the right containers to the client
- Know the correct dose
- Give a glass of water with oral meds
- Listen to the client
- Report and record any changes or questions (especially if the client refuses their medication)
6 DON’Ts of assisting meds
- Leave medications at the bedside for client to take later
- Remove labels from the containers
- Use medications in containers where labels cannot be easily read
- Use discoloured or expired medications
- Give or purchase over the counter medications for clients
- Allow medications to run out before telling someone
Four things the MAR contains
- Client’s name
- Name/dose/administration instructions for each medication
- A place to sign after giving the medication
- Any allergies, expected side effects, special instructions
pr
per rectum
qd
every day
pc
after meals
ac
before meals
sl
sublingual
prn
when necesarry
hs
hour of sleep (at bedtime)
hob
head of bed
LOC
level of consciousness
mcg
microgram
mg
milligram
mL
millilitre
MRSA
methiciline resistant staphylococus aureus
N+V
nausea + vomiting
NKDA
no known drug allergies
NPO
nothing by mouth
VS
vital signs
Tx
treatment
Sx
symptoms
ung
ointment
gtt.
drops
S+S
signs symptoms
H+P
history and physical
Hx
history
Fx
fracture
SOBOE
shortness of breath on exertion
c
with
s
without
CBR
complete bed rest
BRP
bathroom privileges
BM
bowel movement
O2
oxygen
d/c
discontinue
r/t
related to
8 things on prescription label
- Pharmacy name
- File number or prescription number (for reordering medication)
- Client exact name
- Drug name (Brand & Generic) and dosage of medication
- Refills
- Physician’s Name
- Expiry Date
- Date Filled
6 Roles of PSW and Medication Labels
- Read the label on all medication bottles before the client takes the medication
- Make sure the label is legible and has not been changed
- Make sure the medication is in the original container
- Make sure you understand the special instructions
- Read the printed information from the pharmacy
- Ask your supervisor for assistance if you do not understand what you are reading
warning labels (for prescription meds)
Special instructions usually listed on the side of the container in a coloured label.
Pre-Procedure: 9 ‘Rights’
for Oral Meds
- Identify the person
- Explain the procedure to the client
- Wash yours and assist client to wash hands
- Collect the med, measuring device, water to take med with
- Provide privacy
Pre-Procedure: 9 ‘Rights’
for Ear drops
- Identify the person, explain procedure
- Wash yours and assist client to wash hands
- Collect the med and provide privacy
- Person should lie down on side
- Pull ear lobe down– do not let dropper touch ear
- Do not wipe inside ear with tissue
- Wash hands, report/record
Pre-Procedure: 9 ‘Rights’
for Nose drops
- Blow nose
- Block one nostril
- Assist person to place correct amount of drops in nose
- Do not blow nose after application
- Wash hands
- Report and Record meds taken
Pre-Procedure for EYE ointment
- Identify the person, explain procedure
- Wash yours, assist client to wash hands
- Collect the med and provide privacy
- Guide person to grasp lower eye lid and look upwards
- Place drop in lower lid –do not let dropper touch eye
- Assist person to place correct amount of ointment on lower lid of eye from inner to outer corner
- Close eye to help ‘melt’ ointment and distribute med
- Wash hands
- Report and Record meds taken
Pre-Procedure for EYE drops
- Identify the person, explain procedure
- Wash yours, assist client to wash hands
- Collect the med and provide privacy
- Guide person to grasp lower eye lid and look upwards
- Place drop in lower lid –do not let dropper touch eye
- Close eye - do not wipe eye with tissue
- Wash hands, report/record
assisting with transdermal discs
- Standard Precautions- put on gloves
- Remove old disc
- Select new site
- Assist to apply new disc- do not touch medicated surface of disc with bare hands
- Report & Record what you do
ways you can assist for oral med
- Check container label
- Loosen cap for client if necessary
- Place container within reach of client
- Assist person to pour out correct amount of medication
- Assist as to swallowed or sublingual med
- Close containers/return to storage area
what angle should subcutaneous injection
45 or 90 degrees
most common med given by subcutaneous
insulin
normal blood sugar level
4-6 mmol/L
symptoms of hyperglycemia
No insulin = hyperglycemia (elevated blood glucose) Increased thirst Increased urination (polyuria) Weight loss Increased heart rate Abdominal pain Difficulty breathing
4 types of insulin
rapid acting (15 min b4 meals, 15 min onset)
short acting (30 min b4 meals, 30 min onset)
intermediate acting (30 min b4 meals, 1-3 hr onset)
long acting (30 min b4 meals, 3-4 hrs onset)
Pre-mixed Insulin
Give 15 minutes before meals, 70% intermediate acting and 30% short acting. Once short acting Insulin has been absorbed, intermediate acting insulin takes over the action of maintenance of blood glucose levels. Example: InsulinlPen
5 considerations of storing insulin
- New vials to be refrigerated until expiry date
- Opened vials stable in fridge up to one month
- Vials stable at room temperature up to 14 days
- Before drawing up Insulin, remove vial from fridge 30 minutes ahead of time to settle at room temperature
- Do not freeze Insulin
subcutaneous injection sites
abdomen, arms, thighs, buttocks
right expiry date for insulin
Date on the label of vial has been checked, does not exceed 14 days at room temperature, opened vial has not been in fridge longer than one month. Insulin has not been frozen.
if insulin is refrigerated, after checking the vial is useable and correct, what should you do to assist client to use it?
remove from fridge 30 minutes before administration, roll vial between palms of hands, avoid shaking vial
symptoms of hypoglycemia
- Nervousness, feeling of hunger, weakness
- Drowsiness, dizziness, faintness
- Increased perspiration, confusion
- Adverse Effects:
Seizures, shock, death
Lipohypertrophy
soft, grape-like lump under skin as a result of many injections, therefore, need to rotate sites
observations for PSW to report when assisting insulin
- Client’s status and blood glucose level prior to administration of Insulin
- Status of the skin at site of injection
- If lipohypertrophy noted at other areas of skin
- Client’s tolerance to injection
- Client’s ability to assist
- Client’s knowledge re: need for Insulin
antibiotics
meds that kill bacteria
mro’s
multi resistant organisms (MRSA, VRE) aka super bugs
vre
vancomycin-resistant enterococcus
systemic infection effects
whole body
local infection effect
one part of body
6 modes of infection transmission
- direct contact
- indirect contact
- droplet
- airborne
- vehicle
- vector-based
Vector transmission
occurs when a living organism carries an infectious agent on its body (mechanical) or as an infection host itself (biological), to a new host.
Vehicle transmission
occurs when a substance, such as soil, water, or air, carries an infectious agent to a new host.
direct transmission
occurs when there is physical contact between an infected person and a susceptible person
indirect transmission
occurs when there is no direct human-to-human physical contact
what should you ask the client if they checked before taking insulin
did you check your blood sugar? what are the levels?
if a clients glucose is less than 4, what should the psw do
“lets wait, have you eaten?” offer sugar and carbs (natural) and call supervisor how to proceed
nosocomial infection
acquired at health care facility
how does cold impact the blood
causes blood vessels to constrict
how does heat impact the blood
causes blood vessels to dilate
heat increases …?
circulation
cold decreases…?
swelling, pain, bruising, itching
heat can help
with arthritis, muscle cramps, promote healing, stiffness of joints
how long should heat or cold be applied, and how often should it be checked?
no more than 15 minutes, checked every 5
reasons to remove heat application
- redness of skin
- extreme redness of face
- blisters
- client complains of pain or burning
- changes in clients behaviour
- skin irritation: rash, itching, burning
serious complications from heat application
burns, death of tissue, and circulatory shock
reasons to remove cold application
- pale, white, or grey skin
- blue skin (cyanosis)
- shivering
- numbness, pain, burning
- change in clients behaviour
- skin irritation: rash, burning, itching, redness
cyanosis
blue skin
serious complications from cold application
frostbite, tissue death, circulatory shock
clients at risk for complications for heat/cold application
- white people, infant, children, older adults
- delicate and fragile skin
- those with reduced sensation
- medications
- spinal cord injuries
- diabetes
- stroke
- aging
- loss of consciousness
- pacemakers
- joint replacements/metal in body
role of PSW for heat/cold application
- check care plan
- be aware of agency policy
- know equipment to use, apply to specific time and length to be applied
- measure temp according to agency policies (not above 41.1C)
- cloth to cover dry heat or cold
- provide privacy, wear gloves in you or client has broken skin
- observe for complications
when is proper storage of meds the psw responsibility
when medication assistance is your responsibilty
where should be meds are stored
where cognitively aware client wants them
7 storage considerations for meds
- cool, dry place
- refrigerator (if not contraindicated)
- out of reach children
- out of sight of cognitively impaired
- away from light, heat
- medicine cabinet, not ideal - bathroom warm/moist
- not in car (too hot)
examples of medication misuse
- forgetting
- too much
- incorrect timing
- double or decrease dosage
- not disclosing of other meds
- skipping
- sharing med
- expired med use
- not following spec. instructions
- not finishing prescription
why could med misuse be unintentional
- uncomfortable asking questions
- effects not felt immediately
- unpleasant side effects
- did not really think they needed it
- complicated med schedule
- limited financial resources
hypoxia
deficiency of oxygen in cells
role of PSW with oxygen
- monitor client for signs of SOB
- report low tank levels
- maintain safe environment
- give fluids if allowed
- provide nasal care with WATER based gel
- keep tubing free of kinks
- clean masks and cannula as required
cannula
thin tube used to administer meds
sources of oxygen
- oxygen tank
- oxygen concentrator
- liquid oxygen
- wall outlet
LOC x3
oriented to person, place and time
LOC x4
oriented to person, place, time, situation
psw main role around safety
to create and maintain a safe environment at ALL times
REACT upon discovery of fire
Remove person in immediate danger if possible
Ensure the door(s) is closed to confine fire and smoke
Activate fire alarm system using the nearest pull station
Call fire department/notify switchboard
Try to extinguish fire or concentrate further evac
3 components of fire
oxygen, fuel, heat
RACE
Rescue
Alarm
Confine
Extinguish
PSW role in fire
- follow fire policy/plan
- remove those in immediate danger
- keep all exits
- know how to use fire extinguishers - paper/wood, oil/gas and electrical fires
- never use elecators
- know where extinguishes are
- regular practice of escapes
5 ways to prevent suffocation in adults
- cut food well, feed slow
- fit dentures properly
- position in bed correctly
- use bedrails as ordered
- report any gas odors
preventing suffocation in children
- supervise when eating, near water
- remove tie cords/drawstrings
- check floor for small objects
- never leave unattended in car
- do not prop bottles
- dispose of all plastic wrapping
WHMIS
work place hazardous materials information system, national system to provide workers with safety information regarding hazardous materials
OHSA
occupational health & safety act, sets out the rights and duties of all parties in the workplace, as well as the procedures for dealing with workplace hazards and for enforcement as needed.
MSDS
material safety data sheets
order of easiest to evacuate
- ambulatory
- wheelchair
- non-ambulatory
- resistive
horizontal evacuation
move people beyond smoke barrier doors, does not involve stairs
vertical evacuation
evacuate down to a story below the fire floor or to the exterior of building
common areas for adults to fall
bathroom + stairs
ways to prevent fall
- no sock feet
- check clients shoes and clothing fit
- use handrails
- non skid mat
- good lighting
- observe client for unsteadiness, dizziness
- check ambulation equipment
- remove clutter from pathways
- clean spills immediately
- assist client during care as required
- safety over independence
heat exhaustion
illness resulting from being exposed to high temperatures and inadequate fluids for an extended period of time
people vulnerable to hear exhaustion
- hypertension
- elderly
- those working + exercising outdoors in hot weather
warning signs of heat exhaustion
- increased perspiration
- paleness
- muscle cramps
- weakness
- dizziness
- headache
- nausea, vomiting
- fainting
- VS weak and rapid
treatment for heat exhaustion
- resting out of sun, AC, fan
- cool non alcoholic bevarages
- cool shower/bath
- put in light weight clothing
- call 911 if condition worsens or does not get better (risk for heat stroke)
PSW role in home management
- light housekeeping task (ex: vacuum, dust, wash dishes, linens, laundry
- NOT heavy household tasks
- be motivated, organize priorities, consult with client
- client, family & supervisor will decide tasks to be completed by PSW
- listed on care plan, do only what is assigned unless supervisor agrees
9 principles of cleaning
- clear away clutter
- work higher to lower
- work far to near
- work dry to wet
- work from cleanest to dirtiest
- change water and cloths frequently
- use a damp cloth for dusting
- rinse and dry washed surfaces
- avoid soiling a clean area
Vitamin for grown, vision, hair, skin, mucous membranes, resistance to anxiety infection
Vitamin A
Vitamin for muscle tone, nerve function, digestion, appetite, normal elimination, carbohydrate metabolism
Vitamin B1 (thiamine)
Vitamin for Growth, vision, protein and carbohydrate metabolism, healthy skin, and mucous membranes
Vitamin B2 (riboflavin)
Vitamin for Protein, fat, and carbohydrate metabolism, nervous system function, appetite, digestive system function
Vitamin B3 (niacin)
Vitamin for Formation of red blood cells, protein metabolism, nervous system function
B12
Vitamin for Formation of red bloods cells, intestinal function, protein metabolism
Folic Acid
Vitamin for Formation of substances that hold tissues together, healthy blood vessels, skin, gums, bones, and teeth, wound healing, prevention of bleeding, resistance to infection
Vitamin C (ascorbic acid)
Vitamin for Absorption and metabolism of calcium and phosphorus, healthy bones
Vitamin D
Vitamin for Normal reproduction, formation of red blood cells, muscle function
Vitamin E
Vitamin for Blood clotting
vitamin K
