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Foundation of Nursing 2 (Unicon) **Knowledge of the nurse on medication administration** The nurse needs to have knowledge of the action and the effect of the medication by understanding of Life Sciences. Moreover ,To safely and accurately administer medication to the client **the nurse must have...
Foundation of Nursing 2 (Unicon) **Knowledge of the nurse on medication administration** The nurse needs to have knowledge of the action and the effect of the medication by understanding of Life Sciences. Moreover ,To safely and accurately administer medication to the client **the nurse must have an understanding of the pharmacokinetics , Growth and development, human anatomy, nutrition and mathematic, and previous learning.** **Pharmacological Concepts** A medication may have as many as three different names. The chemical name describes the Composition and molecular structure The generic name is approved by the manufacturer who first developed the medication. The trade name, brand name is the name under which a manufacturer markets a medication. Drug interaction Definition: When **two are more drugs** are simultaneously administered to a person, It can alter the body\'s reaction to any of the drugs, leading to Alteration of the pharmacological effect of the other drug ; Then drug interaction instead to occur. Or A drug interaction can be defined as an interaction between a drug and another substance that prevents the drug from performing as expected. This definition applies to interactions of drugs with other drugs (drug-drug interactions), as well as drugs with food (drug-food interactions) and other substances. Pharmacokinetics This is the **science of observing the movement** of drugs through e the body and the various factors that can affect the process. Principles of pharmacokinetics Absorptions Distribution Metabolism Excretion This is often abbreviated as ***ADME*** These are concerned with the entry of the drugs into the body, how it is distributed around the body, What happens to the drug molecules in the body and finally how it is removed from the body. Absorption: drug can be **injected directly into the bloodstream or be absorbed through the stomach, duodenum, jejunum, illeum, rectum, buccal cavity, nasal mucosa, eye, vagina, other membranes or skin.** In all cases except direct injection into the bloodstream, there will be a percentage of drugs, which fails to enter the body The amount that actually enters the body is known as **bioavailability**. Distribution: Following absorption Drug must be taken in the **blood** **plasma** Around the body to the site of action. This means that it must be distributed around the body within The fluids. The measurements of which is called the ***volume of distribution*** Metabolism the body will remove all drugs over a period of time either by excreting if unchanged or by chemically altering it and then excreting it. The **liver** Plays a Role in altering the other molecules and excreting it. Liver disease will Have an effect on the rate at which a drug is metabolized. Excretion : The kidney has a major function on excretion of drugs and it's metabolites. The more water soluble a drug is the easier for the kidney to excrete it. **[Types of medication action:]** Medication varies considerably in the way they act and their types of action, factors other than characteristics of the medication also influence medication actions A client may not respond to some way to each successive dose of medication likewise the same med dosage may cause very different responses in different clients, therefore it is essential for the nurse to understand all the effect that medication can have when taken by or given to clients. Therapeutic effects : The therapeutic effect is the **expected or predicted psychological response of a medication.** Each medication has a desired therapeutic effect for which it is prescribed. for example nitroglycerine is used to reduce the cardiac workload and increase myocardia oxygen supply. A single medication may have many therapeutic effects. For example, aspirin is an analgesic, Antipyretic and anti-inflammatory. It reduces the platelet aggression (clumping). It is important for the nurse to know for which therapeutic effect a medication is prescribed. This will allow the nurse to properly teach the client about the medications intended and is effect on medication. Side effects: Side effects are the **unintended Secondary effect** that the medications predictably will cause. Side effect may be harmless or injurious. If the side effect is serious enough to negate the beneficial effects of medications therapeutic action, the prescriber may discontinue the medications. Clients often stop taking medication because of side effects. Adverse effects[:] Adverse effects are generally considered a **severe responses** to medication. for example a client may become comatose when a drug is ingested. when adverse effect responses to medication occur, the prescriber **must discontinue the medication.** Some advert effect might be unexpected affects that were not discovered during drug testing. Anaphylaxis: This is an **immediate and severe reaction** marked by increased blood pressure local edema prickling feeling in the throat in the face and hand, cyanosis, choking, wheezing etc. This is an **emergency** unless acted quickly death may follow within few minutes. Sera and penicillin should be administered only after sensitive test has been done to prevent such reaction. Effect on urinary system : Anuria, oliguria, hematuria, albuminuria etc might occur where intake and output may be indicated. Frequent urine analysis and blood chemistry studies can prevent such occurrence. Effect on cardiovascular system: Arrhythmia change in the rate, rhyme or volume of pulse, counting of pulse may occur for 1 minute we reveal such irregularities. Blood dispraises: Aplastic anemia, thrombocytopenia, agranulocytosis, leukopenia are some of the ill effects of certain drugs. Education to the public is essential to refrain from taking drugs without Physicians order and supervision. Effect on nervous system : Abnormal involuntary movement such as tumor, chorea, dystonia, stimulations of the central nervous system, anxiety, nervousness, Insomnia, headache, double vision, convulsion may be reposed. Toxic effects: toxic effect may develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. medication may cause unpredictable effects such as an idiosyncratic reaction in which a client over react or under react to medication or has a reaction different from normal. for example a child receiving and antihistamine (Benadryl) may become extremely agitated or excited instead of drowsy. it is impossible to access clients for idiosyncratic responses. Allergic eaction: allergic reaction is an unpredictable response to a medication. they make up 5 to 10% of all medication reaction. A client medication allergy may be mild or severe. allergic symptoms very depending on the individual and the medication. the allergy to a medication may be mild or severe. Effects on the gastrointestinal system: irritation of gastric mucosa, nausea, vomiting, anorexia, small bowel or ulceration, abdominal pain,Malena, distension and diarrhea. factors influencing drug action 1. genetic differences genetic makeup effects the manner in which biotransformation of drugs occur, metabolic patterns are similar within families. genetic factors determine whether, naturally occurring enzymes are present to assist in drop degradation. as results, members of a family May share a Sensibility to the medication. 2. physiological variables: a. ***hormonal differenc**es* between men and women alter the metabolism of certain drugs. hormones and drug compete with each other in the bio transformation because they are degraded by some metabolic processes. Diurnal variations in estrogen secretion may be responsible for the cyclic fluctuation in drug reaction experience by women. b. **age** has a direct effect on drug metabolism, infants lack of the enzymes necessary for normal drug metabolism. a number of physiological changes accompanying the ongoing process influences the responses to drug therapy. 3. environmental conditions: a client exposure to severe physical and emotional stress trigger a hormonal response that eventually interfere with drug metabolism, ionizing radiation create a similar effect by altering the rate of enzyme activity. 4. psychological factors: A number of psychological factors influence the use of drugs and response to a medication. a person attitude about drug may stem from early **experiences** or family influences, seeing parents use medication frequently may cause a child to accept drug as a normal part of life. 5. Diet: Drug and nutrients interaction can alter a drug action or the effect of a nutrient. for example, Vitamin K (found in green leafy vegetable) is a nutrient that antagonize the effect of warfarin sodium (Coumadin) decreasing its effect on blood clotting mechanism. Mineral oil decreases the absorption of fat soluble vitamins. Client may be required to take nutrient supplements when taking drugs that reduces a nutrients effect similarly withholding setting nutrients may ensure a drug's therapeutic effect. Routes of drug administration: the route chosen for administering a drug depend on its properties and desired effect as well as the clients physical and mental condition. because the nurse is constantly involved in caring for the patient, he or she is frequently involved in judging the best route for administration of medication in collaboration with Physicians. Drug Administration: 1. oral route: the oral route is the easiest and the most commonly used route. medication is given by mouth and is swallowed. orally admitted medications are less expensive than many other preparations. they have a slower onset of action and a more prolonged effect. Clients generally prefer the oral route. 2. sublingual administration:. sublingual drugs are designed to be absorb readily after being placed on the tongue to dissolve. a drug given sublingually should not be swallowed because the desired effect will not be achieved. Nitroglycerin is commonly given sublingually. The client should not take liquids until the drug is completely dissolved. 3. Buccal administration:. administration of a drug by the buccal route involves placing the solid medication against the mucus membranes of the cheek until the drug dissolves. client should be taught to alternate cheeks with each subsequence dose to avoid mucosal irritation. Clients are also warned not to chew or swallow the drug or take liquid with it. a buccal medication acts locally on the mucous or systematically as it is swallowed with saliva (dissolve in saliva). 4. Tropical administration.: drug applied on the skin and mucous membrane principally have local effects. the tropical medication is applied to the skin by maintaining or spreading it over the area, applying moist dressing, soaking body parts in a solution, or giving medicated bath. systematic effect can occur if skin is thin, if the drug concentration is high, or if skin contact is prolonged. These tropical medications may be applied a little as 24 hours or up to 7 days. Drugs can also be applied to mucus membrane. they are usually absorbed rather quickly when applied in this manner. the nurse uses the following methods for applying medications to mucus membrane. a. *direct application of liquid* b. *Insertion* of the drugs into the body cavity (eg placing a suppository in the rectum or vagina or inserting medicated package in into the vagina). c. Instillation (slow introduction of fluid into the body cavity eg instilling eardrops, nose drops, and bladder and rectal fluid, eye drops ) d. irrigation (washing out) of body cavity (eg flushing the eyes, ear, vagina, bladder or rectum with medicated fluid). e. Spraying (instilling medication into nose and throat) 5. Inhalation: the deeper packages of the respiratory tract provide a large surface area for drug absorption. Drugs can be administered through the nasal passage, or tubes that have been placed into the trachea - inhaled medication may have local effect. drug such as oxygen and general anesthetics create general systemic effect. 6. parental routes: parental administration : parental administration involves giving a drug through injection into body tissues. parental administration of medication involves the following 4 major types of injection : a. subcutaneous (sc) : injection into tissues just below the dermis of the skin b. intradermal (id): injection into tissues into the Demise c. Intramuscular (im): injection into the muscle body d. intravenous (iv): injection into the vein e. intraspinal or intratheral injection: medication when introduced into the spinal cavity is called an intraspinal or intrathecal injection. f. Epideral drugs: are administered in the epidural space via a catheter which has been placed by a nurse anesthetist or a anesthesiologist. the technique of drug administration is most commonly used for the administration of an analgesic postoperatively. g. Intraperitoneal injection medicine which is introduced into the peritoneal cavity, is called intraparitanial injection. h. interpleural drugs:are administer through the chest wall and directly into the plural space. this may be done directly into the pleural thro an injection or through a chest tube. i. Infusions: when a large quantity of medicine or fluids is introduced into the body it is called infusions. usually these are given intravenously and subsequently. j. Venesection or cut down: opening a vein and introducing a tube or wide bore needle and introducing medicines and fluids or taking out blood is called venipuncture or venesections. this is done in emergencies. k. intra-arterial: this method calls for drugs to be administer directly into the arteries. 1. antidotes - substances used to counteract the effects of poison 2. anti-infective - drugs which act to inhibit, kill or retard the growth of microorganisms 3. anti-inflammatory -- help to reduce the inflammation 4. anticoagulants - substances which inhibit or decrease the blood-clotting process 5. antihistamine - the agent which blocks the effect of histamine, thereby used to prevent or relieve allergies 6. antacid - substances that react with hydrochloric acids to reduce the activity of the gastric secretions 7. anticonvulsant - this drug is used to prevent or treat convulsion and it is used in epilepsy 8. antibiotics - products that help the ability to destroy or inhibit the growth of other organisms 9. broad spectrum antibiotics - drugs which are effective against many strains of microorganisms 10. Antidiarrheal - agents that are used to treat diarrhea 11. anti tissues - drugs that inhibit the cough reflex 12. Antiasmatic - drugs which provide symptomatic relief of asthmatic attack 13. anti-spasmodic -- An agent that relieve this parodic pairs or spasm of the muscles 14. antifungal -- an agent that destroys or inhibit the growth of fungi 15. antiemetics - drugs relieving or preventing nausea and vomiting 16. antitubacular - the specific drug using the treatment of tuberculosis 17. Bronchodilator - medicine which relaxes muscles of bronchioles 18. coagulants - these drugs that help in the clotting of blood 19. Carminatives- drugs which cause exposure of gas from stomach and intestine 20. Laxatives - drugs used to cause intestinal evacuation 21. Corticosteroids - hormonal drugs 22. Diuretics- drugs which increase the flow of urine 23. Analgesic - drug used to relieve pain 24. anesthetics -- drugs which cause loss of Sensation 25. Antihelmintics - drugs which destroys an expelled worms 26. antipyretics - drugs which reduce fever or temperature 27. expectorant - increases the bronchial secretion and in the expulsion of mucus 28. Emnagogues -- a drug that stimulates or favors the menstrual discharge 29. Galactagogues -- substances that increases the flow of milk 30. hypotensive -- any substance capable of lowering blood pressure 31. hypoglycemic -- drugs that lowers the blood sugar levels 32. Hematimics- any agent which tends to increase the hemoglobin content of the blood 33. sedative -- lessens the body activity [Unit 2] Guide line for drug administration The nurse does not bear sole responsibility for drug administration. The physician and pharmacist play key roles to ensure that the right medication gets to the right patient. However, administering medication bears responsibility and accountability for accuracy of the five rights. physicians role: 1\. The physician prescribes medications. 2\. The physician writes an order on a designed form is the clients medical records. 3\. students can not carry out medicatio order 4\. No medication should be gives without an order 5 Common abbreviations are used when writing orders. 6\. The abbreviation indicates dosage, frequencies or times, route of Administration and special information for the nurses to follow in giving the medication..Standing order A standing ting order is carried until the physician Cancels it by another order or until a prescribed number of days elapsed. Nurses role: Nurse is the most appropriate Health Care worker to administer medication, spending most of the time will the client. that puts nurses in an ideal position to monitor client response to medication provide education to the client and the family about the medication regimen. when medications are effective, ineffective, no longer effective or no longer necessary. hence, to determine the need for a potential response to drug therapy, the nurse addresses many factors. medication history provides indications or contraindications for drug therapy. disease or illness May place client at risks for advanced drug effect. for example, if a client has a gastric ulcer of bleeding tendency, compounds containing aspirin or anticoagulants really increase the likelihood of bleeding. History of Allergy 1f the client has a history of allergy to medication, the nurse informs other members of the health care team. All Allergies Should be noted in the nurse\'s admissive notes, admission notes and physical history. Drug Data The nurse assesses information about each drug, including action purpose, normal dosage, route, side effects, and nursing implications for administration and monitoring. often several resources must be consulted together: needed information, pharmacology, textbooks, nursing journals, physician reference, drug package inserts, and the pharmacist are valuable resources. The nurse is responsible for knowing as much as possible about each drugs given. Medication delivery preparation and administration of medication requires accuracy by the nurse. the nurse must pay full attention in preparing medication and must not attempt to do other tasks simultaneously. The nurse must use the five rights of drug administration to ensure safe drug administration. the right of drug administration are right drug, right does, right clients, rights route, Right Time. Right drug : when drugs are first ordered, the nurse Compares the medication ticket or dose from the Physicians written orders. when administering drugs the nurse compares the label of the drugs at the following three times: before the moving the container from the drawer of shelf as the amount of drug ordered is removed from the container and before returning the container to storage. Right dose: the unit dose system of drug distribution minimize errors because most medication come prepared in proper dose. after calculating dosage, the nurse prepares the medication by using standard measurement devices. Right client : if a medications step in administering drug safety is by being sure that the medication is given to the right client. The nurse checks the medication form and patient identification and the clients state their names. Right Route If a medication ordered does not designate a specific route of administration, the nurse consults the physician. like wise, if the Specified route is not the recommended route, the nurse should clarify the concerned doctors. Right Time The nurse should know why a drug is ordered for certain times of the day. The physician often gives specific instructions about When to administer a medication. A preoperative medication is to be given on call, meaning that, the nurse has to administer the drug when the Operating room notifies the staff that the Medication is to be given immediately Medication Error is any event that could Cause or lead to a client receiving inappropriate drug therapy or failing to receive appropriate drug therapy. Medication error can occur by any one involved in prescribing, dispensing , preparation and Administration of medication. Nurse Manager, the physician may decide to counteract the effects of the Error by administering an antidote. When the wrong drug is given , with holding a dose When a previous medication has been given too soon, or monitoring the effects when an unusual dosage given. Attempt Should not be made to hide the medication error. There should be a system in the client record as to what was administered to the client, the notification to the physician, the observed side effects in the client, as a response to the error and the events undertaken to counteract the drugs. for example administration et antidote. **[Special Considerations for administering Medications to specific age groups.]** Infants and children: Children vary is age, weight, body surface area, the ability to absorb, Metabolize and excrete medication. Children dosage are lower than those of adults so special caution is needed in preparing medication for them Older Adult Older adult -- require Special consideration to during drug administration. In addition to the physiological Changes of ageing, behavioral and economic factors will also influence an older Person\'s use of drugs. **[Forms of Medications.]** Capsule - It could be in solid , powders, liquid or oil form and enclosed by gelatin Shell. Elixir - Clear Fluid containing water, alcohol, sweetener added for oral use- 3\. Enteric Coated Tablet: Tablet coated with materials that does not dissolve in stomach but in intestine where medication, is-absorbed. 4\. **Liniment**-preparation usually contains alcohol, oil or soapy, that is applied to the skin. 5\. **Lotion** - Medication in liquid suspension applied externally to protect skin. 6.**Ointment** :Semisolid usually contains one or more medication applied externally. 7\. **Paste Semi- solid** :thick and stiffer than ointment absorbed through skin more than ointment. 8\. **Solution** : Liquid Preparation's that may be used orally, parentally or externally or instilled into body organ or cavity. **[The Storage and cars of drug antibiotics ]** Contains precautionary measures must be taken in hospitals to prevent the occurrence of accidents due to the mishandling of drugs and lotions. The greatest care must therefore be taken in the labelling and Storing of these substances. Three cupboards are usually used for their storage, and all Cupboards, as far as possible, should be outside the actual ward and should be kept locked. Firstly-A Cupboard for drugs and lotions s for External use only. Secondly - A cupboard for drugs For Infernal use only. Thirdly-& Cupboard for dings which are classified as Dangerous drugs. **[Cupboard 1-drugs and lotions for external use only.]** Examples of these substances are Hibitasse, Roceal, and dettol, these are Disinfects and are not usually applied to the body - Examples of other Substances which may be applied externally to the body are Calamine lotions, Methylated spirit, and methylated ether. If the drug and lotions Contain poisonous Substances they should be sent from the pharmaceutical department to the market in the following Manner: 1\. In special distinctive bottles - These bottles are usually deeply Colored, either dark green, blue or brown. 2 The bottles should have a ridged surface. 3\. The bottles should have a distinctive label marked Clearly-for external se only. 4 They should also have a red label marked poison. **[Cupboard 2-Drugs internal use only.]** Many mixtures, pills and tablets and kept in this cupboard and some of these substance may be controlled by law. 1. They Can only be obtained by the public with a written medical prescription. 2. In hospital they must be kept to locked cupboards. Drugs controlled by law are subject to certain restrictions. They should be clearly and distinctly Labelled. **[Cupboard 3. ]** **[1-Dangerous drugs.]** In order to control the illicit use of drugs. of addiction, ie habit Forming drugs, a number of drugs have been designated dangerous. Their use is controlled by law and new additions to the list are made from time to time. Such drugs include; Opium and it's preparations. -Morphine and its derivative s. Cocaine and it's derivative Petidine and it's salts. Amidone (physeptone) Phenadosione (heptalgin) **[CONTROL OF DANGEROUS DRUGS]** 1. Many authorities have established codes of practice for the control of dangerous Drugs that go beyond the regulations laid down by statute. These are for the protection of the patients and the staff. The following is a list to the items usually included is the code of practice 1. In hospitals the use of these drugs is under Strict control 2\. A special cupboard is used for storing these drugs and the Should be marked either \"poisons Cupboard or Dangerous\] Drugs cupboard. 3 The cupboard must be kept locked and sometimes a cupboard within a Cupboard is used. These drugs are under double Lock and key. 4 The key of the cupboard must be kept on the person of the senior purse on duty. 5 None of the drugs many be administered without a written prescription by the doctor. 6 Each dose of the drugs administered must be entered into a Special register provided for the purpose. In this book must be the Following details: -The date -The patient\'s name -The name of the drugs and dose -The name of the person giving the drugs -The time of giving the drug -The name of registered nurse checked the drugs (All these drugs rust be checked by a registered nurse or doctor prior to administration). -The name of the doctor who prescribed the drugs 7\. The person who checks the drug should see the bottle or container form which the drug was taken and check the dose with the written prescription. She should also check that the correct patient receives the drugs. 7. All bottles, ampules and tubes containing dangerous drugs should be conspicuously and clearly labelled. 9\. Renewal of supplies can be obtained only by an order signed by a medical officer and should reach the ward only by the hand of a special messenger, they should be checked and signed for the nurse in- charge. 10\. The hospital pharmacist should check the contents of the cup- board at very Frequent interval, comparing the contents with the register and also with his own register. The Pharmacist keeps his record for at least two years. 11\. Between the time of the pharmacists checks, the nurse-in - Charge also checks the contents of the Dangerous Drugs cup- board. In many hospitals these drugs are checked each time there is a Change of Shift. In this way the nurse in -charge of each shift takes over responsibility for the contents Note: only in the hospitals are these drugs under strict control. outside hospital, they may only be supplied by a written order signed by a medical practitioner or a registered dentist known to be the Pharmacist. **The prescription must bear the following:** The patient\'s name The date Signature of prescriber (not initials). -Name of the drug and the total quantity to be supplied -The amount and the frequency of dose. Every general practitioner must keep a record of all purchases of these drugs and the amount issued to individual patients. **[General Care of all drug Containers.]** 1\. All bottles should be wiped before being replaced in the cupboard. 2\. These bootless and boxes should be clearly labelled and arranged neatly in their own Special Cupboard so that the labels are towards the door. 3\. When pouring from the bottle the other side with label should be the held uppermost in this way the label will not be defaced and possibly made illegible. 4\. The Stopper must fit the bottle securely otherwise evaporation will take place ai so the strength of the medicine will be altered. 5 If there is any alterations in the appearance of the drug it should be returned to dispensary where the bottle will be refilled. 6\. All drugs should be of carried to the patient's reach and kept locked -up. 7 Poison should not be carri to the patient. The correct dose Should be measured and checked, then carried to the patients on a tray. **[Rules of administration of drugs ]** 2. The instructions Should be read carefully and if there is any doubt as to their meaning, the nurse should always that they be clarified by the nurse-in- Chance or the doctor. 3. A dose of medicine should never be given from a bottle which is not clearly labeled. 3\. Always pour the medicine in a food light, using a graduated glass. 4 The label Should be checked against the instructions. \- When the bottle is taken from the Cupboard. \- Just before the drug is poured and -after the drug has been poured but before it is given to the patient 5\. The bottle should be shaken, whether there\'s an obvious sediment or not. 6 Never use a pill, tablet or capsule which has been left out of a labelled container 7\. Stock accuracy , as regard to the time of administration must be observed. If the drug has been ordered for a certain time, then, it is necessary it be administered at that time. 8 No drug which has been taken from its labelled container Should ever be returned to the bottle. If it is not used it should be disposed of safely and disposal recorded. July 12, 2024 Steps on the vein puncture process. **make sure all necessary equipment is easily accessible. check or label all in injection or infusion be given.** **Prepare or assemble equipment, flush IV tubing to remove air ( priming).** **explain in simple terms, the procedure to the patient make the patient comfortable. Position patient extremity for comfort and visibility of veins.** **Be yourself at ease and appear confident, If you fail, it is recommended not to perform more than two failed attempts of venous puncture, it happens to everyone now and then and more important that you ask for help.** **Close the vein according to the Needs** **trim hair over proposed site with scissors** **wash hands thoroughly and wear protective gloves. remember the gloves will not protect you against needle stick injuries, only your techniques will do that.** **Clean sites with antiseptic solution Using friction in circular motion From center to peripheral.allow drying** **be careful not to contaminate sight again, disinfect fingers or gloves if palpation is necessary after skin preparation is done** **apply tourniquet or blood pressure cuff, check if pulse is present, perform vein puncture , enter the skin gently ,needle in dominant hand, bevel side up at 20 to 80° angle and when the needle is through the skin, lower needle until it is nearly parallel to the skin.** **Look for blood return through the tubing of butterfly needle or flashback chamber** **quickly remove protective cap from the tubing and apply pressure distally to prevent blood from flowing out and attach tubing to the catheter or needle.** 1. **start the flow of solution properly by releasing the clamps on the tubing** 2. **Lay the tubing near the site of entry and anchor with tape to prevent pull.** 3. **Write date, time of pleument of IV line, size of needle and nurse initial in Record in nurse notes, type of fluid, injection sites , flow rate, size and type of catheter or needle, time infusion began.** **[Monitoring Intravenous therapy (Nurses responsibility)]**.1 Regulating the drip rate 2\. Care of Cannula 3.Observing for untoward reactions and Complications. 4\. Remove iv Line. **[Responsibilities regarding regulation of the DRIP RATE\"]** -Regulating the drip initially Observing for maintained rate Re- regulating an incorrect rate -Checking the Flow rate on a regular basis, usually every hour. -Determine drop factor. **[Factors Affecting Rate of flow.]** Passage gradient : the diference between two levels in a fluid System. Friction; the interaction between fluid and surface of inner wall of tube. -Diameter and length of tubing: Gauze or canal Height of the fluid Colum (constrictions, Spasm and pain) Vein traumas : Clots, plugging of veins, Venous spasm, vasoconstrictions, and Flow Control Clamp derangement -Patients Emotional State: venous Spasm. **[Nurses Responsibility as Regards the Intravenous therapy.]** Know the purpose its effects, Side effects, interaction and Contraindication of Fluid and medication administered. Ensure that the \"five RIGHT. during administration are followed. -Be familiar with equipment and devices. -be accucrafe and complete is documentation. -Observe and assess the Patient on a continual basis. **[These Recommended methods of ]** **[Administering Intravenous infusion or drugs]** 1. Continuous infusion 2. Intermittent infusion 3. intermittent or direct (bolus or iv-push). **[Equipment necessary for Intravenous infusion.]** Trolley Containing the Following: 1-Disposable gloves. 2- [ **Intravenous**] needle or catheter / cannula 3-Torniquete 4- Tape adhesive 5- spirit swab or gauze in gallipot 6- Arm board (optional) 7-Sterile syringe with 2-3 mls of uls. 8-Scissors 9-Kidney dish 10- iv Stand or pole 11- Iv tubing **[Complications]**. \- Infiltration -Thrombosis \- Pyrogenic reaction -Circulatory overload \- Blood embolism. \--infusion phlebitis \- Thrombophlebitis's -air embolism -Speed shock. **[Golden Rule of iv therapy]** 1. Preplan as much as possible 2. use aseptic technique. 3\. know how to we product selected. 4- Understand the associated noks 5-Avoid unnecessary interference with the lines 6 know the local protocols and understand the reasons behind them. 7- Know how to deal with the risks 8-krow when to seek extra help and from whom?. 9 -evaluate patient Factors 10- Keep good documentation **[Electrolyte Concentrations Commonly used in iv solution ]** **[Isotonic ]** -0.9 % sodium chloride Lactated Ringer\'s -5% dextrose in water **[Hypertonic ]** 0.45% sodium chloride -0.3% -2.5% dextrose in water -0.45% [Common Name for iv Solutions.] Solution: 0-9% Sodium chloride. Other name: 1. 9% Nacl -1/2 NS. **[Solution]**: 0.40% sodium chloride **[Other name:]** 0.45%Nacl 0.5% NS I/2 Nacl 1/2Ns **[Solution]**: Dextrose 5% in 0.45% sodium Chloride **[Other name]** Ds 0.45% Nacl. Ds 0.45% NS Ds ½ Nacl **[Solution]**: Lactated ringer\'s dextrose 5% in lactated Ringers. **[Other name:]** DSLR. **[TOTAL PARENTAL NUTRITION]** Introduction \- Total parental nutrition (TPA) is designed to provide daily, calorie and protein requirement for patients who cannot be maintained Nutritionally by way of gastrointestinal tract. It is a team effort, as biochemical monitoring is necessary throughout. A high standard of pharmaceutical processing is required; as well as total nursing care \"With properly formulated solutions; the nutritional requirement can be spread easily and evenly over 24 hours, utilization of the Constituents of techniques is of wider application. It is used in severe trauma. It is of considerable Value in Conditions where bowel rest may be required, for example in Crohn's disease and severe ulcerative colitis. **[Definitions]**- TPN is a form of nutritional support where nutrients (such as pro, Carbohydrates, fats, electrolytes, vitamins, trace elements and Fruits) are provided solely by Intravenous delivery systems. It started in the sixties as an experimental therapy and has grown into a highly sophisticated treatment. It can be use to supply adequate nutrients for patients. **[Daily Requirements in Parental Nutrition]** Daily basal allowance of nutrients and minerals in adult. Adult daily basal allowance (Kg/per day). Wafer have no caloric value this point is to be kept in mind while considering diet of the client. Other trace elements required are, copper, Chromium, manganese, zinc And Selenium. The minimum requirement of calories per day is 30 kcal/kg. Out of this 50% should be from Carbohydrates (CHS) 30% fat and 20% From protein. For example, If a patient Weight is 70 kg, he will require 2100kcal. Water 30ml -------------- ----------- -- Energy 30kcal Protein 1gm Carbohydrate 2gm Fat 2gm Sodium 1-2gm Potassium 1mmol Calcium 0.1.1mmol Phosphorus 0.15mmol Magnesium 0.04mmol **[Precaution to be taken while administerine TPN]** If Fat is given for Fast, patient may develop headaches, Fever, palpitation. In such cases slowing of drip will overcome the problem. -TPN solution Should be administered slowly -Fat Emulsion Should be administered continuously to patient who have liver disease, compromised Pulmonary Functions and coagulating disorder. -No drug should be added to the Fat solution and the drip should be changed every 24 hours. Complications of Parental Nutriention(TPN). Hyperglycemia Hypoglycemia Hyperkalemia -Metabolic acidosis -Hyperosmolar non Ketonic coma **[BLOOD TRANSFUSION]** Transfusion of blood and the products is a very Common medical procedure in the practice of modern medicine. Nursery staff Play a wary important and crucial pole is the blood transfusion procedures as they are called upon to produce blood and blood products from the blood transfusion laboratory and Conduct Supervise the transfusion. The person directly concern with blood transfusion should have basic knowledge about the products they are handling and must know the most appropriate and Safeway of administering the blood and blood products. Purpose: -To increase circulating blood volume following surgery, trauma or hemorrhagel -To increase the number of red blood cells and to maintain hemoglobin level in clients with severe anemia. -To provide selected cell components as replacement therapy eg clotting factors, platelets, albumin O+ A+ B+ AB+ ---- ---- ---- ----- O- A- B- AB- The classification is done depending upon the presence or absence of antibodies in the serum as shown on the table above. Group ABO system Antigen on RBC Antibodies in serum ------------------ ---------------- --------------------- A A Anti-B B B Anti-A O Nil Anti A & Anti B Rh system \-- \-- Rh positive D Nil Rh Negative Nil \-- **[TEST ON Donor Blood.]** Before transfusion: ABO grouping -Rh-typing Hcv (Hepatitis c virus antibodies) and HBs Ag -VDRL (for Syphilis) -Hiv1 and 2(for AIDS) -Screening for malaria parasites. In some situations; screening for cytomegalovirus (Cmv) is necessary. **[Blood Components and its products.]** Summary of the frequency used blood component and products: 2. whole blood (WB) - contains red cells , granulocytes, platelets and plasma ( All the components of blood) 3. Packed red blood cells- contains red blood cells and a small volume of plasma. 4. Leukocyte poor packed blood cells -- contains white blood cells and a small amount of plasma 5. platelet concentrate-each unit contains 50-60ml of plasma and 50-60 x 10 per packs platelets with few RBCs and WBcs. 6. Apheresis platelet concentrate : this Is collected from individual donors by using apheresis machine. Each unit contains some RBCs and WBCs 7. Fresh frozen plasma-Contains 200-250 ml plasma, with most of the coagulations factors 7 Cryoprecipitate-contains factors that viii(8) C factors Xiii (13) Fibrinogen prepared by thawing the FFP at 40 l. **[Transfusion reaction ]** Transfusion reaction is a systemic response by the body to blood incompatibility or allergic sensitivity to the leukocytes, platelets or plasma. Protein components of the transfused blood or to the potassium or citrate preservative in the blood. Blood transfusion can also result in disease transmission. Transfusion reaction is a threatening Conditions but prompt nursing intervention can maintain the clients Physiological stability. In an event of a suspected reaction, the nurse should do the following: 1 Stop the transfusion immediately. 2 Back 0.9% normal saline into the iv line closet to the access site. 3\. Notify the physician 4. Remain with the patient, observe signs and symptoms and monitor vital Signs every 5 minutes. 5\. prepare to administer Emergency drugs, such as antihistamines, Vasopressor fluid and steroids. 6\. Obtain a urine specimens and send it to the laboratory. 7\. The blood container and tubing should be returned to the laboratory or blood banks with the reaction form. 8.Recording about transfusion reaction in nurses no parses notes is necessary **[Preservation and Storage of blood ]** Blond Collected in to CPD anticoagulant solution can be stored for 28 days In CPDAI Blood can be stored for 35days. whole blood and packed cells are stored in the Blood bank refrigerators (Special type) at 4-6°C. Platelets Concentrate is ofty stored at room temperature in platelets agitator up to 5 days, fresh frozen plasma is stored by freezing at 20 degrees Celsius or below. **PRINCIPLES AND PRACTICE OF REHABLITATION** What is rehabilitation? Rehabilitation is defined as \"a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment\". (WHO,2020) Put simply, rehabilitation helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family. Some examples of rehabilitation include: Exercises to improve a person\'s speech, language and communication after a brain injury. Modifying an older person\'s home environment to improve their safety and independence at home and to reduce their risk of falls. Exercise training and education on healthy living for a person with a heart disease. Making, fitting and educating an individual to use a prosthesis after a leg amputation. Positioning and splinting techniques to assist with skin healing, reduce swelling, and to regain movement after burn surgery. Prescribing medicine to reduce muscle stiffness for a child with cerebral palsy. Psychological support for a person with depression. Training in the use of a white cane, for a person with vision loss. Rehabilitation is highly person-centered, meaning that the interventions and approach selected for each individual depends on their goals and preferences. Rehabilitation can be provided in many different settings, from inpatient or outpatient hospital settings, to private clinics, or community settings such as an individual\'s home. The rehabilitation workforce is made up of different health workers, including but not limited to physiotherapists, occupational therapists, speech and language therapists and audiologists. orthotists and prosthetists, clinical psychologists, physical medicine and rehabilitation doctors, and rehabilitation nurses. **[Unmet global need for rehabilitation]** Globally, about 2.4 billion people are currently living with a health condition that benefits from rehabilitation. With changes taking place in the health and characteristics of the population worldwide, this estimated need for rehabilitation is only going to increase in the coming years. People are living longer, with the number of people over 60 years of age predicted to double by 2050, and more people are living with chronic diseases such as diabetes, stroke and cancer. At the same time, the ongoing incidence of injury (such as a burn) and child developmental conditions (such as cerebral palsy) persist. These health conditions can impact an individual\'s functioning and are linked to increased levels of disability, for which rehabilitation can be beneficial. In many parts of the world, this increasing need for rehabilitation is going largely unmet. More than half of people living in some low- and middle-income countries who require rehabilitation services do not receive them. The COVID-19 pandemic has led to a, new increase in rehabilitation needs as well as causing severe disruption to existing rehabilitation services in 60- 70% of countries worldwide. **[Global rehabilitation needs continue to be unmet due to multiple factors, including:]** Lack of prioritization, funding, policies and plans for rehabilitation at a national level. Lack of available rehabilitation services outside urban areas, and long waiting times. High out-of-pocket expenses and non-existent or inadequate means of funding. Lack of trained rehabilitation professionals, Lack of resources, including assistive technology. equipment and consumables. The need for more research and data on rehabilitation. Ineffective and under-utilized referral pathways to rehabilitation. (WHO. 2020). **[The benefits of rehabilitation]** Rehabilitation can reduce the impact of a broad range of health conditions, including diseases (acute or chronic), illnesses or injuries. It can also complement other health interventions, such as medical and surgical interventions. helping to achieve the best outcome possible. For example, rehabilitation can help to reduce, manage or prevent complications associated with many health conditions, such as spinal cord injury, stroke, or a fracture. Rehabilitation helps to minimize or slow down the disabling effects of chronic health conditions, such as cardiovascular disease, cancer and diabetes by equipping people with self-management strategies and the assistive products they require, or by addressing pain or other complications. Rehabilitation is an investment, with cost benefits for both the individuals and society. It can help to avoid costly hospitalization, reduce hospital length of stay, and prevent re-admissions. Rehabilitation also enables individuals to participate in education and gainful employment. remain independent at home, and minimize the need for financial or caregiver support. Rehabilitation is an important part of universal health coverage and is a key strategy for achieving Sustainable Development Goal 3 - \"Ensure healthy lives and promote well-being for all at all ages\". Types of rehabilitation The three main types of rehabilitation therapy are occupational, physical and speech. Each form of rehabilitation serves a unique purpose in helping a person reach full recovery, but all share the ultimate goal of helping the patient return to a healthy and active lifestyle. Rehabilitation therapy can be used to treat a wide range of injuries or conditions. \"Common conditions treated include orthopedic and musculoskeletal injuries such as sprains/strains/tears or post-surgical rehabilitation, neurological injuries such as stroke, brain injury or spinal cord injury, or multi-trauma injuries due to accidents,\" says Anthony. \"We also treat less common conditions such as genetic disorders, \'degenerative diseases and other specialized conditions. We treat all ages from newborns to our oldest patient to date being 104 years old\" The goal of rehabilitation therapy varies from person to person. \"We ask every patient what their goals for rehabilitation are and develop a plan,\" he says. \"This may include different types of therapy such as physical, occupational, speech, music or recreational, and may include different treatment techniques such as therapeutic exercise, manual therapy, neurological re-education or modalities for pain relief, to name a few of the many possible treatment strategies.\" Inpatients. outpatient rehabilitation treatments First, it\'s important to define the difference between inpatient and outpatient rehabilitation therapy. Inpatient rehabilitation refers to treatment or therapy you receive in a hospital or clinic prior to being discharged. Patients who go through an amputation, suffer a brain injury or stroke, experience an orthopedic or spinal cord injury or receive a transplant may require inpatient therapy to recover to a point where they can safely go home. while an outpatient rehabilitation therapy refers to treatment received when not admitted to a hospital or clinic. Outpatient therapy centers offer a blend of services from/physical therapists, occupational therapists, speech pathologists and psychologists. Outpatient rehabilitation centers tend to offer therapy for a wide range of conditions including cancer, neurological disorders. neck and back pain, speech problems, psychological disorders, pre- and post-natal issues and more. Physical therapy Physical therapists provide treatment for those who are experiencing pain or difficulty in functioning, moving or living life normally. Physical therapy is commonly used to relieve pain. improvement movement, provide rehabilitation after a stroke, injury or surgery, assist in recovery after giving birth, assist in the recovery of sports-related injuries. teach individuals how to use devices such as walkers and canes, manage chronic illnesses like heart disease or arthritis, and more. If physical therapy is recommended by your doctor, a therapist will start by assessing your mobility, balance, heartbeat, posture and how well you can walk or climb steps. From there, your therapist wilt develop a plan to ease symptoms and help you regain functionality or mobility. Physiotherapy uses natural adaptation mechanisms of the body to specifically treat disorders of bodily functions. Some of the treatments include: Manual therapy Physiotherapeutic movement therapy Physical therapy (cryotherapy, ultrasound therapy, thermotherapy, electrotherapy) Hydrotherapy Myofascial-instrumental therapy Proprioceptive re-education Structural osteopathy Taping Massages (classic and reflective) Common therapies include: Special exercises and stretches designed to relieve pain, improve mobility or regain strength. Massage, heat or cold therapy or ultrasound to ease muscle pain and spasms. Rehab and exercises to help you learn to use an artificial limb. Practicing with gadgets that assist in movement or balance, such as canes, crutches. walkers or wheelchairs. Balance and gait retraining. Pain management. Cardiovascular strengthening. Casting, splinting, burn care or use of orthotics (braces or splints). Occupational therapy (OT) Occupational therapists provide occupational therapy treatments to help individuals who require specialized assistance to participate in everyday activities, or \"occupations.\" Occupations don\'t just refer to work or your job, but can also refer to self-care practices, everyday tasks and recreational activities. The goal of occupational therapy is to help individuals participate in the things they want and need to do to live an independent and satisfying lifestyle. OT help by making changes to things that hinder someone\'s ability to complete tasks such as eating, dressing. brushing one\'s teeth, completing school activities and working. Modifications may include changing the way the task is approached, changing the environment in which the task is completed or helping a person develop skills necessary to complete certain tasks. Occupational Therapy aims at training or re-training motions and abilities that have not been developed or have been lost through an illness or trauma. It focuses on increasing patient\'s independency in day to day activities through: Exercising daily activities (ADLs), such as personal hygiene, dressing, meals, housework etc.. Rehabilitation of the upper extremities. Focusing on various motor and sensitive components such as strength, coordination, endurance, dexterity. sensitivity and proprioception. Consultation in support equipment and technical aids to improve the quality of life at home. Hydrotherapy Simple baths, contrast baths and hydrokinesiotherapy (physical exercises in the aquatic environment, taking advantage of the thermal and mechanical properties of the water). This treatment can be performed in groups or individually with a therapy assistant. The aim is to strengthen muscles, improve body image perception, motor coordination and balance. Light Therapy - Sun Exposure Light Therapy and especially sun exposure is a well known and effective treatment for Psoriasis. By exposing affected skin to sunlight, the growth of the skin cells is slowed down which can result in improved skin appearance. Sun terrace, which is exclusively for Psoriasis patients, has been constructed in a way that provides maximum privacy. It enables our patients to feel relaxed while treating their affected skin with sunlight. It is very important for the sun exposure to happen gradually and to remember to apply sufficient sun screen to the areas of skin which are not affected by Psoriasis to avoid sunburn. Speech Therapy Speech therapists pursue the goal of preserving and / or restoring the communicative abilities as well as the food intake of patients. Speech therapist will assess your abilities and develop a therapy plan. Training with our speech therapist helps patients to improve. Speech, voice and swallowing. Patients will learn exercises which can be practiced at home once their stay in Vintersol is over. Speech therapists (or speech-language pathologists) provide treatment for those who have speech issues. Speech therapy can help treat a wide variety of issues involving language, communication, voice, swallowing and fluency. For newborns, a speech therapist may help with conditions such as cerebral palsy, cleft palate or Down syndrome that cause difficulties with drinking, swallowing or communicating. Children with speech issues such as stammering or a lisp can benefit from communication exercises under the instruction of a therapist. Adults with learning difficulties or who have another condition, such as stroke, neck or head cancer, Parkinson\'s disease or dementia, can also benefit from the help of a speech therapist. The goal of speech therapy is to combine the mechanics associated with speech with the use of language. The end result is to help the patient communicate in more useful and functional ways. 1\. Common tactics used by speech therapists include: 2\. Language intervention activities (language drills to practice communication skills) 3\. Articulation therapy (demonstrating how to move the tongue to create certain sounds), and Feeding and swallowing therapy (tongue, lip and jaw exercises designed to strengthen the muscles of the mouth and throat). Conditions or illnesses that may require a speech therapist include: Dyslexia difficulty reading accurately and fluently Dyspraxia - difficulty controlling muscle function for movement, coordination. Aphasia a loss of ability to understand or express speech due to brain damage Dysphagia difficulty swallowing Articulation problems - difficulty speaking clearly and making errors in sounds Fluency problems - difficulty with the flow of speech, such as stuttering Resonance or voice problems - difficulty with voice pitch, volume and quality Oral feeding problems - difficulty with eating. swallowing or drooling Parkinson\'s disease Cerebral palsy Cleft palate Down syndrome Multiple sclerosis Huntington\'s disease Cancer of the head, neck or throat Who needs occupational therapy? OT may be needed by people of all ages, from newborns to seniors. There are endless ways in which occupational therapy may help these individuals, such as: 1.Children with physical disabilities may need a therapist to help them develop the coordination needed to feed themselves, use a computer or improve their handwriting. 2\. Adults with depression may require recommendations from a therapist to re-engage in daily activities gradually and in a manner that maximizes their chances for success. 3\. An individual who has lost the ability to hold a fork due to an injury may work with a therapist to regain grip strength and modify movements so that they can feed themselves independently. 4\. Seniors with physical limitations may need help from a therapist to participate in activities they love in new and modified ways. 5\. Those who have suffered a spinal cord injury may require therapist intervention to help them avoid movements or behaviors that may worsen their injuries. 6\. Corporate professionals may work with a therapist to create an optimal work/life balance designed to reduce stress and maximize health or modify their work environment based on ergonomic principles. 7\. An individual who has experienced a traumatic brain injury and lost cognitive function may require a therapist to assist them with tasks such as applying to jobs or submitting college applications. Therapy in a Multi-Sensory Environment - Snoezelen This multi-sensory treatment room based on the Snoezelen concept offers a different approach to therapy. Snoezelen means to sit or lie comfortable in a cosy. pleasantly warm room enjoying lighting effects. surrounded by soft sounds and melodies. Snoezelen is used to improve sensitive perception and relaxation. The Snoezelen room can be flooded with fragrant scents, which can awake beautiful memories and animate dreaming. This harmonious environment facilitates easier communication between the patient and the therapist and helps to focus on specific goals. The aim is also to create adapted behaviours and to improve the autonomy and quality of life for the patient. The Snoezelen concept is a theory developed in 1970 by Dutch Jan Hulsegge and Ad Verheul. Snoezelen is a combination of the two words in Dutch \"snu elen\" (snooping. sniffing) and \"doezelen\" (dozing, slumbering). Intensive Rehabilitation of Bipedalism, Balance and Gait Intensive physical and functional training: if required with use of belts to reduce the body weight. The aim is to boost the infralesional musculature, re-educate gait activities in patients with spinal cord injury, acquired brain damage or other conditions. Intensive Stretching Stretching exercises especially suitable for muscle stiffness and spasticity, it reduces the risk of injuries and can help to prevent the shortening of muscles. Wheelchair Training - Technique and Fitness This group training will improve skills and techniques for wheelchair users. We train inside and outside the clinic, to learn how to maneuver and overcome obstacles that can be found at home, in parks, shops or other daily life scenarios. The instructor will provide tips and advice with the aim to increase confidence and independence for wheelchair users. These sessions also include fitness exercises and stretching to help keeping it and build strength. Seasonal Group Classes and Activities A team of therapists with a wide background of education and specialization. Every season can offer special classes where our patients can learn new skills and which help to keep minds and bodies active. In the past these included: Medi Yoga Meditation Creative Crafting Afrodance Health Education We host regular forums, talks and seminars hold by our own health experts or friends of Vintersol. These provide an opportunity for our patients to learn more about diseases, to receive advice and share experiences. Those informative and social events help patients to stay updated and provide new insights. Some of the topics we have covered include: Healthy Eating. Life with a Disability, Nutrition. Daily Living Aids. Psoriasis. Rehabilitation Methods and Therapies A Rehabilitation process consists of different elements. here we provide you with more information on the different therapies and treatments that could be part of your rehabilitation process at Vintersol. A high-touch nursing profession Based on rehabilitative and restorative principles, rehabilitation nursing is a philosophy of care that takes a holistic approach to meeting patients medical. vocational, educational. environmental, and spiritual needs. It\'s also a high-touch profession in which nurses get to know their patients and interact with them and their families throughout the healing journey. Rehabilitation nurses work with patients who have disabling injuries or chronic illnesses by helping them adapt to their disabilities. live to their maximum potential, and attain optimal health. Through rehabilitation. patients are able to overcome injury or illness. Rehabilitation nurses have excellent functional assessment skills and take a comprehensive approach to care. aim to increase confidence and independence for wheelchair users. These sessions also include fitness exercises and stretching to help keeping it and build strength. Seasonal Group Classes and Activities A team of therapists with a wide background of education and specialization. Every season can offer special classes where our patients can learn new skills and which help to keep minds and bodies active. In the past these included: Medi Yoga Meditation Creative Crafting Afrodance Health Education We host regular forums, talks and seminars hold by our own health experts or friends of Vintersol. These provide an opportunity for our patients to learn more about diseases, to receive advice and share experiences. Those informative and social events help patients to stay updated and provide new insights. Some of the topics we have covered include: Healthy Eating. Life with a Disability, Nutrition. Daily Living Aids. Psoriasis. Rehabilitation Methods and Therapies A Rehabilitation process consists of different elements. here we provide you with more information on the different therapies and treatments that could be part of your rehabilitation process at Vintersol. A high-touch nursing profession Based on rehabilitative and restorative principles, rehabilitation nursing is a philosophy of care that takes a holistic approach to meeting patients medical. vocational, educational. environmental, and spiritual needs. It\'s also a high-touch profession in which nurses get to know their patients and interact with them and their families throughout the healing journey. Rehabilitation nurses work with patients who have disabling injuries or chronic illnesses by helping them adapt to their disabilities. live to their maximum potential, and attain optimal health. Through rehabilitation. patients are able to overcome injury or illness. Rehabilitation nurses have excellent functional assessment skills and take a comprehensive approach to care. They act as multisystem integrators and team leaders, working with physiciaris, therapists, and others to solve challenges and help their patients achieve their personal-best levels of functioning and independence. Nurses accomplish these goals by: managing complex medical issues collaborating with other healthcare specialists ⚫ setting goals for maximal independence providing ongoing patient, family, and caregiver education establishing plans of care to maintain optimal wellness. Topic: **[FILLING OF THE MONTHLY MONITORING OF INJECTION SAFETY]** This is referring to a form use to track and monitor the safety of injection devices used on a monthly basis. This form is uses in healthcare setting to ensure that injection devices are being used and disposed off properly to prevent needle stick injuries and other safety risks. To Fill out this form, you would typically need to gather information of the following : 1\. Device information: type injection device, manufacturers and lot number. 2\. Usage data: number of devices used, number of injections administered and any issue or problems encountered. 3\. Safety data; any needle stick injuries or other safety incidents reported. 4\. Disposal data: how devices were disposed of and whether Proper Procedures were followed. 5\. Staff training and compliance: Whether staff have received Proper training on injection safety and are following Proper procedures. Once the form is completed, it could typically be reviewed by a supervisor or safety officer to Identity any areas for improvement and ensure. that proper Procedures are being Followed. This may depends on the form and Organizations using it. **[Reason for giving unsafe/unnecessary injections.]** Unfortunately, unsafe or unnecessary injections are still a reality In Some parts of the world. Some reasons that confronted to this Issues include: 1\. Lack of training or education on proper injections Techniques and safety protocols. 2\. Insufficient resources or equipment, such as sterilizations facilities or disposable needles. 3\. Overcrowding and understaffing is healthcare Facilities, leading to rushed or under Compromised care. 4\. Cultural or societal beliefs that prioritize Injections over other treatment options. 5\. Financial motivations, such as Charging patients for unnecessary injections. 6\. Misconception about the effectiveness of injections for certain conditions. 7\. Limited access to alternative treatment options or healthcare Services. 8\. Inadequate regulations or enforcement of injection safety Standards. 9\. Patient demand or pressure on healthcare providers to administer injections. 10\. Lack of accountability and quality control measures in health care Settings. **[Reasons for patients not insisting on safe injections.]** 1. Lack of awareness about injection safety and the risks associated with unsafe injection. 2. Limited Knowledge about proper injection techniques and safety protocols. 3. Trust in healthcare providers and assumptions that they follow proper procedures. 4. Fear of questioning or challenging health care providers. 5. Limited access to Information or resources about injection Safety. 6. Cultural or societal belief that prioritize trust in healthcare providers over self-advocacy. 7. Fear of being perceived as difficult or demanding. 8. Limited English proficiency or Communication barrier. 9. Limited health literacy or understanding of medical Procedures. 10. Prior experiences with unsafe injection that were not addressed or resolved. 11. Feeling rushed or pressured during medical appointments. 12. Lack of support or advocacy 13. Limited access to alternative Healthcare providers. 14. Fear of being denied treatment or care If they Insist on safe injection. 15. Belief that unsafe injections are a necessary risk For their health conditions. **[Stock holding conventions]** The refers to the Standard practice and guidelines for managing and Storing injections supplies. They include: 1. Prop Storage: Keeping injection supplies in a designated area, away from direct sunlight, moisture and extreme temperature. 2. Inventory Management: Regularly tracking stock levels to ensure adequate supplies as prevent overstocking or stock outs. 3. Expiration date tracking: Monitoring expiration dates to ensure that the injection Supplies are used before they expire. 4. First-in, First-out (FIFO) Usage: using the oldest supplies first to minimize waste, and ensure that the oldest supplies are used before they expire. 5. proper labeling and identification: Clearly labeling and Identifying injection supplies to prevent mix-ups and ensure Proper use. 6. Secure Storage: Storing injection Supplies is a secure area to Prevent unauthorized access or tampering. 7. Regular Cleaning and disinfection: Regularly Cleaning and disinfecting storage area and injection supplies to prevent Contaminations. 8. Compliance with regulations: Adhering to relevant regulations and guidelines for inspection Supply management.