Foundations - December 2nd Medical Information PDF

FOUNDATIONS - December 2nd Medication Culture of safety Components of an order What to include in an assessment 5 rights Considerations with children and elderly Principles of documentation Routes Types of syringes a...

FOUNDATIONS - December 2nd Medication Culture of safety Components of an order What to include in an assessment 5 rights Considerations with children and elderly Principles of documentation Routes Types of syringes and needles Injection sites Types of injections Insulin Heparin Elimination Qualities of normal urine Factors affecting urination and function Incontinence Diagnostics Tests Health Promotion Types of catheters Nursing responsibilities Dialysis BOWEL Altered bowel function Specimens Occult blood Diagnostic tests Enema Flexi seal Fecal Diversion Types of colostomies Key Topics in Medication Administration and Safety 1. Medication Errors ○ What are medication errors? Errors such as inaccurate orders, unclear labeling, misidentification of the client, incomplete delivery, time pressure, etc. ○ How to prevent medication errors? Use Physician Order Entry systems, barcode scanning, effective communication, and IPE simulation. 2. Barcode Medication Administration ○ How does barcode medication administration work? The nurse scans the patient's ID bracelet and the medication to confirm correct patient, drug, dose, time, and route. ○ If no ID bracelet is present: Do not administer medication until an ID bracelet is obtained. 3. Culture of Safety ○ Definition: A workplace environment that encourages reporting errors to improve safety without punitive measures. ○ Real-Life Example: RaDonda Vaught’s case highlights the importance of a safety culture and the potential risks when standard safety practices (like double-checking medications) are overlooked. 4. Medication Order Components ○ Essential parts: Medication name, dosage, route, frequency, purpose, and provider signature. ○ Types of orders: Routine, PRN, standing orders, single/one-time, titration, and verbal orders. 5. Safe Medication Administration - The 5 Rights (+1) ○ Rights: Right patient, medication, dose, route, time, and documentation. 6. Special Considerations for Elderly and Children ○ Adaptations: May require alternate forms (liquids over pills), smaller doses, and caregiver assistance. Case Studies and Answers 1. Case Study: Diabetes and Insulin Administration ○ Insulin Order Errors: Specify time and route (e.g., 5 U of regular insulin SQ with breakfast). ○ Types of Insulin: Regular insulin: Short-acting, onset 30-60 min, peak 2-3 hrs, duration 3-6 hrs. NPH insulin: Intermediate-acting, onset 2-4 hrs, peak 4-10 hrs, duration 10-16 hrs. 2. Case Study: IM Injection for 240 lbs Patient ○ Needle Selection: For a 240 lb adult, use a 1.5-inch, 22-gauge needle in the ventrogluteal muscle. 3. Case Study: Infant IM Injection ○ Needle Selection for 9-month-old: 25-22 gauge, 5/8-1 inch needle; injection site: vastus lateralis. Additional Key Points 1. Routes of Administration: Sublingual, buccal, topical, transdermal, ophthalmic, nasal, rectal, inhaled, enteral, and parenteral. 2. High-Risk Medications: ○ Examples: Insulin, heparin, narcotics, and potassium. 3. Patient Controlled Analgesia (PCA) ○ Basal Rate: Steady infusion. ○ Bolus Rate: Patient-controlled dose for additional pain relief. 4. Heparin Administration ○ Subcutaneous: ½-5/8 inch, 25-30 gauge needle. ○ Special Technique: Add air to prevent backtracking and bruising. 5. IM Injection Sites and Volumes ○ Preferred sites for adults: Ventrogluteal (3cc max). ○ For infants and children: Vastus lateralis (0.5-1 ml).  6. Intravenous (IV) and Subcutaneous (SQ) Medication Considerations ○ Use proper needle sizes based on medication type and patient age/weight. ○ Proper hygiene and safety measures, like wearing gloves and needle handling protocols, are essential. 7. Documentation Principles ○ Record only medications you administer and do so immediately. Document reasons for refusal or missed doses, and include therapeutic and adverse effects. Anatomy of Urinary and Bowel Elimination 1. Urinary System Anatomy ○ Key organs: Kidneys, ureters, bladder, urethra. 2. Normal Urine Characteristics ○ Volume: 250-400 ml per void; minimally 30 ml/hour. ○ Daily production: 1200-1500 cc for adults; 500-600 cc for newborns. ○ Color: Light yellow, clear without sediment, no odor. 3. Factors Affecting Urination ○ Fluid Intake: Affects output and frequency. ○ Hypovolemia: Loss of fluid reduces urine output. ○ Nutrition and Medication: Diet, salt, alcohol, caffeine, diuretics impact urine. ○ Body Position and Cognition: Gravity aids urination; cognitive issues can impair control. 4. Altered Urinary Function Terms ○ Dysuria: Painful urination. ○ Polyuria: >2500-3000 ml in 24 hours. ○ Oliguria: