Lab exam - #1.docx

Lab exam - #1 Feb 29th, 2024 Week 2: oral meds and other routes The 10 rights of medication administration: The right medication The right dose The right patient The right route The right time and frequency The right documentation The right reason The right to refuse The right patient education The...

Lab exam - #1 Feb 29th, 2024 Week 2: oral meds and other routes The 10 rights of medication administration: The right medication The right dose The right patient The right route The right time and frequency The right documentation The right reason The right to refuse The right patient education The right evaluation Always make 3 checks before administrating dosage Administer oral medications for clients that have trouble swallowing: Crush medication Crush into liquid to aid with swallowing Contact a language speech doctor for the swallowing issue Contact dietitian as it could affect their meal ingestion Do a swallowing examination ​​A client has an order for eye drops, a cough syrup, a topical cream to the perineum for itching and skin breakdown and 4 tablets to swallow. What is the correct sequence for administration of these medications? Eye drops: not contaminating, decrease of infection Tablets: swallow before cough syrup is in the throat Cough syrup: want the throat to be lubricated Topical cream: they will need to stay still or undress Types of routes: Topical Skin applications Use of gloves or applicators Preparation of skin Thickness of application Transdermal patch Nasal Nasal instillation Nasal spray, drop, or tampon Assessment of nares Patient instruction and self-administration Positioning Eye Eye instillation Drops, ointments Intraocular disc Assessment of Eyes Asepsis Positioning Ear Ear instillation Assessment of ear canal Warming of solution Straightening of canal for children and adults Positioning Suppositories Vaginal instillation Suppositories, foams, jellies, creams Use of gloves and applicator Self-administration Patient positioning, comfort, and hygiene Rectal instillation Suppositories Use of gloves Patient positioning, comfort, and hygiene Inhalation Metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and slow-stream inhaler devices Patient assessment and instruction Use of spacer Determination of doses in caniste Irrigation Medications used to wash out a body cavity, delivered with a stream of solution (sterile water, saline, or antiseptic) Asepsis or clean technique, depending on location Week 3: Subcutaneous and Intramuscular injections IM injections → 90 degree angle SC injections → 45 degree angle Math Medication: Desired / Have x quantity Ex, Give 35mg of Demerol, amuple reads 50mg/mL = 0.7 mL Best IM site for a child: Vastus lateralis The intramuscular (IM) route provides faster medication absorption than the SC route Gauge sizes: Smaller number = bigger guage Bigger number = smaller guage Week 5 / 6: sterile technique and wound management Approximation: the connection, edges being brought together Contusion: a bruise when receiving a direct blow or an impact on the body Debridement: removal of dead (necrotic) or infected skin tissue to help a wound heal Dehiscence: splitting open of a wound or an organ or structure to discharge its contents “snake-hiss” Ecchymotic: a bruise, blood leaks out of blood vessels into the top layer of skin – purple, capillaries have been crushed Eschar: is dead tissue that sheds or falls off from the skin Evisceration: extrusion of viscera outside the body, especially through a surgical incision Exudate: any of the fluid that oozes out from the blood vessels, odour can be strong (infection) Hemostasis: the process to prevent and stop bleeding Laceration: a tearing or rupturing of soft tissue Paresthesia: sensation of tingling, burning, pricking, or prickling of skin Suppuration: the formation of, conversion into, or process of discharging pus Hematoma: an area of blood that collects outside of the larger blood vessels Serous: pertaining to serum, thin and watery Serosanguineous: containing or consisting of both blood and serous fluid Sanguineous: related to or containing blood Purulent: containing, discharging, or causing the production of pus Primary intention: a type of wound healing, the wound edges are approximated, healing is faster Secondary intention: a type of wound healing, the sides of the wound are not opposed and healing must occur from the bottom of the wound upwards Blanching: pale or whitening of the skin – capillaries are broken if stays white Reedap: Abbreviation when checking wounds (redness, edema, ecchymosis, depth, approximation, pain) Wet to damp: Promoting wound healing Wet to dry: Promoting diriment Classification of pressure ulcers: Stage 1 -non-blanchable erythema of intact skin Stage 2 -presents as an abrasion, blister or shallow crater Stage 3 -deep crater with or without undermining or adjacent tissues Stage 4 -full thickness, skin loss with extensive tissue destruction, tissue necrosis or damage to muscle, bone, or support structures Wound Classifications: Acute: (ie surgical) – follows normal healing processes, clean & intact edges – Easy to clean Chronic: (ie. Ulcer) – Does not heal easily – Skin does not return to its normal appearance and function Phases of wound healing: Inflammatory phase: Lasts up to 3 days Platelets begin the process of controlling bleeding & clot formation (hemostasis) WBC’s (neutrophils & macrophages) reach the area to remove bacteria & other debris (phagocytosis) Indications: redness, swelling, warmth, throbbing Inflammatory response is beneficial Proliferative Phase Lasts 3-24 days Granulation: tissue development Various reparative cells secrete collagen & build new capillaries Soft pink/red in colour Wound contraction occurs (edges pull together) Epithelialization (new epithelial cells form) Need a moist surface Remodelling Occus for more than a year Wound tissue gains greater strength as new collagen continues to form Scar tissue is only 80% as strong as original tissue Complications of Wound Healing: Hemorrhage Internal/external, drains, hematoma formation Infection Develops 4th -5 th day post op, drainage- purulent Dehiscence Most likely 3-11 days after injury “something gave way” Evisceration Serious (requires surgery) Visceral organs protruding Cover with sterile towels soaked in sterile NS Fistula formation Abnormal passage between 2 organs or between an organ & the outside body Related to poor healing or disease complication ie. Chrohn’s disease Wound care: Exudate – quality Exudate – quantity Wound dressing products Different ulcer types Exudate - Quantity: Small Exudate fully controlled Non-absorptive dressings may be used Wear time up to 7 days Moderate Exudate controlled Absorptive dressings may be needed Wear time 2 to 3 days Large (copious) Exudate uncontrolled Absorptive dressings required May overwhelm dressing in 1 day Iodosorp dressing: Used in conjunction with a secondary dressing Topical antimicrobial effective for bacteria, fungi, MRSA Slow release iodine which is not toxic to granulating tissues Usually first choice for Diabetic feet Do not use if client allergic to shellfish or iodine Anticoat dressing: Has anti-inflammatory properties Topical antimicrobial effective against bacteria, fungi, MRSA Ionized silver released into wound for up to 3 days Acticoat burn (for min to mod draining wounds) needs to be cut slightly smaller than the size of the wound or will macerate peri-wound) Mesalt dressing: Gauze which has been treated with high concentration of salt Effective as a packing for heavily draining large wounds that have a high slough and odour Usually used for a short period of time to help temporarily with drainage Can be painful for client Proviodine-iodine (Betadine): Effective antiseptic Kills almost every bacteria or fungi but is toxic to granulation tissue (slows healing of wounds) Can be used in wounds where high bacterial burden is more of an issue than healing Gels: Used in extremely dry wounds where moistness is needed for moist interactive wound healing Requires a secondary dressing to cover Intrasite gel (1 time use only) Duoderm gel Ulcer: Arterial Ulcers: are extremity ulcerations that result from complete or partial blockage of the arteries, known as arterial insufficiency. The most common location of arterial ulcers is at or below the ankle, between the toes or over bony prominences. Diabetic Ulcer: Diabetes affects circulation as well as the nerve endings in the feet. Risk factors for developing a diabetic foot ulcer include loss of sensation or peripheral neuropathy, structural foot deformity, infection, and decreased circulation Venous Leg Ulcers: are shallow, irregular shaped ulcers that often appear beefy and red. Typically, they are located below the knee, usually in the inside of legs just above the ankles, however, they can occur almost anywhere on the lower leg. Braden wound scale: Describe severity of ulcers 1 being low, 4 being high 6 categories: Sensory perception Moisture Activity Mobility Nutrition Friction and shear