NCA 1 – Fundamentals of Nursing PDF

NCA 1 – FUNDAMENTALS OF NURSING MIDTERM COVERAGE Transcribed by: Genamae LegaspI, Lady bien cutie VITAL SIGNS (CARDINAL SIGNS) BODY TEMPERATURE - reflect the body's physiologic status and...

NCA 1 – FUNDAMENTALS OF NURSING MIDTERM COVERAGE Transcribed by: Genamae LegaspI, Lady bien cutie VITAL SIGNS (CARDINAL SIGNS) BODY TEMPERATURE - reflect the body's physiologic status and - the measurement of heat inside a person's provide information critical to evaluating body homeostatic balance. - reflects the balance between the heat - clearest indicator of overall health status produced and the heat lost from the body. - Includes T (temperature), PR (pulse rate), RR (respiratory rate), and BP (blood pressure) TWO KINDS OF BODY TEMPERATURE 1. Core temperature – temperature of the deep PURPOSES: tissues of the body that we measure with thermometer and remains relatively constant - to monitor the functions of the body. 2. Surface temperature – temperature of the - reflects changes in function that otherwise skin, the subcutaneous tissue and fat. might not be observed. - to obtain baseline data about the patient BODY TEMPERATURE HEAT TRANSFER 1. CONDUCTION condition. - Direct heat transfer from one area to - to aid in diagnosing patient condition another, minimal heat loss except, when a (diagnostic purpose) body is immersed in cold water. - for therapeutic purpose so that to intervene 2. CONVECTION accordingly - Dispersion of heat through air currents. Ex. Electric fan. Times to Assess Vital Signs - On admission to a health care agency to obtain baseline data. - When a client's health status changes or reports symptoms such as chest pain or feeling hot or faint. - Before and after surgery or an invasive procedure. - Before and/or after the administration of a medication that could affect the respiratory or cardiovascular system. - Before and after any nursing intervention that could affect the vital signs 3. RADIATION - Indirect heat transfer. - According to a nursing or medical order - Transfer of heat from the surface of one - According to hospital/other health institution object to the surface of another object policy. without contact between the two objects, mostly in the form of infrared rays. CARE OF CLIENT WITH PROBLEM IN 4. VAPORIZATION THERMALREGUALTION - continuous evaporation of moisture from respiratory tract and skin: TSB P a g e 1 | 14  SITES AND NORMAL VALUES - Easy to use and well tolerated by infants and young children a. Oral = 37°C = 98.7°F - Measurements do not appear to be - The nurse should wait for 20-30 minutes affected by perspiration and are before taking the temperature of a client consistent when taken on either the right who has taken hot or cold drinks or food, or left side of the forehead. has been smoking or has been through strenuous exercise. TYPES OF THERMOMETERS - Approximately 1ºF higher than the body's 1. Clinical glass mercury thermometers core temperature. - A small hollow glass tube that contains Contraindications: mercury or a mercury free substance in a Child below 7 years old bulb at one end. When heated the mercury If the patient is delirious, mentally ill rises in the tube. Unconscious Uncooperative or in severe pain Surgery of the mouth Nasal obstruction If a patient has nasal or gastric tubs in place b. Rectal = 37.5°C = 99.6°F - Considered the most reliable site because few factors can alter the reading. - Should not be taken in newborns because 2. Electronic thermometer the thermometer can cause rectal trauma. - Usually, a few tenths higher than the oral temperature. Contraindications: Rectal or perineal surgery Fecal impaction - the depth of the thermometer insertion may be insufficient Rectal infection Neonates - can cause rectal perforation and ulceration 3. Infrared thermometer (tympanic c. Axilla = 36.4°C = 97.6°F thermometer) - Safest site for temperature measurement, especially with newborns, but it is less convenient and accurate and requires a longer time (5 minutes) - Noninvasive d. Tympanic Membrane - Excellent site because of its highly vascular nature and easy accessibility. - Directly reflects core temperature - Tympanic thermometer is placed snugly 4. Temperature – sensitive strips (Disposable into the client's outer ear canal. thermometer strips) e. Forehead (temporal artery) - Fast, safe measurement of temperature at the site of the temporal artery P a g e 2 | 14  because temperature-control mechanisms are not yet fully developed. ✓ Clothing must be adequate and exposure to extreme temperatures must be avoided. ✓ 30% of the body heat of newborns is lost through the head, so a cap is to be worn to prevent heat loss. ✓ Temperature regulation stabilizes during puberty. ✓ The elderly are sensitive to extremes in 5. Liquid Crystal thermometer temperature because of: o Deterioration in thermoregulation o Poor vasomotor control o Reduced amount of subcutaneous tissues o Reduced sweat gland activity o Reduced metabolism b. Exercise - muscle activity requires increased body supply → increase in carbohydrate and fat breakdown for more energy → increased metabolism → increased heat production → increased temperature SITE ADVANTAGES DISADVANTAGES ✓ Menopausal women may experience periods ORAL -Accessible and - thermometers can break if convenient bitten of intense body heat and sweating lasting Inaccurate if client has just from 30 seconds to 5 minutes due to the ingested hot or cold food or instability of vasomotor control fluid or smoked -could injure the mouth ✓ The amount of thyroxine, epinephrine and following surgery norepinephrine in the body can also affect RECTAL -Reliable -Inconvenient and more temperature. measurement unpleasant for clients; difficult for client who d. Circadian Rhythms cannot turn to sides - body temperature changes 0.5°C to 1°C during a -Could injure the rectum 24-hour period. - Presence of stool may interfere with thermometer ➤ Temperature is usually lowest between 1:00 a.m. placement. and 4:00 a.m. AXILLARY -safe and non- - The thermometer may need invasive to be left in place a long time ➤ During the day, body temperature rises, steadily to obtain an accurate until 6:00p.m. then declines to early morning levels. measurement e. Stress TYMPANIC -readily -Can be uncomfortable and MEMBRANE accessible involves risk of injuring the - physical and emotional stress increase body -reflects the core membrane if the probe is temperature through hormonal and neural temperature inserted too far stimulation -very fast TEMPORAL -Safe and - Requires electronic - stimulation of sympathetic nervous system can ARTERY noninvasive equipment that may be increase the production of epinephrine and -very fast expensive or unavailable. norepinephrine thereby, increasing metabolic -Variation in technique needed if the client has activity and heat production perspiration on the forehead f. Environment - extreme in environment temperatures can affect a FACTORS AFFECTING BODY TEMPERATURE person's temperature regulatory systems. a. Age Variations in Normal Body Temperature by Age AGE AXILLARY ✓ an infant's temperature may change Newborn 36.8 ºC drastically with environmental changes 1 year 36.8º C 5-8 years 37 ºC 10 years 37º C P a g e 3 | 14  Teen 37º C o cyanotic nail beds Adult 37 ºC o "goose flesh" appearance of the skin o cessation of sweating BODY TEMPERATURE COURSE (PLATEAU PHASE) Alterations in body temperature o absence of chills o skin that feels warm 1. PYREXIA, HYPERTHERMIA (fever) o Photosensitivity - temperature above normal o glassy-eyed appearance o increased pulse and respiratory rate 2. HYPERPYREXIA o increased thirst - a very high fever usually 41 °C o mild to severe dehydration - 42ºC = dead o drowsiness, restlessness, delirium or convulsions 3. INTERMITTENT FEVER o herpetic lesions of the mouth - alternates at regular intervals between periods of o (if loss of appetite the fever is prolonged) fever and periods of normal or subnormal o malaise, weakness and aching muscles temperatures. DEFERVESCENSE (Fever abatement/flush 4. REMITTENT FEVER phase) - wide range of temperature fluctuations (more than o skin that appears flushed and feels warm 2°C) occurs over 24-hour period, all of which are o sweating above normal. o decreased shivering o possible dehydration 5. RELAPSING FEVER -short febrile periods of few days are interspersed with periods of 1 or 2 days of normal temperature. 6. CONSTANT FEVER - the body temperature fluctuates minimally but always remains above normal. Clinical Manifestations Of Fever Onset COLD OR CHILL PHASE o increased heart rate o increased respiratory rate and depth Nursing Interventions for clients with Fever o shivering o Monitor vital signs o pallid, cold skin o. Assess skin color and temperature o complaints of feeling cold P a g e 4 | 14  o Monitor WBC, hematocrit value, and other - Impaired hypothalamic thermoregulation pertinent laboratory reports for indications of infection or dehydration Clinical Manifestations of Hypothermia o Remove excess blankets when the client feels o Decreased body temperature, pulse and warm, but provide extra warmth when the respirations client feels chilled o Severe shivering o Provide adequate nutrition and fluids to meet o Feelings of cold and chills the increased metabolic demands and prevent o Pale, cool, waxy skin dehydration o Hypotension o Measure I & O o Decreased urinary output o Reduce physical activity to limit heat o Lack of muscle coordination production, especially during flush stage o Disorientation o Administer antipyretics as ordered o Drowsiness progressing to coma o Provide oral hygiene to keep the mucous membranes moist Nursing Interventions for clients with o Provide a tepid sponge bath to increase heat Hypothermia loss through conduction o Provide a warm environment o Provide dry clothing and linens o Provide dry clothing o Provide a warm environment o Apply warm blankets o Apply warm blankets o Keep limbs close to the body o Keep limbs close to the body o Cover the client's scalp with a cap or turban o Cover the client's scalp with a cap or turban o Supply warm oral or intravenous fluids o Supply warm oral or intravenous fluids o Apply warming pads o Apply warming pads PULSE Body Temperature Disorders - a wave of blood created by contraction o Heat Exhaustion - Represents the stroke volume output or the - occurs when a person loses amount of blood that enters the arteries with - excessive amounts of water and sodium each ventricular contraction because of profuse diaphoresis. - The palpable pounding of blood flow in a peripheral artery o Heat Stroke - Cardiac output - volume of blood pumped - very high temperatures of 105°F or more into the arteries by the heart and equals the produce tissue damage to the cells of all body result of the stroke volume times the heart organs; has a fatality rate rate per minute (CO= SVxHR) - The individual suddenly becomes giddy, confused or delirious Peripheral pulse - pulse located away from the - Symptoms include extreme thirst, nausea, heart. muscle cramps and visual disturbances - Hot, dry skin is the most important sign Apical pulse - is a central pulse, located at the apex - The individual does not sweat because of of the heart. It is also referred to as the point of severe electrolyte loss and impaired maximal impulse (PMI). hypothalamic function. - The individual develops tachycardia and Pulse volume - also called pulse strength or hypotension, becomes unconscious and amplitude, refers to the force of blood with each beat. incontinent, with blotchy redness of the skin and fixed, nonreactive pupils Pulse deficit - the difference that exists between the apical and radial pulse o Hypothermia - Excessive heat loss Pulse rhythm - pattern of the beats and the intervals - Inadequate heat production between the beats. P a g e 5 | 14  Fear and anxiety as well as the perception of severe Dysrhythmia/arrhythmia - a pulse with irregular pain stimulate the sympathetic system. rhythm 8. POSITION CHANGES CARE OF CLIENTS TO MAINTAIN PULSE - When a person is sitting or standing, blood usually WITHIN NORMAL RANGE pools in dependent vessels of the venous system. - Pooling results in a transient decrease in the Factors Affecting Pulse venous blood return to the heart, a subsequent 1. AGE reduction in blood pressure, and an increase As age increases, the pulse rate gradually decreases in heart rate. 2. GENDER 9. PATHOLOGY - After puberty, the average male's pulse rate is Certain diseases such as some heart conditions or slightly lower than the female's those that impair oxygenation can alter the resting pulse rate 3. EXERCISE - The pulse rate normally increases with activity. APICAL PULSE - used routinely in infant - The rate increase in the professional athlete is often and in patients with less than in the average person because of greater cardiac drugs. cardiac size, strength, and efficiency. BRACHIAL PULSE - used as infant's 4. FEVER primary pulse site during CPR The pulse rate increases: RADIAL PULSE-most common pulse site, a. In response to lowered blood pressure that results readily accessible. from peripheral vasodilation associated with FEMORAL PULSE – leg circulation elevated body temperature assessment. b. Because of the increase metabolic rate. POPLITEAL PULSE-lower leg circulation assessment. 5. MEDICATION POSTERIOR TIBIAL- foot circulation - some medications decrease the pulse rate, and assessment. others increase it. DORSALIS PEDIS-foot circulation - For example: cardiotonic (e.g., digitalis assessment. preparations) decrease the heart rate, whereas epinephrine increases it. 6. HYPOVOLEMIA - Loss of blood from the vascular system normally increases pulse rate. - In adults the loss of circulating volume results in an adjustment of the heart rate to increase blood pressure as the body compensates for the lost of blood volume. - Adults can usually lose up to 10% of their normal circulating volume without adverse effects. 7. STRESS - In response to stress, sympathetic nervous stimulation increases the overall activity of the heart. - Stress increases the rate as well as the force of the heartbeat. P a g e 6 | 14  PULSE TERMS TO REMEMBER GENDER PULSE DEFICIT - After puberty, females usually have lower - any discrepancy between the two pulse rates. blood pressures than males of the same age, BLOOD PRESSURE this difference is thought to be due to - is a measure of the pressure exerted by the hormonal variations. blood as it flows through the arteries. - After menopause, women generally have SYSTOLIC PRESSURE higher blood pressures than before - pressure of the blood as a result of contraction of the ventricles, that is, the GENDER pressure of the height of the blood wave. - After puberty, females usually have lower blood pressures than males of the same age, BLOOD PRESSURE Terms to Remember this difference is thought to be due to DIASTOLIC PRESSURE hormonal variations. - pressure when the ventricles are at rest. - After menopause, women generally have PULSE PRESSURE higher blood pressures than before - the difference between the diastolic and systolic pressure. DIURNAL VARIATIONS - Pressure is usually lowest early in the CARE OF CUENTS TO MAINTAIN BP morning, when the metabolic rate is lowest, WITHIN NORMAL RANGE then rises throughout the day and peaks in the late afternoon or early evening. Factors Affecting Blood Pressure DIURNAL VARIATIONS AGE - Pressure is usually lowest early in the morning, - Newborns have a mean systolic pressure of when the metabolic rate is lowest, then rises about 75 mmHg. throughout the day and peaks in the late afternoon or - The pressure rises with age, reaching a peak early evening. at the onset of puberty, and then tends to decline somewhat. DISEASE PROCESS - In elders, the elasticity of the arteries is - Any condition affecting the cardiac output, decreased-the arteries are more rigid and less blood volume, blood viscosity and/or arteries' yielding to the blood pressure. compliance directly affects the blood pressure. EXERCISE Physical activity Note: increases the cardiac output and hence the blood When taking B/P using a pressure: thus 20 to 30 minutes of rest following stethoscope, the nurse identifies phases in the series exercise is indicated before the resting blood of sounds called Korotkoff's sounds. pressure can be reliably assessed Korotkoff's Sounds. 1st korotkoff sound -clear, rhythmic tapping that STRESS corresponds to the pulse rate and gradually increases Stimulation of the sympathetic nervous system in intensity. Onset of the sound corresponds to the increases cardiac output and vasoconstriction of the systolic pressure arterioles, thus, increasing the blood pressure. 2nd korotkoff sound -murmur or swishing sound reading. appears as the cuff continues to deflate. 3rd korotkoff sound -crisper and more intense RACE tapping African American males over 35 years have higher 4th korotkoff sound - diastolic pressure in infants blood pressure than European American males of the and children, pregnant women, and clients with same age. elevated cardiac output or peripheral vasodilation. P a g e 7 | 14. 5th korotkoff sound - weak and marks the Open valve: Release 2 -3 mmHg per beginning of the disappearance of sound; in heartbeat adolescents and most adults, the sound corresponds Note sounds: Korottkoff's sound (1st systolic with diastolic pressure and last: diastolic sound) Cap: Allow 60 seconds before another blood pressure recheck BP difference: 10 mmHg Category Systolic BP Diastolic BP maximum gap between 2 arms is normal Normal 100 mmHg Smoking cessation programs, screen for hypertension HPN at least every 2 years. Scheduled exercise HYPERTENSION Essential/primary hypertension: - No known cause Secondary hypertension: - Related Disorders DIAGNOSIS Knowledge deficit related to information misinterpretation with info sources Risk for ineffective therapeutic regimen management related to non-adherence to treatment BLOOD PRESSURE HYPERTENSION CRISIS Description: Severe type of elevated BP that BP Reading rapidly progresses Rest: no smoke/coffee for 30 minutes Assessment: Severe headache, extreme high Position: Sit on chair (or lie on bed)Palm: BP, dizziness, blur vision Facing up Mgt: Semi Fowler's, 02 BP Q5-15 min, IV Forearm: Heart level Nitropruside, Nicardipine Feet: Flat on floor. Crossing of knees may increase blood pressure HYPOTENSION Expose: Brachial artery (and palpate) Orthostatic hypotension: Decrease in BP BP cuff: Center cuff bladder over artery, 1 when pt. changes position from lying to inch sitting (20mmHg in systolic and/or 10 mmHg Aneroid: At zero gauge diastolic) Palpate pulse: Inflate BP cuff until pulse is Management: Change position slowly gone Deflate: Promptly & wait 15 - 30 seconds RESPIRATION Bell: Place bell of stethoscope on brachial - It is the mechanism of the body, uses to artery exchange gases between the atmosphere and Inflate: Rapidly up to 20- 30 mmHg higher the blood and the cells than that of palpatory blood pressure reading P a g e 8 | 14 Act of breathing 2 Types of Breathing Inhalation/inspiration - intake of air into the lungs a. Costal (thoracic) breathing - involves the external intercostal muscles and Exhalation/expiration - breathing out or the other accessory muscles, such as movement of gases from the lungs to the atmosphere sternocleidomastoid muscles; - observed by the movement of the chest External respiration - process of taking oxygen into upward and downward. and eliminating carbon dioxide from the body - Commonly used for adults. b. Diaphragmatic (abdominal) breathing Internal respiration - the use of oxygen, the - involves the contraction and relaxation of the production of carbon dioxide, and the exchange of diaphragm, these gases between the cells and the blood - and it is observed by the movement of the abdomen, which occurs as a result of the Respiratory rhythm- regularity of themexpirations diaphragm's contraction and downward and the inspirations movement. - Commonly used for children. Respiratory depth- described as normal, deep or shallow & Processes Deep : a large volume of air inhaled and exhaled, a. Ventilation - mechanical movement of gases into inflates most of the lungs & and out of the lungs Shallow: exchange of a small volume of air, minimal b. Diffusion - the movement of oxygen and carbon use of lung tissue dioxide between the alveoli and the RBC. c. Perfusion -the distribution of RBC to and from the Respiratory quality or character - those aspects of pulmonary cavities breathing that are different from normal, effortless breathing. Factors Affecting Respirations * 2 aspects of breathing Exercise 1. Amount of effort a client must exert to breathe - increases respiratory rate and depth to meet 2. Sound of breathing the body's need for additional oxygen and rid the body of CO2 Observe the rate, rhythm, and depth of respiration. Stress Normal respiration is regular in depth and rhythm. - readies the body for "fight or flight" Acute pain - pain alters the rate and rhythm of respirations; - breathing becomes shallow - Client may inhibit or splint chest wall movement when pain is in the area of chest or abdomen Anxiety - Anxiety increases respiration rate and depth as a result of sympathetic stimulation Smoking - Chronic smoking changes the lung's airways, resulting in increased rate of respiration even at rest and when not smoking. P a g e 9 | 14  Body position Gender - A straight, erect posture promotes full chest - Men have a larger lung capacity than do expansion women, men have a lower respiratory rate - A stooped or slumped position impairs ventilatory movement Acceptable Respiratory Rates - Lying flat prevents full chest expansion AGE RATE (Breaths/Min) Medications Newborn 35-45 - Narcotic analgesic, general anesthetics and Infant (6 months) 30-50 sedative hypnotics Toddler ( 2 years) 25-32 - depress respiration rate and depth Child 20-30 Amphetamines and cocaine may increase rate Adolescent 16-19 and depth Adult - Bronchodilators slow rate by causing airway dilation NURSING DIAGNOSIS Neurological injury Altered Breathing Patterns - Injury to the brainstem impairs the ✓ Rate respiratory center and inhibits respiratory rate Tachypnea - quick, shallow breaths& and rhythm Bradypnea - abnormally slow breathing Apnea - cessation of breathing Hemoglobin Function Eupnea - normal breathing rate and depth - Decreased hemoglobin levels reduce the oxygen carrying capacity of the blood, which ✓ Volume increases respiratory rate. Hyperventilation -overexpansion of the lungs - Increased altitude lowers the amount of characterized a rapid and deep breaths saturated hemoglobin, which increases Hypoventilation - underexpansion of the respiratory rate and depth lungs, characterized by shallow respirations - Abnormal blood cell function reduces the ability of hemoglobin to carry oxygen, which ✓ Rhythm increases respiratory rate and depth Cheyne-stokes breathing -rhythmic waxing Age and waning of respirations, from very deep to - Normal growth from infancy to adulthood shallow breathing and temporary apnea results in an increased lung capacity. Biot's breathing -cyclic breathing pattern - As lung capacity increases, lower respiratory characterized by shallow breathing rates are sufficient to exchange air. alternating with periods of apnea - As the adult ages, lung elasticity decreases. Kussmaul breathing -increased rate (above With this decrease in elasticity, respiratory 20 cpm) and depth of respiration rate increases to allow for adequate air ✓ Ease and Effort exchange Dyspnea - difficult and labored breathing during which the individual has a persistent, Altitude unsatisfied need for air and feels distressed - Oxygen content of the air decreases as the altitude increases Orthopnea -ability to breath only in upright - To compensate for the decreased oxygen sitting or standing positions content, the rate and depth of respirations at higher elevations increase to improve oxygen Altered Breath Sounds supply available to the body tissue ✓ Audible without Amplification Stridor -a shrill, harsh sound heard during inspiration with laryngeal obstruction P a g e 10 | 14  Stertor -snoring or sonorous respiration, GENERIC NAME- given before a drug usually due to a partial obstruction of the becomes officially an approved medication. upper airway& OFFICIAL NAME- the name under which Wheeze -continuous, high pitched musical it is listed in one of the official publications. squeak or whistling sound occurring on CHEMICAL NAME- a name by which a expiration and sometimes on inspiration chemist knows it; It describes the constituents when air moves through a narrowed or of the drug precisely. partially obstructed airway TRADE NAME OR BRAND NAME - the Bubbling - gurgling sounds heard as air name given by the drug manufacturer. passes through moist secretions in the DRUG ABUSE- is inappropriate intake of a respiratory tract substance, either continually or periodically. Substernal retraction -indrawing beneath CHEMICAL NAME- a name by which a the breastbone chemist knows it; It describes the constituents Suprasternal retraction -indrawing above of the drug precisely. the clavicles TRADE NAME OR BRAND NAME - the name given by the drug manufacturer. ✓ Secretions and coughing DRUG ABUSE- is inappropriate intake of a Hemoptysis - the presence of blood in the substance, either continually or periodically. sputum ILLICIT DRUGS- also called street drugs, Productive cough - a cough accompanied by are those sold illegally. expectorated secretions PHARMACOLOGY- study of the effect of Nonproductive cough - a dry, harsh cough drugs on living organisms. without secretions PHARMACY - art of preparing, compounding, and dispensing drugs. ✓ Place hands on chest when respirations are - also refers to the place where drugs are difficult to count prepared and dispensed. PHARMACIST - a person licensed to prepare and dispense drugs and to make up prescriptions. PHARMACOPOEIA (pharmacopeia)-a book containing a list of products used in medicine, with descriptions of the product chemical tests for determining, identity, purity, formulas and prescriptions. Effects of Drugs 1. THERAPEUTIC EFFECT/DESIRED MEDICATION EFFECT - Is a substance administered for the diagnosis, - is the primary effect intended, that is, the reason cure, treatment, or relief of a symptom or for the drug is prescribed. prevention of disease. 2.SIDE EFFECT - or secondary effect is one that is unintended. DRUG/MEDICATION - generally used - Digitalis- N and V interchangeably 3. ADVERSE EFFECTS OR REACTIONS- DRUG - has a connotation of an illicitly - severe side effects obtained substance such as heroin, cocaine, -D/C or amphetamines. 4. DRUG TOXICITY(Deleterious effects of PRESCRIPTION - the written direction for drug)- Results from overdosage, ingestion of drug the preparation and administration of drugs. intended for external use and build up of the drug in P a g e 11 | 14 the blood because of impaired metabolism or Chemotherapeu Destroys Busulfan for excretion. tic malignant leukemia 5.DRUG ALLERGY- An immunologic reaction to cells a drug Restorative returns the Vitamins, 6.ANAPHYLACTIC REACTION body to health Mineral A severe allergic reactions usually occurs supplements immediately after the administration of the drug. 7.DRUG TOLERANCE- Exists in a person who Key terms related to drug actions: has unusually low physiologic response to a drug and 1. ONSET OF ACTION who requires increase in the dosage to maintain a - The time after the administration when the body given therapeutic effect. initially responds to the drug 8. CUMULATIVE EFFECT 2. PEAK PLASMA LEVEL - increasing response to repeated doses of a drug that - The highest plasma level achieved by a single dose occurs when the rate of administration exceeds the when the elimination rate of a drug equals the rate of metabolism or excretion. absorption rate. 9.IDIOSYNCRATIC EFFECT - one that is unexpected and maybe individual to a Routes of Administration client. 1. ORAL - most common 10. DRUG INTERACTION 2. SUBLINGUAL - placed under the tongue where - Occurs when the administration of one drug before, it dissolves at the same time as, or after another drug alters the 3.BUCAL - means "pertaining to the cheek", a effect of one or both drugs. medication is held in the mouth against the mucous 11.SYNERGISTIC membranes of the cheek until the drug dissolves - Is when two different drugs increase the action of 4. RECTAL- can be used when drug has one another drug. objectionable taste or odor. Provides local Therapeutic Actions of Drugs therapeutic effect. 5. VAGINAL DRUG TYPE DESCRIPTI EXAMPLE 6. PARENTERAL ROUTE -is defined as other than ON through the alimentary or respiratory tract, that is, by Palliative Relieves the Morphine needle. symptoms of sulfate, a. Subcutaneous- (Hypodermic) into the a disease but aspirin for subcutaneous tissue, just below the skin. does not pain b. Intramuscular - into a muscle affect the c. Intradermal disease itself 7. TOPICAL - applied to a circumscribed surface area of the body. Curative Cures a Penicillin for a. Dermatologic preparations- applied to disease or infection the skin condition b. Installations and irrigations- applied into Supportive Supports Norepinephri body cavities or orifice such as urinary body function ne bitartrate bladder, eyes, ears, nose, rectum, vagina until other for low blood c. Inhalations - administered into the treatments or pressure; respiratory tract by nebulizer the body's aspirin for response can high body take over. temperature Substitutive Replaces Thyroxine for body fluids or hypothyroidis substances m Insulin for diabetes mellitus P a g e 12 | 14  Example: Heparin is often distributed in vials in prepared dilution of 10,000 units per milliliter. If the order calls for 5,000 units, the nurse can use the preceding formula to calculate. 5000 1 𝐷𝑜𝑠𝑒 = = = 0.5 𝑚𝑙 10000 2 therefore, the nurse injects 0.5 ml. for a 5,000 unit dose 10 RIGHTS OF MEDICATION ADMINISTRATION Types of Medication Order ✓ Right medication 1. Stat order ✓ Right dose 2. Single dose or one-time order ✓ Right time 3. Standing order ✓ Right route 4. PRN order ✓ Right client ✓ Right client education Calculating Using ratio ✓ Right documentation 𝐷𝑜𝑠𝑒 𝑜𝑛 𝐻𝑎𝑛𝑑 𝐷𝑒𝑠𝑖𝑟𝑒𝑑 𝐷𝑜𝑠𝑒 ✓ Right to refuse 𝐷𝑜𝑠𝑒 = = (𝑥) ✓ Right assessment 𝑄𝑢𝑎𝑛𝑡𝑖𝑡𝑦 𝑜𝑛 ℎ𝑎𝑛𝑑 𝑄𝑢𝑎𝑛𝑡𝑖𝑡𝑦 𝑑𝑒𝑠𝑖𝑟𝑒𝑑 ✓ Right evaluation 𝐷(𝐷𝑒𝑠𝑖𝑟𝑒𝑑 𝑎𝑚𝑜𝑢𝑛𝑡) ✓ Right approach 𝐷𝑜𝑠𝑒 = (𝑥 𝑄 (𝑄𝑢𝑎𝑛𝑖𝑡𝑦) 𝐻(𝑎𝑚𝑜𝑢𝑛𝑡 𝑜𝑛 ℎ𝑎𝑛𝑑) EXAMPLE: Erythromycin 500 mg. is ordered by the physician to 1.RIGHT PATIENT the patient. Stock: liquid form containing 250 mg. in - Check the name on the order and the patient. 5 ml. How many ml of Erythromycin will Use 2 identifiers. you give to the patient. - " Ask patient to identify himself/herself. 500 𝑚𝑔 - When available, use technology (for example, 𝐷𝑜𝑠𝑒 = 𝑥 5𝑚𝑙 = 2(5) = 10 𝑚𝑙 250 𝑚𝑔 bar-code system). 2. RIGHT MEDICATION Doctor's order: - Check the medication label. Ketorolac 30mg. IV push now. The bedside stock is - Check the order. 15mg/ml.How many ml be administered by the nurse to the patient who is in pain? 3. RIGHT DOSE 30 𝑚𝑔 Check the order. 𝐷𝑜𝑠𝑒 = 𝑥 1 𝑚𝑙 = 2(1) = 2 𝑚𝑙 15 𝑚𝑔 Confirm appropriateness of the dose using a Physician's order: current drug reference. Give Amoxicillin 250 mg PO, q6hrs. Bedside If necessary, calculate the dose and have another available stock is 125 mg/5ml. suspension. How nurse calculate the dose as well. many ml will you incorporate to the IVF? 250 𝑚𝑔 4. RIGHT ROUTE 𝐷𝑜𝑠𝑒 = 𝑥 5 𝑚𝑙 = 2(5) = 10 𝑚𝑙 125 𝑚𝑔 Again, check the order and appropriateness of the route ordered. Order 1,200 units of Heparin in DgW 250 cc to run Confirm that the patient can take or receive the for 4 hours.How many units of Heparin is to be medication by the ordered route. infused every hour? P a g e 13 | 14 5. RIGHT TIME - Be knowledgeable about the medications you - Check the frequency of the ordered medication. administer. - Double-check that you are giving the ordered dose You need to know why the client is at the correct time. receiving the medication. - Confirm when the last dose was given. Look up the necessary information if you 6. RIGHT DOCUMENTATION are not familiar with the medication. - Document administration AFTER giving the - Federal laws govern the use of narcotics and ordered medication. barbiturates. Keep this medication in locked - Chart the time, route, and any other specific place. information as necessary. For example, the site of an - Use only medications that are in clearly injection or any laboratory value or vital sign that labeled containers. needed to be checked before giving the drug. - Do not use liquid medications that are cloudy or have changed color. 6. RIGHT PATIENT EDUCATION - Calculate drug doses accurately, if you are - Check if the patient understands what the uncertain, ask other nurse to double-check medication is for. your calculations. - Make them aware that they should contact a - Administer only medications personally healthcare professional if they experience side- prepared. effects or reactions. - If a client vomits after taking an oral medication, report this to the nurse in charge, 7. RIGHT TO REFUSE MEDICATION or the primary care provider, or both. - The patient has the right to refuse any medication. - Take special precautions when administering However, the nurse is obliged to explain to patients certain medications; for example, have why the drug is prescribed and the consequences another nurse check the dosages of refusing medication. anticoagulants, insulin, and certain IV preparations. 8.RIGHT ASSESSMENT - Most hospital policies require new orders - Some medications require specific assessment from the primary care provider a for a client's before their administration e.g. checking of vital post surgery care. signs. Before a medication like Digoxin is - When a medication is omitted for any reason, administered the pulse must be checked. record the fact together with the reason. - Some medication orders may contain specific - When a medication error is made, report it assessments to be done prior to medication immediately to the nurse in charge, the primary care provider, or both. 9. DRUG APPROACH AND RIGHT TO Parts of Prescription Order REFUSE 1. Prescriber - Give the client enough autonomy to refuse to the Information and medication after thoroughly explaining the effects Signature 2. Patient Information 10.RIGHT EVALUATION 3. Date Prescription was · Ensure the medication is working the way it should. written 4. Superscription Ensure medications are reviewed regularly. - holds the Rx symbol Ongoing observations if required. meaning "take thou","you take", or Practice Guidelines on Administering "recipe." Medications 5. Inscription - it is the - Nurses who administer medications are medication prescribed responsible for their own actions.. Question 6. Subscription - the dispensing instruction to the any order that is illegible or that you consider pharmacist 7. Signa - the given direction or incorrect. Call the person who prescribed the instruction to the patient medication for clarification. 8. Special Instructions (Optional) P a g e 14 | 14