NCM103FNP Endterm Exam PDF

1. Verbal Communication: spoken or written words The transmission of information between and among individuals As a member of the health team, nurses need to commu...

1. Verbal Communication: spoken or written words The transmission of information between and among individuals As a member of the health team, nurses need to communicate information about client's accurately, timely, in an effective manner. The quality of client care greatly depends on the caregiver’s ability to communicate with one another. Communication is a basic component of human relationships and nurse – patient relationships. 2. Non-verbal Communication: gestures, facial Non-verbal communication is more accurate expression, body movement, gait/posture, eye expression of a person’s thoughts and feelings contact, tone of voice, physical appearance than verbal communication. When assessing nonverbal behaviors, consider cultural influences. Variety of feelings can be expressed by a single non-verbal expression. Head nodding does not always mean agreement. Sender: the source Receiver: ultimate destination Message: subject matter Channel: means used to pass the message Feedback: response or reaction or reply to the message 1. Physical 2. System design faults 3. Attitudinal Barriers 4. Psychological 1. The patient should be the primary focus of 5. Different languages interaction. 6. Physiologic 2. A professional attitude sets the tone of the 7. Presentation therapeutic relationship. 3. Use self-disclosure cautiously and only when it has a therapeutic purpose. 1. Simplicity 4. Avoid social relationships with patients. commonly understood words. 5. Maintain patient confidentiality. 2. Clarity saying exactly what is meant. Speak slowly and enunciate words well. Repeat the 1. Establish a therapeutic nurse-patient relationship. message as needed. 2. Identify the most important patient's needs. 3. Timing and relevance 3. Assess the patient's perception of the problem. ask one question at a time. Wait for the 4. Facilitate the patient’s expression of emotions. answer before making another comment. 5. Implement interventions designed to address the 4. Adaptability patient's needs. adjustment on what the nurse says and how 6. Assess the patient's intellectual competence to it is said depending on moods and behavior determine the level of understanding. of the client. 7. Implement interventions from a theoretic base. 5. Credibility 8. Maintain a non-judgmental attitude. Avoid making worthiness of belief. Nurse should have judgment about patient's behavior. adequate knowledge. She should be a good 9. Avoid giving advice. role model for what she teaches. 10. Guide the patient to interpret his or her experiences rationally. Effective communication S - Sit facing the patient Tow-way process O - Open posture Based on trust L - Lean forward towards patient Aimed at identifying clients’ needs. E - Establish eye contact Developing mutual goals R - Relax!! 1. USING SILENCE Foundation of nurse-client relationship Sitting quietly (or walking with the client) and Develops gradually. waiting attentively until the client is able to put Client perceives an attitude of acceptance, thoughts and feelings into words. understanding, and empathy from the nurse. 2. PROVIDING GENERAL LEADS Confidential Can you tell me how it is for you? Perhaps you would like to talk about... Would it help to discuss your feelings? 3. BEING SPECIFIC AND TENTATIVE Fundamental concept in all phases of the Rate your pain on a scale of 1 to 10 (specific) Nursing Process Are you in pain? (General) Effective nurse-client relationship You seem concerned about your diabetes. 4. USING OPEN ENDED QUESTIONS Tell me more... You said you were frightened yesterday. How do you feel now? 5. USING TOUCH  Placing your hand over the client's hand 6. Audit and quality assurance Putting your arm over the client's shoulder 7. Planning client care 6. RESTATING OR PARAPHRASING 8. Reimbursement Client: I couldn't manage to eat any dinner last night -- not even dessert. Nurse: You had difficulty eating yesterday. Client: Yes, I was upset after my family left. 7. SEEKING CLARIFICATION 1. Admission sheet I'm not sure I understand that. Would you 2. Physician’s order sheet please day that again? Would you tell me 3. Medical history more? 4. Nurses’ notes 8. OFFERING SELF 5. Special records/reports I will stay with you until your daughter arrives, we can sit here quietly for a while. 9. PERCEPTION CHECKING OR SEEKING S – subjective data CONCENSUAL VALIDATION O – objective data Client: My husband never gives me presents A – assessment Nurse: You mean he has never given you a P – planning present for your birthday or Christmas? I – Intervention Client: Well -- not never. E - Evaluation 10. GIVING INFORMATION Your surgery is scheduled for 11 am tomorrow. You will feel a pulling sensation when the tube us removed from your stomach. 11. ACKNOWLEDGING You walked twice as far as today with your walker. I notice you keep squinting your eyes. Are you having difficulty seeing? 12. PRESENTING REALITY That telephone ring came from the program on TV. Your magazine is here in the drawer. It has not been stolen. 13. CLARIFYING TIME AND SEQUENCE Client: I vomited this morning. Nurse: Was it after breakfast? 14. REFLECTING Client: What can I do? Nurse: What do you think would be helpful? Documentation serves as a permanent record of client information and care. F – focus Reporting takes place when two or more people D – data share information about client care, either face to A – action face or by telephone. R – response Purposes of Client’s Record/Chart: 1. Communication 2. Legal documentation 3. Research 4. Statistic 5. Education  Huge volume of information All client information in one record Client database – add new data, create & revise care plan, document client progress. S – Situation o state name, unit, and client name o Briefly state the problem B – Background o client admission diagnosis o Date of admission, medical history o Brief summary of treatment A – Assessment o vital signs, pain scale, any change? R – Recommendation o state what you would like to see done. o HCP – orders or tests or medications o If no improvement, call HCP? Database Problem List Care Plans Progress Notes Initial Problems Nurses’ information listed in order narrative about the in which they notes client are identified. Assessment All aspects of Initial list of Flow sheets History, social, the person’s orders Discharge family data, life requiring Referral PE, and health care summaries baseline labs I – Identify S – Situation B – Background A – Assessment R – Recommendations R – Read back  Change of shift o For continuity of care Telephone Reports o When the call was made o Who made the call? o Who was called? o To whom was the information given? o What information was given? o What information was received? Transfer Reports o Transfer of patient from one unit to another OTHERS o Incident Report o Referral System o Health care electronic devices Abraham Maslow advocates that safety and security needs of people rank second in the priority needs. The need of people to protect themselves and in some instances to be protected is always Brevity present. o entries are concise. The environment around us contains many Ink hazards, both seen and unseen. o Avoid pencil. The need for safe environment relates to the o Evidence in legal court national concerns as well as to the community Accuracy and to the immediate environment of a person. o Facts A safe environment is one where the likelihood Appropriateness of a person becoming ill or injured because of o Information pertaining to the client only. factors in the environment is reduced to the Completeness lowest degree of possibility. o Chronology, organization, sequencing, Safety, is often defined as freedom from and timing. psychological and physical injury, is a basic Standard Terms human need. o Correct spelling and grammar Health care provided in safe manner and a safe o Approved abbreviations community environment is essential for a Signed patient’s survival and well-being. o Affix signature at the end of charting It is one in which people can function safely and Confidentiality one in which they obtain a sense of security. o Only health personnel are allowed to A safe environment has a number of general read the chart. characteristics. In Case of Error o It means freedom from injury such as o Draw a single line through the error. thermal, mechanical, radiation, electrical, Legal Awareness microbial, chemical, and psychologic. o Chart only what you have done, observed, heard, and felt. Legible o Writing must be clear and easily read by 1. Adequate lighting others. Night light as necessary, to prevent falls if the o If not legible, then PRINT client needs to go to the bathroom. Do not use patient or PT in the chart. To eliminate shadows. This would prevent o The word “patient” is not used in the chart. unnecessary fear, especially among children and o All information in the chart pertains to the confused clients patient. 2. Neat and clean 3. Emotions Litter and clutter are removed to prevent Acute anxiety, depression, preoccupation with accidents. pain/illness, alter ability to perceive Spilled food and liquid are cleaned up to prevent environmental hazards. slipping on the floor. Furniture are in accustomed places. 4. Injury or illness Ill or weak people are prone to accidents 3. Safe equipment Furniture/equipment is regularly maintained; 5. Sensory or communication impairment broken equipment and furniture can cause Unable to perceive potential danger or express accident. need for assistance. Electrical equipment in good repair. 6. Information/ safety awareness 4. Noise level is comfortable Knowledge deficit on safety risks for various Sound above 120 decibels is painful/damaging types of accidents. to the ears. 5. Cleanliness 1. Falls Excessive dirt and microorganism cause most common accident in the hospital infection 2. Client Inherent accidents 6. Medication Altered consciousness, impaired sensation, Kept separately in cupboards out of reach of impaired vision children to prevent poisoning 3. Procedure related accidents 7. Temperature of environment Hot water bag, steam inhalations, transport 65-75 F (18.3-23.9 C) 4. Equipment related accidents 8. Relative humidity Broken stretchers or wheelchairs 30-60% 9. Free of pollution such as: Air pollution Infant Toys – soft Land pollution Sides of the crib – up Water pollution Cover outlets Do not leave baby alone in bath, bed, Noise pollution table Toddlers Keep knives and other sharp tools Keep cleaning solutions in locked 1. Age cabinets Injuries are leading causes of death: poisoning All medicines in locked cupboard Play outside must be free from wells accidents, burns, falling, choking. deep ditches and pools Don’t accept candy from strangers. Preschooler Teach them to observe and to act safely Sport safety: helmet, knee pads, and elbow School Age Understand traffic rules pads. Learn to use equipment Use of drugs or nicotine :Health risks, accidents Need to handle farm animals (drowning, or motor vehicle). Adolescents Develop inner discipline (safe driver) Lifestyle habits: alcohol, smoking, stress Wear safety helmets Water safety 2. Orientation and level of consciousness Understand the Danger of alcohol & Unconscious, Semiconscious, Neurologic drugs impairment. Adults Don’t drink and drive Inability to communicate Elders Toys need to be out of the way Paralyzed, confuse Rugs need to be fastened Hand railings in the bathroom Alcohol withdrawal Safe environment Unable to perceive stimuli that may cause Frequently used supplies within reach trauma or injury  Microorganisms are tiny, microscopic, capable of carrying on living process. Falls Microorganisms are naturally present in the o Table near bed environment, as well as on the human body. o Lock wheelchair o Footstool Many microorganisms are harmless, unless an o Floors – non slip individual is ill, and then highly susceptible to o Tidy environment – don’t trip on cords, infection. furniture, toys There are some microorganisms that do cause o Railings in bathroom and corridors specific diseases or infections. Restraints SURGICAL ASEPSIS MEDICAL ASEPSIS o last resort Surgical asepsis, known Medical asepsis, known as sterile technique, as clean technique, Burns destroys all inhibits the growth and o check bath temperature, check heating microorganisms and spread of pathogenic pads, heat lamp, etc, assist with hot their spores. microorganisms: beverages Sterile technique and Hand washing. Chemical Trauma use in special skills and o label medication, keep medicine out of procedures. Changing the patients reach to young children, records linen daily. medications taken in Care of surgical wounds. Daily activities of cleanliness. Radiation Injury Urinary catheters. o injure skin, reproductive organs, bone Principles of medical marrow Invasive procedures and asepsis is common at surgery. home. Six elements must be present for infection to Microorganisms cause infection. occur: The growth and reproduction of a microorganism must be stopped to prevent an infection. 1. INFECTIOUS AGENT/ETIOLOGIC AGENT: Concern and education regarding transmissible microorganisms (bacteria, fungi, virus and infections have increased in both hospitals and parasites, protozoa, rickettsia) homes. 2. RESERVOIR: source (human beings, animals, Joseph Lister (1827 – 1912) is known as the inanimate objects, plants, general environment – father of aseptic technique. air, water, soil) 3. PORTAL OF EXIT: sputum, emesis, stool, blood 4. MODES OF TRANSMISSION: contact (b0dy to The education of all staff personnel is to minimize body – dressing, bathing, insertion of tubes), the risk of nosocomial infections. vehicle (food, water, milk, blood, utensils, Any patient entering a health care facility, due to pillows), airborne (dust particles contain the illness or need for invasive procedure is at risk pathogen) or vectorborne (rats, snails, for developing an infection. mosquito/infected body fluids through syringes The application of infection control principles, and and needles) use of common sense help protect the patients. Nurses are very often exposed to pathogenic 5. PORTAL OF ENTRY: mouth, nose, ear, vagina, microorganisms and should use specialized and rectum, urethra/breaks in the skin, wounds or routine practices of cleanliness to prevent the abrasions) spread of infection. 6. SUSCEPTIBLE HOST: immunosuppressed children, elderly, chronically ill, trauma or surgery Age  Concurrent diseases Adequate exercise, well balanced diet, current Stress immunizations. Immunization/vaccination status Discuss susceptibility of the patient to disease. Lifestyle and occupation Teach correct and safe methods of storing and Nutritional status preparing foods. Heredity Hygiene. Know family and others susceptibilities to disease. Incubation Stage: the time between entry of an Home cleaning techniques for patients cared for infectious agent and the onset of symptoms. at home. Prodromal Stage: the time from the onset of nonspecific symptoms until specific symptoms begin to manifest. Illness Stage: the time when client has specific signs and symptoms. Convalescent Stage: from the beginning of the Set of guidelines designed to reduce the link of disappearance of acute symptoms until client transmission of blood born pathogens and returns to previous state of health. pathogens from moist body secretions. Guidelines apply to: o Blood o All body fluids, secretions and excretions o Nonintact skin Term taken from the Greek word, meaning health o Mucous membrane care facility. o Precautions promote: An infection that is acquired while in a hospital or ▪ Handwashing other health care agency. ▪ Use of gloves, masks, eye This infection is usually acquired at least 12 hour protection after admission. ▪ Use of gowns when appropriate The hospital harbors microorganisms that may be for patient contact highly virulent. Infection acquired in hospital or other health care facility that was not present at the time of the The most important and basic preventive client’s admission technique for interruption the infectious process. Include those infections that become 2 minute handwashing will provide protection symptomatic after the client is discharged before the nurse cares for a patient. Four categories: urinary tract, surgical wounds, 30 second handwashing before caring for pneumonia, and septicemia. another patient should be sufficient to ensure These infections cause extended stays and minimal transmission of microorganism between treatment for patient, and increase cost of care for patients. the hospital. Valuable discipline in the health care arena. Hand hygiene–the most basic and effective These teams include who ? infection-control measure to prevent and control o OSHA has pressured hospitals to better the transmission of infectious agents. organize these teams, and document Single most important procedure for preventing infections within the hospital. nosocomial infections. What is the duty of infection control personnel ? Performing a 2 minute hand wash o Employee health services. Using an Alcohol-Based Waterless Antiseptic for Routine Hand Hygiene.  The nurse will need to educate patient about the nature of infection and the techniques to use in Standard precautions planning or controlling its spread: Airborne precautions o Infection control for home and hospice Droplet precautions settings. Tuberculosis isolation o Prevention of infection: Contact Precautions ▪ Hand washing Immunocompromised patients ▪ food preparation Monitoring of isolation ▪ lines ▪ waste containers ▪ body fluid spills Removal of soil or organic material from instruments and equipment used in providing client care. A host’s immune system is a defense against Involves the use of water, mechanical action, and infectious agents. sometimes, a detergent. An immune response against an antigen protects Nurses should wear gloves, masks, and goggles the body from infection. during cleansing. Immune defenses are identified as nonspecific and specific. Physical Method o Steam under pressure/moist heat Adaptive Immunity o Boiling water o Cellular (cytotoxic) o Radiation o Humoral (antibodies) o Dry heat Innate Immunity Chemical Process o Macrophages, neutrophils, eosinophils, o Gas basophils, monocytes o Chemical solutions o The complement system Non-specific Physical and Chemical Defenses o Barriers: skin, mucous membranes, Elimination of pathogens, except spores, from stomach acid, lysozymes in tears. inanimate objects. o Expulsion: coughing, sneezing, vomiting, diarrhea. Disinfectants – chemical solutions used to clean inanimate objects. Germicides – chemicals that can be applied to both animate (living) or inanimate objects to Protects host from all microorganisms; eliminate pathogens. does not depend on prior exposure to antigen: o Skin and normal flora. o Mucous membranes. Destroying all microorganisms including spores o Coughing, sneezing, and tearing Equipment that enters normally sterile tissue or reflexes. blood vessels must be sterilized. o Elimination and acidic environment. Methods include: o Inflammation: non specific cellular o Moist heat (steam) response to tissue injury o Dry heat ▪ Redness (erythema) (rubor) o Ethylene oxide gas ▪ Heat (calor) Autoclaving (moist heat or steam) is the most ▪ Pain (dolor) common method. ▪ Swelling (edema) (tumor) ▪ Loss of function ▪ Purulent Exudate (pus) Response specific to an invading antigen:  Acquired immunity – protects individual against Nosocomial Infection Also referred to a future invasions of already experienced antigens healthcare-associated Vaccination – an inoculation with a vaccine to infections (HAI), are produce immunity against specific diseases. infection acquired during the process of receiving health care that was not present during the time of Also called specific defenses, specific admission. immunity, adaptive immunity. Iatrogenic Infection An infection after medical Develops only after exposure to inducing agents or surgical management such as microbes, toxins, or other foreign or induced unintentionally substances. by the treatment or Involves a very specific responses to pathogens. comments of a physician or diagnostic procedures. Endogenous Infection Infection that is caused due to presence of an Localized Infections: limited to defines area or infectious agent already single organ with symptoms that resemble present in the body but inflammation (redness, tenderness, swelling), previously asymptomatic. such as cold sore. Exogenous Infection Infection in which the Systemic infections: affect entire body, involve bacteria or pathogen is multiple organs, such as AIDS. present in a closed system of our body, but it Type of Infection Definition enters sterile area such as Primary Infection The first time a host is brain, muscles, and result exposed to and infected in a disease. by a pathogen. During a Latent Infection Infection in which a primary infection, the pathogen resides in the body has no innate body without any manifest defenses against the symptoms. organism, such as antibodies, which can be developed through exposure or vaccination. Reinfection An infection by the same Risk for infection microorganisms, after Ineffective protection recovery from or during Impaired tissue integrity the course of a primary Impaired oral mucous membrane infection. Impaired skin integrity Secondary Infection The infection in which Deficient knowledge host cell has low immunity due to pre-existing infectious disease and gets infected by a new pathogen. Focal Infection A condition in which infection occurs at a problem solving approach to a clinical decision localized site such as making particular organ or part of The use of the best clinical evidence in a body but it shows o Making patient care decisions generalized effects on the o Comes from research. body. o Conducted by a nurse. Cross Infection It is an infection in which a o Or person in health care. patient is already suffering from a disease and a new infection is set 1. Clinical problem-solving strategy 2. Minimize decisions based on customs, authority opinion or ritual 3. Identifies the best available research evidence an integrate with other factors Offers a solution in improving health care quality in the current cost-constrained environment. Provides the best possible care to most people. Provides an important framework for self-directed lifelong learning. 1. Asking clinical questions that are answerable with research evidence. 2. Searching for and collecting relevant evidence 3. Appraising and synthesizing the evidence. 4. Integrating the evidence with your own clinical expertise, patient preferences and values and local context.  nurse should bear in mind that ALL substances are poisons: there is none that is not a poison. The right dose differentiates a poison from a A medication is a substance administered for the remedy. diagnosts, cure, treatment, or relief of a symptom or for prevention of disease. Pharmacology is the study of the effect of drugs One drug can have as much as 4 different names on living organisms. as follows: The written direction for the preparation and o Chemical Name any typical organic administration of a drug is called a prescription. name; this precisely describes the constituents of the drug ▪ Example: N-(4-hydroxyphenyl) Drugs can be administered for these purposes: acetamide for paracetamol Diagnostic purpose: to identify any disease Generic Name: is given by the manufacturer who Prophylaxis: to prevent the occurrence of first develops the drug it is given before the drug disease. Example: heparin to prevent thrombosis becomes official. It is the name by which the drug or antibiotics to prevent infection will be known throughout the world no matter how many companies manufacture it. This name is Therapeutic purpose: to cure the disease. usually agreed upon by the WHO. Often the generic name is derived from the chemical name. E.g., acetaminophen Prevention: used as prophylaxis to prevent Official Name: United States Adopted Name diseases e.g., vaccines; fluoride - prevents tooth (USAN) or Japanese Accepted Name UAN). It decay. will also apply for an International Nonproprietary Diagnosis: establishing the patient's disease. or Name (INN) through the World Health problem e.g., radio contrast dyer tuberculosis Organization (WHO). (Mantoux) testing. Suppression: suppresses the signs and symptoms and prevents the disease process Medications may be classified according to from progressing e.g., anticancer, antiviral drugs The body system that the medicine is targeted to Treatment: alleviate the symptoms for patients interacts with, e.g., cardiovascular medications, with chronic diseases e.g., anti-asthmatic drugs nervous system medication etc. Cure: complete eradication of diseases e.g., Therapeutic usages of the medicine, e.g., antibiotics, anti-helminthics antihypertensives, neuroleptics, Enhancement aspects of health: achieve the The diseases the medicine is used for o. B best state of health e.g., vitamins, minerals. anticancer drugs, antimalaria drugs anthelminthics etc, Preparation, dispensing and administration of Principles include 3 checks and 10 Rights: medications are all covered by laws in every country. Dangerous Drug Act 1930 and The Narcotic Drugs and Psychotropic Substances Act 1. Check when obtaining the container of medicine. 2. Check when removing the medicine from the 1985. It is an act that governs the procurement and use of some drugs especially the narcotics container. 3. Check when replacing the container. e.g., morphine, pethidine, cocaine etc. These drugs are prescription only drugs hence cannot be bought or administered without prescription. Dangerous drugs are always kept under lock and Medication errors can be detrimental to patients. To key In the Dangerous Drug Cupboard under the prevent these errors, these guidelines are - the rights- are care of trusted senior nurses. used in drug administration. It is worth knowing that nurses are responsible for 1. Right Patient: the correct identification of the their own actions regardless of the presence of a client cannot be over emphasized. This can be written order. If a nurse gives an overdose of a done by asking the client to mention his/her full drug because it is written by a doctor, the error is name which should be compared with that on the accounted to the nurse and not the doctor. The  identification bracelet or the patient's folder and medication/treatment chart for confirmation. 2. Right Medication: before administering any The drug order, written by the physician, should has 7 medicine, compare name on medication essential parts for administration of drugs safely. chart/medication order with that on the 1. Patients full name medication at least 3 times-checking medication 2. Date and time labels when removing it from storage unit, 3. Drug name compare medication label with that on treatment 4. Dosage chart and medication label and name on 5. Route of administration. treatment chart with patient's name tag. Beware 6. Time und frequency of administration. of same and similar first and surnames to prevent 7. Signature of physician. the error of administering one person's medication to another and vice versa. 3. Right Time: drug timing is very especially with some drugs like antibiotics, antimalaria drugs etc. Four types of medication orders are commonly used: to achieve cure and prevents resistance. Some 1. Stat order: A stat order indicates that the drugs must be given on empty stomach e.g., medication is to be given immediately and only antituberculosis drugs; and some after meals e.g. once e.g., morphine sulfate 10 milligrams IV stat. NSAIDS-these must be noted and adhered to. 2. Single order: The single order or one-time order The interval of administration of drugs should also Indicates that the medication is to be given once be adhered to because it is important for many at a specified time. e.g., Seconal 100 milligrams drugs that the blood concentration is not allowed at bedtime. to fall below a given level and for others two 3. Standing order: Standing order is written in successive doses closer than prescribed might advance carried out under specific increase blood concentration dangerous level circumstances. (e.g., amox twice daily 2 days). that can harm the patient. 4. PRN order: "PRN" is a Latin term that stands for 4. Right Dose: careful and correct calculation is "pro re nata," which means "as the thing is important to prevent over or under dosage of the needed. A PRN order or as-needed order, medication. permits the nurse to give a medication when the 5. Right Route: an acceptable medication order client requires It. (e.g., Amphojel 15 mL prn) must specify the route of medication. If this is unclear, the prescriber should be contacted to clarify or specify it. The nurse should never Medications are available in variety of form. The form of decide on a route without consulting the the medication determines its route of administration. prescriber. 6. Right to information on drug/client education: Tablet: It is the powdered medication the patient has the right to know the drug he/she compressed into hard disk or cylinder. is taking, desired and adverse effects and all there is to know about the medication. The Capsule: Medication covered in gelatin shell. charter on patient's right made this clear. Gel or jelly: A clear or translucent semisolid that 7. Right to Refuse Medication: the patient has the liquefies when applied to the skin. right to refuse any medication. However, the Lozenge: A flat, round, or oval preparation that nurse is obliged to explain to patients why the dissolves and releases a drug when held in the drug is prescribed and the consequences mouth. refusing medication. Lotion: Drug particles in a solution for topical 8. Right Assessment: some medications require use. specific assessment before their administration Ointment: Semisolid preparation containing a e.g., checking of vital signs. Before a medication drug to be applied externally. like Digoxin is administered the pulse must be Powder: Single or mixture of finely ground drugs. checked. Some medication orders may contain Solution: A drug dissolved in another substance. specific assessments to be done prior to Suspension: Finely divided, undissolved medication. particles in a liquid medium; should be shaken 9. Right Documentation: documentation should be before use. done after medication and not before. Syrup: Medication combined in a water and 10. Right Evaluation: conduct assessment to sugar solution. ascertain drug action, both desired an side effect. Suppository: An easily melted medication preparation in a firm base such as gelatin that is inserted into the body (rectum, vagina, urethra)  Transdermal patch: Unit dose of medication Therapeutic Effects: the therapeutic effect is the applied directly to the skin for diffusion through expected or predicted physiological response that skin and absorption into the bloodstream. a medication causes. o E.g., paracetamol reduces pain, fever, and inflammation Side Effects/Adverse Effects: every medication Different route of drug administration are: causes some harm to patient. Oral o Side Effects: are predictable and often Parenteral unavoidable secondary effects produced o Parenteral administration involves at a usual therapeutic dose. injecting a medication into body tissues. ▪ E.g., Nausea, loss of appetite, The following are the four major sites of stomach pain. injection: o Adverse Effects: are undesirable and ▪ Intradermal (ID): injection into unpredictable severe responses to the dermis just under the medication. epidermis. Toxic Effects: develop are prolonged intake of a ▪ Subcutaneous (SC): Injection medication or when a medication accumulates in into tissues just below the dermis the blood because of impaired metabolism or of the skin. excretion. ▪ Intramuscular (IM): Injection o E.g., liver damage or kidney damage into a vein or muscle. Allergic Reactions: unpredictable ▪ Intravenous (IV): Injection into a immunological responses to a medication. vein. o E.g., paracetamol produces rash or swelling as allergic reaction. Idiosyncratic Reactions: a patient overreacts or underreacts to a medication or has a reaction different from normal. o E.g., a child receives Benadryl becomes extremely agitated or excited instead of drowsy. Different systems available are: Topical Metric system o Medications applied to the skin and Household system mucous membranes (eye, ears, nose, Metric System Household System mouth, vagina, urethra, rectum) 1 ml 15 drops Inhalation 5 ml 1 teaspoon o Administer inhaled medications through 15 ml 1 tablespoon the nasal and oral passages or Apothecary system: It is an older system. The endotracheal or tracheostomy tubes. basic unit of weight in the apothecary system is Some medications are administered into body cavities. the grain (gr) and the basic unit of volume in the These additional routes include: minim. The other units of weight are the dram, the ounce, and the pound. The units of volume are Epidural: administered in the epidural space. the fluid dam, the fluid once, the pint, the quart, Intrathecal: administration of medications into and the gallon. subarachnoid space or one of the ventricles of the Solutions: A solution is a given mass of solid brain. substance dissolved in a known volume of fluid or Intraosseous a given volume of liquid dissolved in a known Intraperitoneal volume of another fluid. For example, 1 10% Intrapleural solution is 10g of solid dissolved in 100mL of Intraarterial solution.  Metric System Apothecary System Dietitian: design special diets and they supervise the preparation of meals according to 1 mg 1/60 grain doctor’s prescription. 60 mg 1 grain Physiotherapist: provide assistance to patient 1g 15 grains who has problem related to musculoskeletal 4g 1 dram system. 30 g 1 ounce o Functions: 500 g 1.1 pound (lb) ▪ Assessing mobility and strength 1 ml 15-16 minims ▪ Providing therapeutic measures 5 ml 1 fluid dram ▪ Teaching patients new skills and 30 ml 1 fluid ounce measures. 500 ml 1 pint Social Worker: provide assistance to the family 1L 1 quart and patient. He provides assistance in the 4L 1 gallon problems such as finances, counselling r marital problems, adoption of children, etc Occupational Therapist: assist patient with some impairment of function to gains skills as they related to activities of daily living and help with a skill that is therapeutic. First, convert the drug amount to the same units and then Laboratory Technician: examines and study use the formula. specimens such as urine, feces, blood, and discharge from wound. 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ 𝑟𝑒𝑞𝑢𝑖𝑟𝑒𝑑 Radiologic Technologist: assist with wide 𝐷𝑜𝑠𝑒 𝑅𝑒𝑞𝑢𝑖𝑟𝑒𝑑 = = 𝑛𝑜. 𝑜𝑓 𝑡𝑎𝑏𝑙𝑒𝑡𝑠 𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ variety of X-Ray procedures. Pharmacists: dispense drugs and medications Stock strength is the amount written on the drug cover. prescribed by physicians, physician assistants. Nurse practitioner, and dentists. Community Health Worker: a member of the First, convert the drug amount to the same units and then community and play an important role in use the formula. identifying a community’s problems and in developing solutions. 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ 𝑟𝑞𝑑 𝑥 𝑣𝑜𝑙. 𝑜𝑓 𝑠𝑡𝑜𝑐𝑘 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 Other members include dentist, respiratory 𝑉𝑜𝑙. 𝑟𝑒𝑞𝑢𝑖𝑟𝑒𝑑 = therapist, and spiritual support personnel. 𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ  Coordinator o coordinates and plans care Health team is defined as “a group of persons o piece together fragmented care who share a common objectives determined by o prepares patient for discharge community needs and toward the achievement of o liaison in health care team which each member of the team contributes in  Communicator accordance with her/his competence and skills, o establish rapport and respecting the functions of the other. o establish therapeutic (helping) relationship o be aware of verbal and non-verbal communication Physician: is a person who is legally authorized o assertive communicator to practice medicine. In hospital setting, the  Teacher physician is responsible for the medical diagnosis o educate patient to develop self-care and for determining the therapy required by a abilities person who is ill or injured. o provide knowledge to allow patient to Nurse: number of personnel may be involved in make informed decisions a health team. The team leader “head nurse” is o demonstrate needed skills responsible for delegation od duties to members o promote health, prevent illness, restore of her team and care given to the patient. health and facilitate coping  Counselor o assist and guide patient in solving  the role of the nurse is varied and complex. problems or making decisions  caring for patient requires that nurses take on o utilize the interpersonal (helping) different roles at different times relationship  nurses need to fulfill their varied roles as best as o nurse does not tell patient how to solve possible by understanding their roles and problem. Guides patient to decisions knowing how to improve in eacg role. (self-determination) o utilize the nursing process. o “could you just listen)  Manager o plans o organizes o directs o controls o delegates  Leader o have visions to energize others o motivates others to achieve goals o encourages others to do their best o works collaboratively o have wider variety of roles then managers  Team Player o nurses are part of a team o do not work on isolation o who are the other team members? o what does being a team player mean?  Motivator o motivation – is the internal impulse that allows one to take action or change behaviors. o nurses motivate patients to make changes by: having a positive attitude, listening to patient needs, encouraging, rewarding, and devoting time and energy to assist with changes.  Critical Thinker o a way of looking at problems other than the obvious o “thinking outside the box” o looking at the big picture o question why something is being done o ask, “what if….” o open to new ideas  Innovator o Takes action to make things happen o Initiates change o Sees a problem and looks for solutions. Instead of, “Oh well, there’s nothing that can be done about it” the innovator will be proactive.  Advocate o protect and support the patient o patient representative for all patient o assertiveness o promote self determination