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By Z. Hengley. Unity College. 2018.

Differentiate drug dosage forms for various routes and purposes of administration fucidin 10gm free shipping. Mabel Zack is transferred to your rehabilitation facility after a cerebral vascular accident (stroke) 2 weeks ago quality fucidin 10 gm. When you review her chart generic fucidin 10gm free shipping, it indicates she has right-sided hemiparesis 10gm fucidin, memory deficits order fucidin 10gm with amex, and dysphagia (difficulty swallowing). Reflect on: Outline appropriate assessments to determine if it is safe to give Ms. Zack can take medications orally, what precautions can you take to help ensure her safety? OVERVIEW GENERAL PRINCIPLES OF ACCURATE DRUG ADMINISTRATION Drugs given for therapeutic purposes are called medica- tions. Giving medications to clients is an important nursing • Follow the five rights consistently. The basic requirements for accurate drug adminis- effects, adverse effects, and any specific instructions tration are often called the five rights: giving the right about administration). These rights require knowledge of the name, dose, frequency of administration). Question the drugs to be given and the clients who are to receive them as prescriber if any information is unclear or if the drug well as specific nursing skills and interventions. This chapter is concerned with safe and accurate different dosage forms and concentrations; it is ex- medication administration. You explain that desirable interactions with other drugs and IV solutions). On exiting the room, you look at the room number and realize that you just gave medications to Mr. LEGAL RESPONSIBILITIES This promotes safer administration and reduces errors. When abbreviations are used, by prescribers or others, in- Registered and licensed practical nurses are legally empow- terpret them accurately or question the writers about ered, under state nurse practice acts, to give medications or- intended meanings. Current nursing practice re- nurse practitioners may prescribe medications. However, when they are needed, accuracy is for safe and accurate administration. For medications with a narrow safety margin may be held liable for not giving a drug or for giving a wrong or potentially serious adverse effects, ask a pharmacist drug or a wrong dose. In addition, the nurse is expected to or a colleague to do the calculation also and compare the have sufficient drug knowledge to recognize and question results. The fact that a physician wrote an check measurements of insulin and heparin, unusual erroneous order does not excuse the nurse from legal liability doses (ie, large or small), and any drugs to be given if he or she carries out that order. The nurse also is legally responsible for actions delegated • Use the correct procedures and techniques for all routes to people who are inadequately prepared for or legally barred of administration. For example, use appropriate anatomic from administering medications (such as nursing assistants). The basic techniques and guidelines de- cations to ordered drugs; new signs or symptoms that scribed in this chapter are aimed at safe and accurate prepa- may indicate adverse effects of administered drugs; ration and administration; most errors result when these heart, liver, or kidney disorders that may interfere with practices are not followed. Legal responsibilities in other aspects of drug therapy are • Verify the identity of all clients before administering less tangible and clear-cut. One reason is their great diversity, in age from birth to MEDICATION ERRORS 18 years and weight from 2–3 kilograms (kg) to 100 kg or more. Another is that most drugs have not been tested Increasing attention is being paid to the number and conse- in children. A third reason is that many drugs are mar- quences of medication errors. In one study of 1116 hospi- keted in dosage forms and concentrations suitable for tals, medication errors (a total of 430,586) were reported in adults. This often requires dilution, calculation, prepara- approximately 5% of admitted patients. Each dose of a drug must be recorded require additional treatment, or death). Specific drugs often associated with errors include in- ized, locked cabinets for which each nurse on a unit has a sulin, heparin, and warfarin. These automated systems maintain an inventory getting each dose of a medication to the intended client.

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The pain undergo remodeling fucidin 10 gm with visa, although the ability of pathologic os- decreased from a mean of 8 order 10 gm fucidin with mastercard. Ability to perform activities of daily living The effect of different cement volumes on the biome- improved significantly post PVP order 10 gm fucidin. For simplex P buy 10 gm fucidin with mastercard, the volumes marked to complete relief and 32% had moderate relief of needed were 6 cc and 8 cc order fucidin 10gm otc, respectively. At a mean fol- that approximately 15% volume fraction or approximately low-up of 11 months, pain relief was complete in 47% and 3. The largest prospective study re- foramen ported on 100 patients who underwent PVP for vertebral compression fractures. At final follow-up averaging 21 months, 97% of the patients reported significant pain re- duction, with the VAS improving from 8. They all underwent PVP and showed a statistically significant improvement in VAS pain score immediately after the procedure, which remained at 30, 90, and 180 days after the procedure. Ad- ditionally, there was a significant improvement in the gen- eral health status as assessed by Nottingham Health Pro- patients without causing any clinical symptoms, while file, which includes pain, mobility, emotional reaction, so- there have been reports of transient neuropathy and cial isolation, and energy. The longest follow-up has been reported by Perez- We have consulted on a patient in whom PVP was per- Higueras et al. The VAS improved sig- the spinal canal causing symptoms of spinal stenosis. The nificantly from a score of 9 pre PVP to 2 immediately post patient underwent a decompression and removal of ce- PVP, to 1 at 3 months. There was a significant pain reduc-, 17 patients had CT scans performed immediately af- tion, as the mean VAS decreased from 9. There was one case of a pedicle fracture and no to the vertebra was found in 48% of the cases, with only cases of pneumothorax. The risk of ce- The issue of timing of vertebroplasty was reviewed by ment leakage into the spinal canal or venous system is in- Kaufman et al. Seventy-five patients with 122 VCFs creased with higher volumes of injected cement. The age of the fracture at time of PVP problem is so feared that some have advocated the use of was not independently associated with post PVP pain or pre PVP venography to assess the risk of cement leakage. The procedure was efficacious in reducing pain Venography can document sites of potential leakage dur- and improving mobility in patients, regardless of the age ing cement injection [21, 42, 63]. However, the authors found that increasing raphy was performed prior to vertebroplasty, and the results age of the fracture was independently associated with in- retrospectively reviewed. Whether the delay in flow characteristics of cement within the vertebral body and carrying out PVP leads to tolerance of and dependence on within the venous structures. While venography could pre- pain medication, leading to higher requirements post PVP, dict cement leakage into endplates or central defects in is not known. Another study specifically looked at 205 PVP procedures in 137 patients Complications without antecedent venography, and found only one ce- ment leakage causing symptoms of radiculopathy. The value While these clinical studies have shown good success rates of antecedent venography will need to be determined with in improving pain and function, the procedure is not with- prospective studies. Most series report a compli- A topic of interest is the occurrence of new vertebral cation rate of between 4 and 6% [3, 15, 18, 28]. Reported body fractures after PVP in patients with osteoporosis [2, complications associated with the insertion of the needle 9, 62]. This was noted in a follow-up of 25 patients who include rib fractures, neuritis, pedicle fracture underwent PVP. The most feared complication is The authors found a significantly increased risk of verte- the potential for leakage of cement into the spinal canal bral fractures adjacent to a cemented vertebra, with the (Fig. In another report, 177 patients treated with PVP tebral height, to 30% of the original height. The abil- for osteoporotic fractures were followed for a minimum ity to restore vertebral body height has been shown in other of 2 years. Two-thirds (67%) of shown increased vertebral height, but not the level of in- the new fractures involved a vertebra adjacent to a previ- crease obtained in the laboratory. The patients were followed prospec- New developments for treatment tively for 3 months. In 70% of the patients, height was re- of osteoporotic spine stored to 46.

Because it acts by trading sodium for potassium discount fucidin 10gm mastercard, the sodium retention may lead to edema buy fucidin 10 gm. Drugs that increase effects of minerals and electrolytes and related drugs: (1) Alkalinizing agents (sodium bicarbonate): effects are Small amounts of antacids may be absorbed to produce additive increased by antacids cheap fucidin 10gm without a prescription, such as magnesium hydroxide order 10 gm fucidin with amex, cal- effects order fucidin 10gm on line. It may produce hyperkalemia if given in com- bination with potassium supplements. Drugs that decrease effects of minerals and electrolytes and related drugs: (1) Alkalinizing agents: effects are decreased by acidifying Acidifying drugs neutralize effects of alkalinizing agents. Iron is best absorbed in an acidic environment and antacids increase alkalinity. An iron preparation and a caffeine-containing substance (eg, coffee) should be separated by at least 2 hours. What are the major roles of minerals and electrolytes in Answer: Ferrous sulfate is an iron preparation that helps restore normal body functioning? Take 1 tablet with meals to avoid gastric irritation, which can occur if 2. When a client is given potassium supplements for hypo- stool black or dark green and is very constipating. Because con- kalemia, how do you monitor for therapeutic and adverse stipation may be a factor during the postoperative period because drug effects? Adding KCl to an IV bag with only 200 cc remaining would could you provide about good food sources of iron? Also, adding KCl to an existing IV should be avoided whenever possible because 9. What are advantages and disadvantages of iron supple- if the potassium is not mixed adequately with the solution in the ments? It would be prudent in this situation to waste the 200 cc of IV fluid in the bag that is hanging and hang a new 1000-cc bag with the ad- SELECTED REFERENCES ditional 20 mEq of KCl added. Medical Clinics of North Amer- Pathophysiology: Concepts of altered health states, 6th ed. Discuss important elements of using anti- adverse effects of antimicrobial drugs. Identify clients at increased risk for adverse with renal or hepatic impairment, and those drug reactions. A major characteristic of microorganisms is their abil- ity to survive in various environments. Bacteria, for example, Antimicrobial drugs are used to prevent or treat infections may form mutant strains, alter their structures and functions, caused by pathogenic (disease-producing) microorganisms. These adaptations The human body and the environment contain many micro- may protect them from normal body defense mechanisms and organisms, most of which live in a state of balance with the antimicrobial drugs. Drug-resistant bacterial strains can be human host and do not cause disease. Classifica- upset and infection occurs, characteristics of the infecting tions, normal microbial flora, and common pathogenic mi- microorganism(s) and the adequacy of host defense mech- croorganisms are described in the following sections. Conditions that impair defense mechanisms increase the incidence and severity of infections Classifications and impede recovery. In addition, use of antimicrobial drugs may lead to serious infections caused by drug-resistant micro- Bacteria are subclassified according to whether they are aer- organisms. Viruses are intracellular parasites that survive only in liv- ing tissues. They are officially classified according to their structures, but are more commonly described according to MICROORGANISMS AND INFECTIONS origin and the disorders or symptoms they produce. Human pathogens include adenoviruses, herpesviruses, and retro- In an infection, microorganisms initially attach to host cell re- viruses (see Chap. For example, Fungi are plant-like organisms that live as parasites on some bacteria have hair-like structures that attach them to living tissue or as saprophytes on decaying organic matter. Most microorganisms preferen- Approximately 50 species are pathogenic in humans (see tially attach themselves to particular body tissues. Detection of antigens uses The human body normally has areas that are sterile and areas features of culture and serology but reduces the time required that are colonized with microorganisms. Another technique to identify an organism in- body fluids and cavities, the lower respiratory tract (trachea, volves polymerase chain reaction (PCR), which can detect bronchi, lungs), much of the gastrointestinal (GI) and geni- whether DNA for a specific organism is present in a sample.

Now exhale and bring the body weight to a 50/50 distribution fucidin 10gm for sale, while bringing both hands together in front of the chest and squeezing a meatball order fucidin 10 gm otc, or holding an imaginary ball with the hands purchase 10gm fucidin fast delivery. Points for Attention: Palms should be as flat as possible when hold- ing the plate of spaghetti discount fucidin 10 gm overnight delivery. Effects: Good for inflammation in the shoulder buy fucidin 10 gm with mastercard, elbow, and wrist joints and for asthma, trachitis, and kidney diseases. From the end of the previous movement (holding an imaginary ball at chest level), let both arms drop to the sides of the body and bend knees slightly [Photo 16]. Bringing the arms backward and upward, begin raising the arms until they are overhead, palms facing forward [Photo 17]. Allow the arms to drop slowly down, palms down, while bending the knees. This movement is repeated continuously, effecting a rowing, or butterfly stroke, motion. Points for Attention: Keep the back straight when descending and keep the gaze level. Effects: This form helps improve the function of the digestive system and is good for gastrointestinal ailments, heart disease, and neurasthenia. Scoop with the right hand across the body to the left and upward, as if scooping up a ball, and hold the palm up at shoulder level [Photo 18]. Drop the right hand back down to your right side, and repeat the movement with the left hand toward the right side of the body. Points for Attention: Look at the ball you are imagining to be holding, and keep the shoulders relaxed. Visualization: Imagine you are a young child, gleefully playing with a ball. Effects: Increases coordination and balance, works the shoulder joints and wrist joints. TLFeBOOK Q igong E xercises / 83 Form 8 Gazing at the Moon Over the Shoulder 1. Swing the arms backward, upward, and to the left while turning the trunk in coordination, turning the head as if to look at the moon, and exhale. The left arm is outstretched and pointing at the moon, the right hand is palm up beneath the left armpit [Photo 20]. Swing both arms down and repeat to the right side of the body [Photo 21]. Points for Attention: The arms, trunk, and head should all move as a single unit. Visualization: Imagine you are pointing out the magnificent moon to a friend. Press the right palm, fin- gers pointing up, across your stomach and to the left side of the body, keeping the right arm close to the body. Meanwhile, the left hand parks on the left side, palm up with the little finger touching the side of the body and the fingers pointing forward [Photo 22]. Bring the hands back to a central position with the palms facing upward and fingers pointing at each other [Photo 23]. Repeat this movement in the opposite direc- tion, with the left hand pressing and the right hand parking [Photo 24]. TLFeBOOK Q igong E xercises / 85 Points for Attention: Keep the arms close to the body and low on the torso. Visualization: Imagine you are slowly pressing against two walls that are pressing in on you. Move the hands as if there is a short length of string tied to both wrists, so that they move in unison. Effects: This form is good for toning the waist muscles and learning to use minimal effort. From a neutral stance, begin circling the left hand counterclockwise, keeping the palm facing the body [Photo 25]. As the left hand passes in front of the face, the right hand is slowly being pulled across the lower abdomen to the left by virtue Photo 25. As both arms arrive at the left side of your body, drop the left arm down and raise the right arm [Photo 28]. Now circle the right hand clockwise, again keeping the palm toward the body at face level, as the left arm is allowed to pass across the lower abdomen [Photos 29 through 32].

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