Case Studies, Chapter 29, Medications PDF

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Case Studies, Chapter 29, Medications 1. You are a nurse caring for a 47-year-old patient who is homeless. He is admitted to your unit two to three times per year. His medical history includes diabetes mellitus (type 2), hypertension, and alcoholism. After extensive hygienic interventions (to decrease his body odor, wash his hair, and perform oral care), you complete your assessment and find that he is not in compliance with any of his dietary and medication instructions from his last admission. (Learning Objectives 4 and 5) a. Considering his history, what types of medications would you expect to be ordered? I would expect his orders to look like: insulin, to control his diabetes; an antihypertensive to regulate his blood pressure. Being that our patient is homeless, he may have additional things going on with his skin: possible bug bites, rashes, lice (etc); these should be taken into consideration during an assessment and the hospitalist should be notified. b. Outline the patient variables that could impact the action of these medications. Is the patient allergic to the medication? Do they require patient education? Will they be resistant to the medication? c. Indicate the components of an acceptable medication order. Client’s name, medication name, dosage, the route of the medication, the frequency given, and the signature of the person who ordered the medication.

d. Describe acceptable practice when nurses are ordered to dispense a medication with which they are unfamiliar. To research the medication before they give it in order to be able to educate the patient on the medicine and know the side effects and contraindications. e. How would you identify that patient before dispensing his ordered medication? It is important to make sure you have the right patient so you do no give the wrong meds to someone. This mistake can lead to a fatality.

f.

What measures would you take if the patient refused his oral medications because he didn’t like the taste? I would try crusing his medications and putting them in applesauce or pudding to mask the taste

2. You are a nurse preparing a medication safety presentation for your unit’s monthly staff meeting. The focus of the presentation is avoiding medication errors and the necessary due diligence for every member of the nursing staff. (Learning Objectives 4 and 7) a. When can medication errors occur? Errors can occur at any time, when the order is being prescribed, during communication about the order, during labeling. It is important to pay attention to the clients prescription order at all times.

b. Which classes of medications are more typically connected to medication errors? Narcotics and other controlled substances. c. Outline the appropriate label check opportunities. I should check the label when retrieving the drug, when I enter the patients room and when I rescan at the eMar. d. What “rights” should be monitored to ensure accurate medication administration? The right patient, time, route, to refuse, dose, medication e. Describe how often nurses should check medication data to protect their patients. Three times f.

Indicate the additional information you would expect to document upon administering a narcotic medication. The patient’s vital signs, the time of dosage

g. What steps are pertinent to administering medications via GI tube to maintain patient comfort and safety?

1. Administer each medication separately. 2. Stop the feeding and flush the tube with water before and after medication administration. 3. Crush only those medications which are immediate-release. 4. Use liquid medications when available.

h. Outline precautions necessary to prevent needlesticks. 1. 2. 3. 4. 5. 6. 7. 8.

Avoid re-capping of needle Before beginning the procedure involved needles, plan safe handling and disposal of needles Use needles with safety features Report all needlestick and sharp-related injuries to the concerned authority. Avoid leaving sharps and needles lying around Do not bend, breaking the needles before discarding them Lock the container when it is three-quarters full using the closure mechanism Carry sharps containers by the handle, away from the body...