Nursing Essentials Essay Example

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The acceptable time-frame for administering scheduled medications as a nurse is defined as 30 minutes before and 30 minutes after the prescribed time (some institutions allow 1 hour before and 1 hour after). The "six rights" rule provides guidelines to ensure accurate medication administration. The first rule, the right patient, requires using two forms of patient identification and asking for their name and birth date instead of "Are you...?" to avoid confusion. If the patient is confused, assistance from family or another staff person during report may be necessary. The second rule, the right drug, involves understanding the drug's intended action and double-checking orders and medications with similar names or appearances (such as Dioxin or Dalton). In case a patient questions the medication, thorough double-checking is essential before administering it. The right dose rule encourages nurses to consider if the dose falls within the normal range prior to administration.

Review the units of measurement ordered against the units of measurement supplied - Gram-milliards Micrograms-milliards. During clinical work, develop familiarity and skills using med cups, eye/ear droppers, and needles/syringes. Shake all liquid suspensions well before pouring. Double check pediatric dosages with another nurse. Double check high-risk meds with another nurse. Clarify all your questions first. Right Route: Physicians order the route to be given. If no route is ordered, clarify with the physician and rewrite the order correctly. If the patient cannot tolerate the ordered route, clarify and obtain or write the new order. Assure that the ordered route is compatible with the drug reference recommended route. When mixing powders, be reasonable in the amount you mix - make sure the patient will be able to

drink all of it. Right Time: The physician orders the number of times per day - Bid, did, quid, q 6 h, daily. Know the standard administration times policy in your facility. Daily @0900 or HAS @2100. Drugs may be given 30 minutes before and 30 minutes after prescribed time (some facilities allow 1 hour before and 1 hour after). For PRNG drugs, know the purpose for which the drug was ordered, assuring it corresponds to why you are giving it. Always check on the time it was last given.

Immediately after administering a medication, it is essential to chart and record the administration details. It is crucial to follow up and document any instances where a medication is not given and provide the reason for this omission. If a patient refuses a medication, unless they are legally mandated to take it, their refusal should be respected. Medications should only be recorded after they have been administered, and they should never be left at the bedside for the patient to take later unless specifically instructed by the Director. In case of a drug error, it must be documented in the patient's chart, including information on what was administered, who was notified, and any subsequent assessments conducted on the patient. The documentation should consist of factual information without explicitly stating that an error occurred. Additionally, a variance report must be completed to explain the incident's specifics. Regularly checking medication orders and being vigilant for signs indicating changes or discontinuation of medications is crucial.

The sterile areas of a syringe and needle include the shaft and barrel. Subcutaneous (SQ) injections are given in adipose tissue. When selecting

a site for SQ injections, it is important to choose an area that is free of skin lesions, bony prominences, and large underlying muscles or nerves. To ensure consistent absorption of insulin, it is recommended to rotate injections within the same body part. For example, if the morning insulin is injected into a patient's arm, the next injection should be administered in a different location on the same arm, at least 2.5 CM away from the previous site.

It is recommended to avoid using the same site for at least 1 month. The abdomen has the fastest absorption rate, followed by the arms, thighs, and buttocks. Adults should use a needle size of 20-23 gauge with a 1 inch needle, while children should use a needle size of 25-27 gauge with a half to 1 inch needle. The injection angle can be either 45 or 90 degrees (45 degrees if pinching up 1 inch of skin, and 90 degrees if pinching up 2 inches of skin). Certain medications require specific subcutaneous (SQ) sites for administration. SQ anticoagulants are given in the abdomen using an air-locking injection technique. The maximum amount that can be injected into an SQ site is 1 ml. Insulin syringes must only be used for insulin and cannot have their needles changed. Regular syringes need their needles changed when mixing drugs from multi-dose vials. It is recommended to inject morning insulin into one arm for patients receiving daily SQ injections and the next injection should be given in a different location in the same arm, at least 2.5 cm away from the previous site.

The discussion revolves around the administration of intramuscular

(IM) injections and their specific locations. The recommended muscle for these injections is called Vast laterals. They should be given in the middle 1/3 of this muscle, which is located a hand breadth above the knee and below the greater trochee.

When administering the injection, it is advised to position the patient in a supine position with a slightly flexed knee. This method is commonly used for infants and toddlers, with a maximum injection amount of 2 ml.

Another acceptable site for IM injections is the Ventricular area. To administer in this area, place your hand's heel on the greater trochee, with your index finger on the anterior superior iliac spine and your middle finger toward the iliac crest, creating a Y shape with your hand. For this site, position the patient on their side opposite to where you will inject them, with their knees flexed.

It is considered to be the safest and deepest muscle to inject even when patients are emaciated as it contains fewer nerves.

The maximum injection amount allowed is 3 ml. For injections in the upper outer quadrant of the buttocks (gluteus medius), find the posterior superior iliac spine and greater trochanter. The patient should be positioned prone with their knees turned in. Please be careful as there is a risk of hitting the sciatic nerve or major blood vessels in this area. Additionally, for injections in the deltoid muscle, locate the lower edge of the acromion process and identify the triangular shaped area below it. Inject in the center of this triangle, which is approximately 1-2 inches below the process and 3 finger breadths below it. The patient can be

either sitting or lying flat with their lower arm flexed. Be aware that this is a small muscle and is in close proximity to the radial and ulnar nerves.

The choice of needle gauge and length is influenced by various factors. Smaller gauge needles are used for elderly, emaciated, or atrophied muscles. The acceptable needle length/size for adults is 20-30 gauge with a 1 inch needle, while for children it is 25-27 gauge with a 1 inch needle. The injection should be administered at a 90 degree angle. Among the available sites, the least desirable one is Deregulated because there is a possibility of hitting the sciatic nerve or major blood vessels in this area. The amount of medication that can be injected into each IM site varies, with Vast laterals allowing for ml, Ventricular allowing for ml, Deregulated allowing for 3 ml, and Deltoid allowing for 1 ml. The purpose of the "Z-track" technique is to minimize irritation caused by irritating substances by sealing the drug in the muscle to prevent leakage into subcutaneous tissue. It is commonly used in deeper muscles like Ventricular or glutens medius. To create an "air-lock," a small amount of air (Ml) is drawn into the syringe after measuring the medication dosage, leaving an air-bubble at the end of the syringe. The air-bubble is then injected after the medication to prevent bruising and stinging, and to disperse the medication throughout the tissue, avoiding nerve endings. For infants and toddlers, Vast laterals is preferred because their muscle is thick and well-developed.Ventricular is the preferred and safe site for people of all ages, including adults, children, and infants. This muscle

is the safest and deepest even if it becomes weak due to lack of nutrition. Additionally, it has fewer nerves. To properly pour a liquid medication, place the medication on a flat surface at eye level and explain the procedure verbally.

Take caution when pouring medication into a medication cup to prevent overflowing the label, rendering it illegible. In such cases, return the cup to the pharmacy and request a replacement. If a medication is dropped or contaminated, it is your responsibility to dispose of it appropriately and notify the pharmacy for a replacement. When delivering medication, if a patient questions its accuracy, ensure thorough double-checking before administering it. To properly receive verbal or telephone orders, include all previously mentioned information along with the name and credentials of the person providing the order. The specific order is as follows: 8/25/10, 2100 Demeter 100 MGM IM sq h PRNG for path DIR.

Marc D Ryan/Juliann Kennedy, RAN Noted 8/25/11@2110Juliann Kennedy, RAN 15. The priority of medication administration should be determined by assessing the patient's clinical condition on an ongoing basis. This includes prioritizing nursing diagnoses and administering medications in the order of highest priority. Timely administration of medications that are required around the clock, such as antibiotics, is necessary to maintain therapeutic serum levels. Medications aimed at managing pain or preventing serious harm to the patient, such as cardiac medications and antiserum drugs, often have a higher priority than other medications. 16.

It is essential to evaluate various factors when administering medication to patients, including their current state which encompasses medical and surgical history, current medications, allergies, diet, mental and physical capacity. Other considerations include coordination

deficits, attitudes towards medication use, learning needs, family involvement, and availability of community services.

If there are any uncertainties or concerns about a doctor's prescription, it is crucial to question it and take appropriate actions. Likewise, expectations for all physician orders for patients undergoing surgery should be discussed.

When giving medications to unprepared patients, specific actions must be taken such as waiting for readiness or providing necessary assistance.

The term "parental routes" refers to different methods of administering medication like subcutaneous (SQ or SC), intramuscular (IM), intravenous (IV), or intramural.

To extract medication from a vial or ampule, certain steps need to be followed. These steps should be verbally communicated and carefully executed throughout the process.

The VIAL Cap is removed and the stopper is considered sterile until it is touched or used. For multi-dose vials, you must wipe them with alcohol before drawing up medication. It is important to date and tie all lit-dose vials, as multi-dose vials are only good for 24 hours and must be disposed of after this period (insulin is an exception). Before inserting a needle into the stopper, draw up an equal amount of air to the amount of drug you plan to withdraw for easier withdrawal. For example, if you need 1 ml of medication, inject 1 ml of air into the vial first. Some vials contain powder and will need to be mixed with an acceptable diluent (solution).

When preparing normal saline or sterile water, it is crucial to adhere to the manufacturer's guidelines. Some powders may take longer to dissolve, so gently shaking or rolling them in your hands can assist in the process. Wait for a brief period

until the mixture is fully dissolved. Remember to review the storage requirements for each medication, as some may require refrigeration. When using an AMPLE (Allergies, Medications, Past medical history, Last meal, Events leading up to the problem) for a single dose, cover the neck/stem with an alcohol wipe for finger protection. Snap off the top away from yourself to avoid any injuries. It is essential not to inject air into the AMPLE before withdrawing the drug. Instead, employ a filter needle to draw up the contents and prevent glass fragments from contaminating the solution. Always replace the needle prior to administering an injection. Lastly, discuss the distinctions between insulin syringes and regular medication syringes.

To prevent contamination when using two medications in multi-dose vials, it is important to change the needle before withdrawing each medication. However, for insulin syringes, needle changes are not allowed.
If a medication accidentally falls on the floor, it must be discarded and the pharmacy should be informed for a replacement.
The essential components of a medication order include the date and time of writing the order as well as the patient's name and birth date (or ID number) on the physician's order form. It is also crucial to understand different types of orders such as STATS, NOW, PRNG, standing orders, and single orders.

Name of drug Dosage of drug to be administered Route of administration Frequency-how often (sometimes orders are for specific number of doses-ex-q 8 hours xx doses) Signature of physician or licensed independent practitioner (LIP) Any special orders, if applicable, such as STATS, etc The licensed nurse must note/verify each order 6/15/09, 2100 Morphine 4 MGM IV sq h

PRNG for pain. Dir. Joseph M. Jones Noted 6/1 5/09 @2120 Tiffany Johnson, RAN Telephone and verbal orders Must include the same information plus the name and credentials of person giving the order 8/25/10, 2100, Demeter 100 MGM IM sq h PRNG for pain Dir. Marc D. Ryan/Juliann Kennedy, RAN Noted 8/25/11 @2110 Juliann Kennedy, RAN STATS orders A STATS order means that you guava a single dose of medication immediately and only once.

Health care providers often issue STAT orders in emergency situations when there is a sudden change in the patient's condition. These orders are more specific than one-time orders and are used when medication needs to be administered quickly but not immediately, as in a STAT order. It is crucial to refer to your agency policy to determine the time frame for administering a NOW medication after it has been ordered. NOW medications should only be given once. For example, administer pantomimic 1 g IV piggyback NOW according to PRNG orders. Occasionally, a health care provider may prescribe a medication to be administered only when necessary for a patient. This type of order is called a PRNG order. You must rely on objective and subjective assessment as well as nursing discretion to decide whether the patient requires the medication.

The healthcare provider often sets a minimum time interval for medication administration, meaning the medication should not be given more frequently than prescribed. In cases of constipation, the recommended dosage is 30 ml of Magnesium hydroxide to be taken orally as needed (PRN). This medication is typically continued based on a standing order until it is canceled by the healthcare provider or after

a certain number of days. Standing orders may have a specified end date or number of doses. Many institutions have policies in place to automatically discontinue standing orders. For severe pain treatment, initially 20 milligrams (mg) of Aquamarine are taken orally, followed by 500 mg intravenously (IV) daily for 2 days, and finally 500 mg orally daily for 7 days. Single (One-Time) Orders are given when a healthcare provider instructs for medication to be administered only once at a specific time.

This is a common practice for administering preoperative medications or medications given before diagnostic examinations. In this case, Versed, 6 MGM IM, is given on call to OR 26. One advantage of using intravenous therapy is that drugs are directly injected into the bloodstream, allowing for immediate drug action. As for the assessment and documentation nurses make for patients receiving IV therapy, they evaluate the potency of the infusion system by observing how fluid is being infused from the bag to the patient. This assessment includes verifying the correct IV fluid and rate, and it is an ongoing process carried out at the beginning, throughout, and at the end of a shift. Any abnormal findings should be communicated to the RAN. Additionally, nurses also assess the condition of the IV site for infiltration.

When the needle is taken out of the vein and the solution is infused into the surrounding tissue, it can cause swelling, pain, decreased skin temperature in that area, pale color, or redness. To treat this condition, it is advised to stop the intravenous (IV) therapy and use a warm or cool washcloth.
Phlebitis refers to inflammation of the vein caused by

irritation or trauma. It can be identified by redness, swelling,
pain, warmth at the site, and a hard or cord-like feeling in the affected vein. To treat phlebitis, discontinue IV therapy and apply warm moist soaks to prevent clot dislodgement.
If there is an infection or inflammation due to bacterial contamination at the catheter tip, symptoms may include redness,warmth,tenderness swelling at site with possible pus drainage. In such cases, it is necessary to discontinue IV therapy. The physician will prescribe appropriate treatment and may request a culture test on site if needed.
Lastly,it's important to mention that microorganisms can enter bloodstream skeptically.

Usually a result of poor aseptic technique or contaminated equipment, the signs and symptoms of infection include fever, chills, or profuse sweating, as well as AN/D (affected nursing diagnosis) and malaise. The recommended treatment is to discontinue the intravenous (IV) and inform the physician, who will likely order blood cultures, a culture of the tip of the IV catheter, antibiotics, and increased observation.

Circulatory overload occurs when excessive amounts of fluids are infused too rapidly or when a volume of fluid is too great for a patient with poor heart pumping function. The signs and symptoms include tachycardia, Wesleyan (a type of abnormal heart rhythm), cough, shortness of breath, inspiration crackles, 3rd heart sound, arrhythmias, restlessness, change in level of consciousness, and decreased oxygen saturation. The recommended treatment is to slow down the IV rate to TOOK (to keep open) and inform the physician immediately, following any new orders provided.

Air embolism is a rare but lethal condition in which air enters the bloodstream through the IV. The signs and symptoms include chest pain, shoulder pain,

shortness of breath, occasions (notably coughing up frothy sputum), tachycardia. It is crucial to immediately report these assessment findings to the physician. In case of cardiopulmonary arrest, basic life support should be initiated.

Allergic reactions can occur as a result of blood transfusion or medications. The signs and symptoms are similar to any allergy and may include hives, itching, wheezing, and possible nonphysical effects. The recommended treatment is to discontinue the allergen but keep the IV fluids infusing TOOK to maintain access for emergency medications. It is important to notify the physician immediately and follow facility protocols for allergic reactions if available.

The discussion should focus on the best practices to reduce the rates of unnecessary injuries among healthcare workers. One important approach is to avoid using needles whenever alternative systems that do not require them are available, or when using sharps with engineered sharps injury protection (SEPSIS) safety devices. Additionally, it is crucial not to recap any type of needle. Proper planning for the safe handling and disposal of needles should be done before starting any medical procedure. It is essential to dispose of needles, needless systems, and SEPSIS immediately into puncture-proof and leak-proof sharps disposal containers. Another topic of discussion should be interventions to address potential complications experienced by patients.