2050 Exam 2

Role of EHR in Med Admin

Ensures Right Dose
Ensures Right Patient

Role of RN in Med Admin

Administration
Patient Education
Allows Patient to be Knowledgeable

Role Of Unit Clerk in Med Admin

Scanning/Labeling

Role of Pharmacy Techs in Med Admin

Fill Omnicell

Responsibility of RN in Med Administration

Know Normal Doses
Appropriate Route
Approved Use of Medication
Know Mechanism of Action
Understand Side Effects, Toxicity, and Adverse Reactions
Last line of Defense for Medication Errors

Parts of A Complete Medication Order

Name/DOB
Date of Order
Drug Name and Dose
Route
Administration Time
Signature of Provider

Drug Resources

Electronic Health Records
Phone Apps
Drug Guides

Types of Medication Orders

Written - Very Rare
Computerized Physician Order Entry - COPE
Verbal Orders - highly discouraged

Steps of Verbal Medication Order

Write Down, Read Back, Obtain Signature within 24hr

5 Rights of Med Administration

Right Patient
Right Dose
Right Time
Right Drug
Right Route

One Time Dose

Start 15mins before or After

BID

Twice a Day

TID

Three times a Day

3 Checks of Med Administration

Check the MAR
Compare Drug to MAR when Pulling
Compare Drug to MAR when Administering

PO

Orally

Buccal

Mucosa of Inner Cheek

Sublingual

Under the Tongue

Nasal/Ophthalmic

Nose

Inhalants

By Mouth - with Inhaler

National Patient Safety Goals

Improve Accuracy of Patient ID
Improve Safety of Using Medications

Medication Reconciliation

Comparing what the patient is taking with what they should be taking
Done with Every Admission, Transfer, and Discharge
Includes Prescription, Herbal, and OTC

Wearing Gloves in Med Admin

Not Needed Unless Touching Bodily Fluids

Ophthalmic Medications

Soothing
Dilates or Constrict Pupils for Surgery
Treats Eye Diseases
Place Drops in Conjunctival Sacs
Be Sure To Place in Correct Eye
Use Ordered Amount of Drops
Do not Abbreviate When Documenting Which Eye

Nasal Medications

Given by Sprays, Drops, or Tampons
Rebound Effect can Happen with Sprays
Require Proper Positioning

Do Not Leave Meds in Patient Room

Otic Medication

Unaffected Ear Up
Main purpose is to treat infection, or soften wax
Given at room Temperature

Inhalation Medications

Local Effect - Broncho Dilators - Mucolytic Agents
Have potential systemic Side Effects
Metered doses

Topical Medications

Lotions, Patches, Pastes, Ointments
Use Gloves When Applying
Clean Area of Application
Remove Patches as Ordered

Rectal Medications

Clean Technique
Local Effect - Promote Defamation
Systemic Effect - Relieve Nausea
Contraindicated with Rectal surgery or active bleeds
Use Water Based Lubricant
Do Not Cut Suppository
Monitor Heart Patients

Enteral Medications

Verify Tube Patient
Assess Client for Gastric residual and bowel function
Head of Bed at 30 degrees minimum
Only Liquid meds in tube - shush tablets and Capsules

Standards Of Nursing Practice

Define Tasks ALL nurses are expected to be competent in
Provide Care with Ethics
Standard of Care

Standard of Care

Care a nurse provides as compared with other nurses of the same education and training
Equal care for Equal Education

Read over Nurse Practice Acts

Role of APRN

Providers
Autonomy depends on state - practice directly under physician in most
Leadership
Participate in professional development and Education
Participate in Healthcare Policy

APRN and Patient Care

Plan Care, Prescribe Meds, Prescribe Interventions, Document Patient Outcomes, Follow Nursing Process

Role of RN in Patient Care

Nursing Process, Delegate, Assess, Educate

Nursing Process

Assessment, Diagnosis, Planning, Implementation, Evaluation

Assessment

Independently Assess Clients

Diagnosis

Analyze and Interpret Assess - Cannot Diagnose Disease Process
Determination of Priorities
Determine Whether Patient Findings are Expected or Unexpected

Planning

Patient Outcomes
Interventions
Perform Ongoing Tasks
Delegation of Tasks
We Receive Tasks from the Providers

Implementation

Develop and Implement Teaching Plans
We have the ability to do IV therapy
We act Autonomously within and interdisciplinary Team

Evaluation

Did Interventions Work
Evaluate Others Work

Practical Nurses - LPN

Take NCLEXPN
Partial Nursing Process - Data Collection, Planning, Implementation, Evaluation
Works Under Supervision of RN
Cannot Diagnose or Independently treat clients
Often Work in Long Term Care facilities, or physicians offices

Assistive Personnel

Unlicensed
Can be Certified Nursing Assistant - Still not Licensed
No Decision Making Model
Cannot Feed Anyone with Swallow Precautions
Vital Signs on Stable Clients Only
Can do Specimen Collection

Delegation

Process of assigning part of responsibility to another qualified Person
State Nursing Boards Assist with how Delegation Works
RN is Still Responsible for Tasks Delegates
Delegation is Based on Nurses Assessment Findings

5 Rights of Delegation

Right Task
Right Circumstance
Right Person
Right Directions
Right Supervision

Right Task

Is it within employee's job description
Describe expectations, limits, and required training for an activity
Job descriptions and training can change based on unit

Right Circumstance

Is the patient Stable

Right Person

Is the delegate prepared in both knowledge an skill

Right Directions and Communication

Clear, Concise, Descriptions of the Task
Include Objectives
Communication should be ongoing between staff involved
Communication allows for shared decision making

Right Supervision and Evaluation

Provide Monitoring - timeliness, documentation, security for NA
Evaluate - Outcome, Intervene as Needed - knowledge error or work overload
RN's must follow up

Definitions of Pain

Whatever the person says it is doing, whatever the patient says it does - Margo McCaffery
Unpleasant sensory and emotion experience associated with actual or potential damage or described in terms of such damage

Biopsychosocial Spiritual Model

Physical/Biological Pain
Phycological Pain
Social Pain
Spiritual Pain

Physical/Biological Pain

Physical Limitations can heighten pain
Sleep Heightens Everyone

Psychological Pain

We don't remember pain
Depression/Anxiety/fear can heighten pain
Past Experiences with Pain can lend to Fear/Anxiety of being in pain again

Social Pain

Affects Quality of Life
Culture
Finances

Spiritual Pain

Why am I in Pain - Will it go Away - Why God?
Cultural
Some Believe they must suffer through pain because they are being punished

Nociception Pain Mechanism

Transduction
Transmission
Perception
Modulation

Types of Pain

Nociceptive Pain
Neuropathic Pain
Referred Pain
Acute Pain
Chronic Pain

nociceptive pain

Caused by damage to somatic or visceral tissue

Somatic Pain

Deep aching or throbbing - localized from joint/bone/muscle/skin/connective tissue

Visceral Pain

Internal Organs/intestine/bladder due to inflammation/ stretching/obstruction/surgial incisions - produces cramping/squeezing

neuropathic Pain

Damage to peripheral nerves or structure in the CNS
Trauma/inflammation/metabolic diseases/ infection of nervous system/neurological diseases
Cannot Be treated by Opioids Alone

Neuropathic Pain Symptoms

Numbing/Burning/Shooting/Stabbing/lingering/sharp/electric shock like pain

Neuropathic Diseases

Herpes
MS

Phantom Pain

Pain experienced in a limb which in no longer there

Referred Pain

pain that is felt at a place in the body different from the injured or diseased part where the pain would be expected

Acute Pain

Sudden

Chronic Pain

Gradual
>6 months
Mild to Severe
Original Pain may differ from Machnisms that maintian the pain
Pain does not go away - wakes and waning - flairups

Pain Assessments

OLDCARTS - PQRST

Subjective Findings

Patient Reported
Pain Scale
Pain Characteristics

Objective Findings

Nurse Observed
Vital Signs
Assessment Finding

Mild Pain Scale

1-3

Moderate Pain Scale

4-6

Severe Pain Scale

7-9

10/10 Pain

Worst Pain Imaginable

Wong Baker Scale

Ages 3 and Up - point to the face on the paper

FLACC Scale

Can be used from 2 months to 7 years old
Can be used throughout life with cognitive impairments
Face, Legs, Activity, Cry, Consoleability

Consequences for Untreated Acute Pian

Increased Morbidity
Respiratory Dysfunction
Increased Heart rate and Cardiac Work Load
Increased Muscle contractions/spasms
Decreased GI motility
Increased Catabolism
Hyperglycemia

When to Reassess for Pain

15-30 mins after IV pain meds
45mins -1 hour after IM,SQ
1 Hour after PO medications

Nonpharmacological Methods for Pain Managment

Distraction
Massage
Exercise
Acupuncture
Cold/Heat Therapy
Elevation
TENS Unit
Music Therapy
Guided Imagery

Multimodal Approach To Pain Medication

2 Analgesics used together
Goal is to provide maximum pain relief with minimum doses, and adverse effects

Drug Therapy NSAIDS

Analgesic Ceilings
Mild to moderate pain
Available OTC
In conjunction with Opioids produces Sparing Effect

NSAID risk Factors

GI Bleeds

Ibuprofen Ceiling

600mg

Max Dose of Acetaminophen

4000mg per day

NSAID examples

Ibuprofen, Ketorolac, Meloxicam

Morphine

Prototype Opioid
Moderate - Severe Pain

Hydromorphone (Dilaudid)

Stronger than Morphine - lasts shorter duration
1.5g M = 10mg D
Severe Pain

Oxycodone ER

moderate to severe pain
ER - extended release - used for chronic pain

Methadone

Chronic Pain Med
AMDA Receptor Agonist
Accumulates with Repeat Dosing

Tramdol

Dual Mechanism - MU receptor - Blocks reuptake of serotonin and NE
Chronic Back/Bone pain

Fentanyl

Patches 12-17 hours effect - Remove after 48 Hours
Small Doses
Can be Given continuously IV for sedated Patient

Opioid Naive

Never Had Opioid

POSS Opioid Sedation Scale

1 Awake and Alert
2 Slightly Drowsy
3 Frequently Drowsy - Monitor Patient
4 Somnolent - No Response - Cease Opioid Immediately

Tolerance

Lack of response to Drug
Requires Increase Opioid to Relieve Pain
Rotate Opioids

Physical Dependance

Body is Dependent on Opioid
Experience Withdrawal
Taper Doses
NOT ADDICTION

Drug Addiction

Neurobiological Condition
Compulsive use
Loss of Control
Use Despite Risks of Harm
Affects Limbic (survival System) and Prefrontal Cortex

Early Manifestations of Opioid Withdrawal 6-12 hours

Anxiety
Diaphoresis
Hacking, Chills, Tremors
Dilated Pupils
Anorexia

Late Manifestations of Opioid Withdrawal 48-72 Hours

Excitable - easy to stimulate
Diarrhea, Nausea, Vomiting
Restlessness
Fever
Hypotension - Tachycardia
Insomnia