Journal 1.1
When managing verbal orders, the overriding principle for every nurse is safety. This is because it has a higher potential for causing errors as the speaker may be misheard or misinterpreted due to the medium being used. This order may be accepted by a registered nurse when the authorized prescriber is absent. The procedure requires that the nurse first starts by identifying him or herself, then specifying the patient’s name before communicating the order. Thereafter, the receiver documents this order immediately through the prescriber order form. The order information is then repeated back to the authorized prescriber including; the name of the patient, drug name and its spelling, dosage which is given in single digits, route of administration, and frequency (Gorbach et al., 2015). Thereafter, the receiver follows up on the medication indication to ensure an error was not made. Finally, he confirms with the prescriber if there are any uncertainties. After the order has been successfully communicated, the prescriber must countersign the order in not more than 24 hours.
A standing order, on the other hand, authorizes specific persons with no prescribing rights, to supply and administer given medicines and other controlled drugs to a given group of people without prescription. The procedure involves printing out the appropriate standing order administration document and completing it. Next, the authorized individual administers or dispenses the medication. Thereafter, the administration is also updated in the document. If the patient showcases any adverse reactions or complications, these should also be indicated in the documentation (Gorbach et al., 2015). Lastly, the document is scanned into record, and the original is placed in the Senior Nurse Practice’s in-tray for review and audit.
PRN is an abbreviation of a Latin term which usually means, “As is needed”. It is a medical order made by the health care professional. First, the order needs to be signed and dated. Second, the healthcare professional is expected to identify the name of the medication, its strength and the formulation. Third, the quantity and route of administration are also included. Next, the professional is supposed to calculate the required intervals between doses so as to understand the number of times a dose is to be taken. The result is also indicated in the document. Next another determination which is needed is the maximum dose for a 24 hour period. The reason for administration and the expected outcome must also be documented in the PRN order. The date the doctor started PRN is also indicated in the document.
Journal 1.2
The standard routes of medication administration are; oral, injection, rectal, vaginal, ocular, otic and nasal. The abbreviation S/C should never be used to refer to subcutaneous as it has been reported for causing confusion and medication errors. It is often assumed to mean sublingual. Therefore, the recommended term is “subcut”. Also, the abbreviation µg should not be used in medical orders because of confusion as well. It intends to mean microgram, which is also mistaken for mg. Therefore, the best approach is to write “microg”.
Journal 2.1
From the case study, the patient is suffering from severe dehydration. When administering IV solutions, the patient should be given that which has a tonicity that is opposite their problem (Greenberg & Bowden, 2009). Therefore, the solution that should be given in this case is a hypotonic solution since the patient’s blood is hypertonic as a result of dehydration. The hypotonic solution will bring back the tonicity to the normal range.
Journal 2.2
When a patient is dehydrated, the blood vessels tend to position deeper into the skin. This is because the body tries to respond to the excessive loss of water through sweating too. Therefore, this will make it quite difficult to locate and access the vein for IV therapy. Using access devices are advantageous both for the patient and professional because the whole process becomes simple and effective. It allows for frequent access to the veins without the need for deep needle sticks. It has other advantages in the sense that it reduces risk of vein irritation, formation of blood clots and even inflammation and scarring. It is more comfortable for the patient, hence reducing anxiety that one would have experienced when using the usual IV.
Journal 3.1
To determine the total mls per hour of the IV normal saline solution, the following formula will be used since the infusion pumps do not feature a calibrated drop factor.
Volume (mL) = Y (Flow Rate in ml/hr)
Time (min)
Therefore,
1000ml
1 hour
= 1000 ml/ h
In relation to Gentamycin the following calculation will be used to determine dosage.
Amount Desired x quantity
Amount on hand
=300 x 2ml
80
= 7.5 mls will be administered to Mr. Bourke
Lastly, to calculate the drip rate for administering the metronidazole using a macro infusion set, the following formula is employed.
Volume x drop factor
Time
Since 100 mg of the metronidazole is added to 100 mls of saline solution, it is necessary to start by calculating the total volume first. In this case, there is 100 mg/100 mls, which is equal to 1mg/ml
=100mls x 20
20
= 100 drops per minute.
Journal 4.1
The purpose of medication alerts is to offer the various health care professionals with the necessary safety information relating to the different medicines prescribed (Phansalkar et al., 2014). These alerts are basically information from the local, national and even international sources. This alert specifies the actions which the health professionals should take, the time within which these steps must be taken, and the responsibility of such an action. Basically, it seeks to offer guidance on specific realizations to ensure patients receive the best medication and in the appropriate dosage. In case a medication is noted to trigger negative effects, the alerts will warn the health services and give them guidance on how to prevent the medication from being prescribed to individuals.
Journal 4.2
As an enrolled nurse, my administration of medication is defined by specific factors. First, I am allowed to prescribe medication because I have completed the EN medication administration education. Second, I rely on the rules presented on the legislation which is why I have had to conduct a thorough analysis of the state and territory drugs and poisons legislation. I have also had to gain sufficient knowledge of the policy requirements of my health department, the workplace policies, and even the procedures and protocols that must be followed during drug administration. Therefore, these are the rules which I must follow whenever I am administering drugs to patients.
Journal 4.3
The therapeutic goods act is responsible for the regulation of therapeutic goods such as prescription medicines, vaccines, vitamins and minerals, blood and blood products, and even medical devices. It controls the supply of these products within Australia by requiring that they all pass through the Australian Register of Therapeutic Goods before any distributions are made.
Journal 4.4
The national health act applies to the benefits relating to medications, sickness and hospital benefits, including the medical and dental services. It features several laws and regulations which try to ensure that patients will benefit from the healthcare services offered to them.
Journal 5.1
When educating a patient on taking a course of oral medications, the three important points are; first, always take the right dosage at all times. Do not increase or decrease unless advised otherwise by the healthcare professional. Second, always take the dose at the required time to ensure a balance in the time difference. Third, always complete the dose. Do not stop even if you start experiencing relief from the symptoms.
Journal 5.2
When there is a delayed adverse drug reaction, the situation needs to be managed promptly. The first step to take is to administer antihistamine to the patient to relieve the discomfort (Brodowy & Nguyen, 2016). Second, since this is a delayed reaction, it is impossible to determine which drug caused it. Therefore, all the drugs prescribed recently will be identified and set aside for further research. When an acute adverse drug reaction is experienced, the next step will be to provide antihistamine before considering which drug it was and stopping the dosage immediately (Brodowy & Nguyen, 2016).
Journal 5.3
The five assessments that I would conduct on a patient receiving peripheral therapy are as follows; First, assess whether the systolic blood pressure falls under 100 mmHg; second, Assess whether the heart rate is going much faster than 90 beats per minute; third, check for the capillary refill time. It should not be more than 3 seconds, and the peripherals should not be cold; fourth, check for the respiratory rate which should not be beyond 20 breathes per minute. Lastly, assess for peripheral oedema, the peripherals should appear normal and not swollen.
References
Brodowy, B., & Nguyen, D. (2016). Optimization of clinical decision support through minimization of excessive drug allergy alerts. American Journal Of Health-System Pharmacy, 73(8), 526-528. doi:10.2146/ajhp150252
Gorbach, C., Blanton, L., Lukawski, B. A., Varkey, A. C., Pitman, E. P., & Garey, K. W. (2015). Frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center. American Journal Of Health-System Pharmacy, 72(17), 1471-1474. doi:10.2146/ajhp140673
Greenberg, C. S., & Bowden, V. R. (2009). Administration of Hypotonic Solutions vs. Isotonic Solutions In Hospitalized Children. Pediatric Nursing, 35(1), 62-63.
Phansalkar, S., Zachariah, M., Seidling, H. M., Mendes, C., Volk, L., & Bates, D. W. (2014). Evaluation of medication alerts in electronic health records for compliance with human factors principles. Journal Of The American Medical Informatics Association, 21(e2), e332-e340. doi:10.1136/amiajnl-2013-002279
