Exam 1: Patient Safety; Medication Administration and Vital Signs
Responding to medication errors Steps after PT is safe
1. Check the pt's condition immediately once error is realized, observe for development of adverse effects related to the error 2. Notify the provider and charge nurse and/or unit manager 3. Report the incident using hospital reporting system (follow hospital protocol)
Bradycardia
<60 beats/min; can be from: hypothyroidism, congenital heart defects, Infection, etc.
Tachycardia
>100 -180 beats/min; Shortness of breath at rest or activity
Identifying systemic factors on the unit that may have contributed to the event
A near miss has taken place on a medical unit in which a client nearly received a unit of packed red blood cells of an incompatible blood type. In the follow up to this event, which action should be prioritized?
The nurse details the client's response and the examination and treatment of the client after the incident.
A nurse is filing a safety event report for an older adult client who tripped and fell when getting out of bed. Which action exemplifies an accurate step of this process?
Important info needed prior to administering medications:
Allergies Weight Diagnoses/ co-morbidities Pregnancy, breast-feeding Other medications being taken
Drug half life
Amount of time it takes for 50% of serum drug concentration to be eliminated from the body
12-20 breaths per minute
Normal respiration rates for an adult person at rest range from
Adverse drug reaction
Noxious unintended, undesired effect; can be severe, may require d/c drug
PASS (fire extinguisher)
Pull, Aim, Squeeze, Sweep
Encourage exercise that improves balance and muscle strength
The nurse is providing education to a group of healthy older adults. Which nursing recommendation best promotes client safety in an independent living environment?
Ask to examine the client alone in order to speak to her privately
The nurse overhears an older adult client's son talking to her in a very aggressive and violent way. When the nurse walks into the room, the son changes and speaks kindly to his mother and the health care providers. What should the nurse do about this observation?
Morse Fall Risk Assessment Tool (scored)
Total Score: <25 Low Risk 25-45: Moderate Risk >45: High Risk
Distribution
Transportation of drug molecules to action sites in the body (into cells)
Hyperthermia interventions
•Apply cool/room temperature water to skin •Ice packs to underarm, groin area, behind neck (wrapped so as not cause injury) •Electric fan placed in safe area of room •Cooling blankets if available •Medications (antipyretics) Cool liquids if appropriate for patient
Metabolism (Biotransformation)
•Change of drug from original form into a new form •Liver tends to be primary site for this (most drugs are inactivated here and prepped for excretion)
Systemic improvements to prevent medication errors
•Computerized health records (EMR) •Computerized provider order entry •Bar code medication administration •Automated drug-dispensing systems •Unit dosing
Normal pulse range
60-100 beats per minute
-Use filtering software to block objectionable information. -Be alert for downloaded files with suffixes that indicate images or pictures. -Investigate any public chat rooms used by the children.
A nurse is teaching parents about Internet safety for children. Which action(s) is a recommended guideline for Internet use? Select all that apply.
Prescribing stage
Order must include the following: Patient's name and secondary identifier (DOB, MRN) Name of drug to be given Dosage of the drug Route of drug administration Frequency of administration Date and time order is written Signature of prescribing provider
Timed Up and Go (TUG)
Performance based, timed test measuring patients ability to rise from a chair, walk 3 meters and return to chair. Results may be correlated with risks for fall and need for assistive ambulation device. (14 seconds or more = high risk of falling)
Hypoventilation
Rate: <10 breaths/min Pattern: Slow Depth: Shallow, < normal depth Apneic: 0 breaths/min for short period of time •Sleep apnea, infant respiratory distress, Whooping cough Hypoxia can occur with poor lung function Hypercapnia occurs - retain CO2
Hyperventilation
Rate: >24 breaths/min Pattern: Rapid Depth: Deep, > normal depth (individual) Hypoxia can occur in the brain Vasoconstriction Hypocapnia occurs - release of CO2
Hyperthermia: Too high
T>100.5 F Febrile with symptoms T>101 F Fever of Unknown Origin (if >3 weeks investigate) T>104 F Febrile, potential for seizure (ex: heat stroke, infection..) T>106 F Hyperpyrexia (brain damage..) (look for LOC)
Idiosyncratic effect (paradoxical effect):
Unusual or peculiar response to a drug -unique to individual patients
Adverse Events Reporting Errors
•Failure to monitor and document patient's response •Failure to identify and report adverse drug reactions/events
Adolescent variables affecting temperature
•Gonadal hormones (mood) •Muscle mass/injury/disease
High alert medications
•Insulin (subQ and IV) •Anticoagulants (heparin, warfarin) •Narcotics (morphine, oxycodone) •Neuromuscular blocking agents (succinylcholine, vecuronioum) -2 nurses check
Infant variables affecting temperature
•Reduced skin surface •Underdevelopment of thermal regulatory system
Rights of Administration
•Right medication •Right patient •Right dosage •Right time •Right reason •Right assessment data •Right documentation •Right response •Right to education •Right to refuse
Pulse determined by palpation:
•Unable/weak to palpate (0-1+) •Normal/thready palpation (2-3+) •Bounding to palpation (4+)
When to assess Vital signs
Admission/per policy guidelines (shifts) Change in condition (trends) Before administering certain medications (safety) Procedural care (reactive outcomes) Change in orders (plan of care)
One
Although____ of every four older people (>65 years old) falls each year, less than half of them tell their provider.
Generic name of Drug
Assigned by the manufacturer that first develops the drug
Drug tolerance
Body becomes accustomed to the drug; over time larger doses of the drug must be given to achieve desired effect
Trade name
Brand name copyrighted by the company that sells the drug
Adult/Elderly variables affecting temperature
Chronic disease Mobility/exercise Decrease in skin integrity/decreased metabolism Endocrine disorders
Medication cart
Contains drawers for individual pt room #s to place medications in; may have scanner attached for barcode med administration
Oral
Rectal or ear readings are higher than
RACE (fire safety)
Rescue Activate (alarm) Confine Extinguish/Evacuate
1 breath to 4 heart beats
Respiration measured in breaths/min
Toxic effect
Specific groups of symptoms related to drug therapy that carry risk for permanent damage or death
•130-139 (diastolic 80-89 mm Hg)
Stage I Hypertension
•>140-149 (diastolic >90 mm Hg)
Stage II Hypertension
Trough drug level
The lowest plasma concentration of a drug, and it measures the rate at which the drug is eliminated
Rectal reading
The most accurate way to take a temperature is through
-Bedside table with client's personal items is at the foot of the bed. -Oxygen by nasal cannula in place; tubing on floor; flow meter at ordered 3 L. -Call light is at top of bed under the pillow. (these all need to be fixed)
The nurse is caring for an older adult client. Which situational assessment findings establish the need for interventions? Select all that apply.
Two (2) Thermoregulatory Centers:
•Cardiac, abdominal •Skin (peripheral)
Responding to medication errors
*Immediate priority is the safety of the patient*
Sentinel event
An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
Chemical name of drug
Describes the drug's chemical composition and molecular structure
Allergic effect
Drug is interpreted as foreign substance by body--body has immune response, antibodies form against the drug; may lead to anaphylaxis
Drug interactions
Drug(s) is affected by another drug, food, or other substance taken at the same time
•120-129 (diastolic <80 mm Hg)
Elevated Blood Pressure (not yet hypertension)
Neurogenic fever
Fever with an origin in the CNS usually caused by CNS trauma, intracranial bleeding, or increase in ICP. High fever resistant to antipyretics and not associated with sweating.
•Females maintain lower BP until postmenopausal •Asymptomatic •Males have higher BP on average
Gender factors affecting BP
Four
How many med checks do you perform on insulin?
Eleven
How many rights are there to medication administration?
•>180 (diastolic >120 mm Hg) (emergency--need IV meds)
Hypertensive crisis
<90/60 •Normal for some individuals •Sudden change in patient condition
Hypotension (low BP)
Standing order
May or may not have a termination date; may be carried out indefinitely or for a specific # days/dosages; in place until canceled
Dispensing stage
Medication dispensed by pharmacy/ Errors that may occur at this stage: •Poor distribution practices •Failure to check for drug interactions •Miscounts •Wrong drug in container •Labeling/packaging confusion •Delay in dispensing •Incorrect compounding/reconstitution •Data entry error
Restraints Use
Monitor patient at least every hour or according to policy
Excretion
Most drugs are excreted from the body by the kidneys
Absorption
Movement of a drug from its entry site of the body into bloodstream
Official name (monograph) of Drug
Name by which the drug is identified in official publications United States Pharmacopeia (USP) and National Formulary (NF) (typically generic name)
Normal body temperature
Normal Range 97.0 F to 100.5 F
Bioavailability
Portion of drug that reaches systemic circulation & causes effect on cells
Tall man lettering
Practice of writing part of a drugs name in upper case letters to help distinguish drugs that sound and look alike - to avoid errors - only for portion of drug name that are similar
Therapeutic effect
Primary intended effect/ desired effect without causing toxicity
Hypothermia: Too low
T<98.6 F Well below normal temperature T<95.0 F Irreversible damage or death
Hypothalamus
Temperature control is facilitated by the ________ through metabolism of hormones & neurotransmitters: •Thyroid, Insulin, estrogen, ADH... •Epinephrine, norepinephrine serotonin... •Illness and trauma
Therapeutic Range
The concentration of drug in the blood serum that produces the desired effect without causing toxicity
Peak drug level
The highest plasma concentration of a drug at a specific time
-Communication ability -Developmental level -Mobility
The nurse is able to help promote safety and prevent injury by identifying which factors that have a direct impact on client safety? Select all that apply.
Transcribing stage
These errors may occur with order processing: •Lost prescription/order •Transmission errors •Inadequate formulary/ formulary controls •Incorrect transcription onto MAR •Texted order
Side effect (common reactions)
Unintended secondary effect, usually predictable
Idiosyncratic effect (paradoxical effect)
Unusual or peculiar response to a drug -unique to individual patients
Cuff size: Too small or too large Stethoscope: Poor placement over brachial artery Technique: •Cuff inflated too high or not high enough •Cuff deflated too fast or too slow •Cuff placement incorrect Equipment:Air leak, cracked tubing, bulb defect
What factors could cause ERROR or FALSE readings?
Pharmacokinetics
What the body does to the drug
Pharmacodynamics
What the drug does to the body
Social pressure
Which reason best explains why adolescents behave in an unsafe manner despite knowledge of a particular activity's risk?
Vital Stats
pH: 7.35-7.45 PaCo2: 35-45 HCO3: 22-26 PaO2: 80-100 O2 saturation: 94-100%
Hypothermia
•Blankets/extra clothing •Radiant warmers (newborns, warming blankets) •Physical contact (family) •Warm liquids •Hyperbaric chambers (orders only)