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)