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John [pseudonym], 76-year-old Male, presented to the emergency department…
John [pseudonym], 76-year-old Male, presented to the emergency department [ED] as he was falling to the left when trying to walk straight.
Medical History
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Mitral Valve Replacement
Removal of the mitral valve and replacing it with a mechanical valve or valve made from pig, cow or human heart tissue.
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Coronary Artery Disease
Type of blood vessel disorder that is included in the general category of atherosclerosis, CAD is a progressive disease and when symptomatic the disease is generally well advanced.
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Congestive Heart Failure
Defined as a syndrome encompassing several different types of cardiac dysfunction, resulting in inadequate tissue perfusion. Typical symptoms include: dyspnoea and fatigue that occur either at rest or on effort.
Systolic HF is the inability of the heart to generate an adequate cardiac output to perfuse vital tissues, the most common cause of decreased contractility is MI.
Diastolic HF is defined as HF with preserved systolic function, either occurring in isolation or alongside systolic HF, resulting from pulmonary congestion, decreased left ventricle compliance and abnormal diastolic relaxation.
Right HF can result from left HF when there is an increase in the left ventricular filling pressure, causing rising pressure in the systemic venous circulation causing peripheral oedema.
Noise Induced Deafness
Damage to sensitive inner ear structures resulting in deafness that is either temporary or permanent.
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Reason For Admission
Query Subdural Hemorhage/ Haematomas
May be acute, subacute, or chronic
Acute: Develop Rapidly, normally within 48 hours and are usually found at the top of the skull
Subacute: Develop more slowly, normally over 2 weeks.
Chronic: develop over weeks/months are common in elderly and those who abuse alcohol and have brain atrophy, when the increased intracranial pressure eventually compresses the bleeding vessels.
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Scope of Practice, Acts and Laws in relation to medication administration
Nurses have a duty to maintain and improve the well-being of health consumers, this encompasses both developing and maintaining public trust.
Ethical codes and legislation directives are also implemented into the Code of Conduct, Competencies and Consumers Rights, thus promoting medication and cultural safety.
The Medicines Act New Zealand, regulates medicines and related products/device utilisation and determines if medications used are both safe and effective.
There are four classifications/schedules of medicines: Prescription medicines, Restricted Medicines, Pharmacy only medicines and general sale medicines
Regulations regarding prescription forms under section 41 include making sure they are legible, signed personally and dated, as nurses there is a need to be aware of all essential elements and not administer medications if these arent present.
Controlled Drugs, include medicines available on prescription from a health professional and is more tightly controlled then the prescribing of other medicines
The Misuse of Drug Regulations 1977 specifics restrictions on controlled drug prescribing including the maximum supply period is no more than 1 month for class A and B controlled drugs and 3 months for class C, dispensed at 1 monthly intervals.
Prescription Requirements for controlled drugs include: they must be handwritten on a form approved by the director of General health or on a form that is electronically generated from an approved system and they must be signed.
All prescriptions must include the date, patients name and address, medication name, dose and frequency and the prescriber's name and address.
Medsafe (the NZ medicines and Medical Devices Safety Authority) operates a bussiness unit within the MOH and is responsible for administering most aspects of the Medicines Act 1981 and its associated regulations in NZ.
Health Practitioners Competence Assurance Act 2003,
All RNs take responsibility for all actions performed whist caring for their patients, including medication administration if done so incorrectly they face the consequences.
RNs must not assume medication ordered is correct or the correct dose.
RNs must acknowledge errors in professional practice, medication errors are any events that could cause or lead to incorrect administration and are often attributed to an inconsistency in adherence to the 'seven rights'.
The Nursing Council of New Zealand governs the practice of nurses, by setting and monitoring standards in the interests of the public and the profession and its main concern is public safety.
Code of Conduct, provides a guide for the public to assess the minimum standards expected of nurses and for nurses to monitor their own performance and that of colleagues.
RNs need to understand the competence and scope of practice for their job description, local workplace policies and guidelines relevant to medication administration.
The Code of Health and Disability Services Consumers‘ Rights (Health and Disability
Commissioner, 2004) applies to all health and disability services in NZ
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Administering Medicines
Who can administer? Any person may administer medicines but whoever administers these is required to do so in accordance with the directions of the prescriber or in accordance with a standing order
To administer medications safely and accurately RNs should have an understanding of physiology, pharmacology, human growth/development, autonomy, nutrition and mathematics.
All people in employment who administer medicines must be familiar with their
employer‘s policies and guidelines regarding medicine administration.
The Nurses Role: Accountability for knowing the prescribed medications, there therapeutic/non-therapeutic effects and need for the drugs, this should be assessed before giving the medications, and patients should be reviewed after the evaluate the effects and outcomes.
Nurses should assess when appropriate a patients ability to self-administer medications and provide education as necessary about correct administration and monitoring.
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