Please enable JavaScript.

Coggle requires JavaScript to display documents.

Bob Smith (pseudonym) (Medical history (Age: 65 Gender: Male …

- - - - Lives locally with his 62 year old wife in a house
        
        Independent with ADLs
        
        1 of 3 daughters lives in the front house and visits often
        
        2 remaining daughters live in Australia
        
        Current dairy farmer
        
        Wife is an accountant
        
        Wife is a non-smoker
  - - - Vital observations on admission
        RR - 24 (score of 2)
        Sp02 - 92% (score of 2)
        HR - 98 (score of 1)
        BP - 125/78
        Temp - 38 (score of 1)
        Pain - 6/10
        EWS = 6
        His vitals suggest that his oxygen demand is compromised. As a result, his work of breathing has increased (24 breaths per minute) to compensate a lowered oxygen oxygen content of 92%. He is febrile which indicates an infection. Bob's heart is working harder (HR=98) to compensate his increased work of breathing and increased temperature.
  - - - The Misuse of Drugs Act 1975
        This act categorises controlled drugs into separate classes. These groups are dependent on the risk to the public. Nurses must be aware of the legislation around these drugs ( i.e. storage, recording, administration, and policies).
        Nurses are responsible for accurate medicine administration, this includes following and abiding by workplace policies (these differ across the health sector).
        
        7 medication rights nurses should do each time they administer
        
        1. Right patient
        Is this the right patient?
        
        Nurses should use two identifiers to confirm:
        
        Ask patient to identify themselves (full name + DOB)
        
        Check NHI on patients ID band against NHI on chart
        
        2. Right medication
        Is the right medication being given for the right reason?
        
        Check the medication label against the prescription
        
        Check for any allergies and nurses should ask the patient if they have any drug allergies
        
        1 more item...
      - Standards for the medication administration
        Prior to administration
        
        Nurses must ensure correct protocols regarding the preparation, administration and documentation of controlled drugs are followed
        
        Check the 7 medication rights
        
        Check the expiry date of medication
        
        Prepares the medicine as specified by the appropriate protocol
        
        Informs the patient on the purpose of the drug
        
        During administration
        
        Nurses must monitor the patient for adverse effects and take appropriate steps to managing these
        
        After administration
        
        Nurses should make clear and accurate recordings of all medications given to the patient and those that have been refused or declined.
        
        All documentation must be timely completed
        
        Record positive and negative effects of the medicine
        
        Responsibilities of a registered nurse
        
        Must be able to understand the legislation and ethical/professional issues regarding the medication process
        
        Follow the employers policies and guidelines when directing and delegating medicines.
        
        Report any concerns to management regarding risks in the medication process
        
        Understands and follows the correct process when checking medications.
        
        Responsibilities of a student nurse
        
        Student nurses must understand the laws regarding the medication process
        
        Abide by their institutes policies and guidelines relating to medication administration
        
        Must never administer medications without direct supervision from a registered nurse
        
        Understand that they can decline from a task if they do not feel confident to do so
        
        Students are not regulated under the law therefore the nurse working with the student is responsible for the actions of the student
      - The Code of Health and Disability Services Consumers rights
        The code promotes and protects the rights of health consumers and disability services while they receive healthcare.
        All health consumers are entitled to 10 rights identified in the code, and all health care professionals are subject to the duties in the code.
        
        Nurses must be familiar with the 10 consumer rights and ensure their nursing role incorporates these while administering medications.
        
        Nurses who do not comply by the rights in the code thereby breach the HDC act 1994.
        
        Consent
        A patient or their guardian has the right to not give consent to medications.
        The health professional should:
        
        Establish the reasons for refusal
        
        Identify whether the refusal of medication will compromise the patients health and wellbeing
        
        Inform the prescriber or on call doctor regarding refusal
        
        Accurately document the refusal and discussion
- - - - Why Bob needs Augmentin:
        Augmentin is an antibiotic that is prescribed to help treat Bob's pneumonia - a condition in which the alveoli in the lungs become inflamed. Augmentin treats pneumonia by fighting the bacteria in the body and thereby treat Bobs infection by preventing the replication of bacterial cells.
- - - - The reason why Bob has been prescribed Metformin:
        Bob is a type 2 diabetic and is on Metformin, a hypoglycaemic agent, which works to control the amount of glucose found in his blood. Metformin will improve Bob's body's response to insulin, prevent excessive uptake of glucose, and lastly, delay the absorption of glucose during digestion. As a result, Metformin will lower the amount of glucose in his blood.
    - - Therapeutic actions
        Metformin works in three ways:
        1: Metformin improves insulin sensitivity
        Metformin acts as a "key" which allows insulin to move more effectively into cells. In turn, metformin helps lower blood glucose levels.
        2: Metformin prevents the liver from producing excessive levels of glucose
        The liver becomes the main source of glucose (other than food) during the fasting state. During this state, the liver will produce and release glucose into the cells when glucose levels are low. This state occurs in the early hours of the morning. In those who have type 2, the liver will produce more glucose than the body requires and thereby causes a rise in the blood glucose levels. Metformin prevents the liver from producing more glucose than the body needs.
        3. Metformin delays glucose absorption during digestion
        After a meal glucose in the blood will rise. Metformin works by slowing this rise in glucose down.
        Pharmacokinetics
        
        Absorption: Metformin is absorbed along the gastrointestinal mucosa
        
        Distribution: Metformin is not bound to plasma proteins
        
        Metabolism: Excreted unchanged in the urine and does not undergo further hepatic metabolism
        
        Excretion:* Excreted in urine
- - - - Contraindications and cautions
        
        Patients who have hypersensitivity to any components of this medication
        
        People with active liver disease or a history of alcoholic liver disease, as this could exacerbate and lead to severe liver failure.
        
        Pregnancy and lactation due to the potential of adverse effects on the fetus or neonate
        
        Caution should be used in patients with impaired endocrine function because Atorvastatin has the potential to alter steroid hormones.
        Side effects
        Flatulence, abdominal pain, cramps, nausea, vomiting and constipation are all common adverse effects.
        Adverse effects on the CNS include headaches, dizziness, blurred vision, insomnia, and fatigue.
        Atorvastatin has been reported to increase concentrations of liver enzymes and in turn cause acute liver failure. A rare adverse effect is rhabdomyolysis which is a breakdown of skeletal muscles. This can injure the glomerulus and cause acute renal failure.
        Drug to drug interactions
        
        Rhabdomyolysis increases when Atorvastatin is concomitant with erythromycin, cyclosporin, gemfibrozil, niacin or antifungal drugs.
        
        Increased serum levels and resultant toxicity may occur in combination with digoxin or warfarin.
        
        Increased oestrogen levels may occur with oral contraceptives.
        
        Grapefruit juice may increase serum levels of the drug. leading to an increased risk of adverse effects.
- - - - Therapeutic actions
        Felodipine lowers arterial blood pressure by decreasing systemic vascular resistance. It does this because it is a vascular selective calcium antagonists, which means this drug inhibits the movement of calcium ions across the membranes of myocardial and arterial muscle cells, blocking muscle cell contraction. This action depresses myocardial contractility, slows cardiac impulse formation and relaxes/dilates arteries. In turn, the venous return and blood pressure will decrease.
        Since this medication has a high degree of selectivity for smooth muscle in the arterioles, this medication has no direct effect on cardiac contractility or conduction. Therefore, felodipine has no association with orthostatic hypotension.
        Pharmacokinetics
        Absorption: Felodipine is well absorbed in the gastrointestinal tract via an oral route
        Metabolism: Metabolised in the liver by cytochrome 3A4
        Excretion: 70% of felodipine is excreted as metabolites in the urine, the remaining is excreted in the faeces.
        
        Drug-drug interactions
        Interactions vary with different calcium channel blockers used to treat hypertension. A serious effect to note involves an increase in serum levels and toxicity of cyclosporin (immunosuppresant) when Felodipine is taken with diltiazem.
        
        The importance of Felodipine for Bob
        Bob has a history of hypertension, however if Bob takes 5mg of Felodipine each day his blood pressure will be more effectively controlled. Taking Felodipine will reduce Bob's risks of having a stroke, heart attach and potential kidney problems.
- - - - Contraindications
        Patients with hypersensitivity budesonide, formoterol, or lactose
        Side effects
        Palpitations, candida infections, headache, tremour, coughing, throat irritation
        Less common: tachycardia, nausea, diarrhoea, weight gain, muscle cramps, dizziness
        Drug to drug interactions
        Budesonide and formoterol have limited reports regarding interactions with other medications in the treatment of asthma.
        Symbicort should be avoided when in combination with ritonavir (antiretrovial), itraconazole antifungal), ketoconazole (antifungal). Research has shown concomitant treatment with these drugs have the potential to increase systemic adverse reactions, such as Cushing's syndrome.
        Pharmacokinetics
        Absorption: absorption is rapid after inhalation and the maximum plasma concentration is reached within 30 minutes after inhalation.
        Distribution/ Metabolism: Budesonide undergoes biotransformation on first passage through the liver
        Elimination: Formoterol is eliminated by metabolism in the liver and then followed by renal excretion. 8-13% of formoteral is excreted in the urine. Budesonide is eliminated via urine.