Q1a. Assess Mr. Laurent’s medication chart and identify and explain two (2) significant risks that may be associated with the use of these medicines.
The two significant risks associated with the medicines prescribed to Mr. Laurent are Risk of hypotension and Risk of kidney impairment.
Risk of hypotension
Having been diagnosed with hypertension, Mr. Laurent suffers the risk of hypotension due to the medicines administered to deal with hypertension. Hypertension drugs cause low blood pressure which leads to hypotension (Figueroa, Basford & Low, 2010). For instance, drugs such as diuretics and angiotensin which are used to treat hypertension lead to low blood pressure. Moreover, Ventolin which is a known asthmatic prescription medicine has caused hypotension in some cases. Ventolin has a component called Albuterol sulfate which is used in the treatment of asthma. This component affects the body and one of its side effects is that it leads to low blood pressure which causes hypotension. In addition, type 2 diabetes also poses the risk of hypotension. In this case, low blood pressure is mainly postural meaning that hypertension occurs when the person stands or lies down. The damage of autonomic neuropathy nerve is what leads to postural hypertension and the failure to control diabetes medication well might lead to this condition (Jorgensen, 2013). Therefore, hypertension medicines, Ventolin, and some type 2 diabetes medications pose the risk of hypotension to Mr. Laurent.
Risk of kidney impairment
Kidneys are one of the most important organs in the body charged with the responsibility of getting rid of waste products in the body and they also help in keeping the blood pressure steady. However, one faces the risk of kidney impairment if some medications to treat some illnesses are not carefully administered. Antibiotics, for instance, pose the risk of kidneys impairment. Mr. Laurent having been suffering from a chest infection, the doctor prescribed to him antibiotics. Some antibiotics produce crystals (Goncalves & Povoa, 2010). These crystals may block urine passages which hamper the primary function of kidneys. Moreover, Mr. Laurent being asthmatic means he is allergic to some things. This might contribute to allergic reactions resulting from the intake of antibiotics which may also lead to kidneys impairment (Bel at al., 2011). Moreover, Mr. Laurent suffers from hypertension and some drugs used to treat hypertension such as diuretics may lead to kidneys impairment. Diuretics facilitate the body in doing away with extra fluids in the body. This may lead to dehydration which in return may lead to kidneys impairment (Vasikalou et al.,2013). Therefore, the use of antibiotics and some hypertension medicines such as diuretics predisposes Mr. Laurent to the risk of impaired kidneys.
Q1b. Describe the nursing strategies a nurse may implement to prevent/manage the risks you have identified in Question 1a.
Hypotension which is low blood pressure can be managed by implementing and adhering to some strategies. To start with, increasing blood pressure is one of the ways of managing hypotension. A nurse may advise a patient suffering from hypotension to increase the amount of sodium in the food he or she takes (Gangavati et al., 2011). The increase in the amount of sodium will ensure that the blood pressure rises to normality. Moreover, a nurse may advise the patient to stop the intake of alcoholic beverages since they lead to low blood pressure. Low blood pressure can be a side effect resulting from medication prescribed to other illnesses. For instance, if a person is suffering from hypertension some of the medication he or she is prescribed might lead to hypotension. In this case, a nurse proposes a change in the medication. Medicines that lead to hypotension are withdrawn and substituted with medicine that does not have such a side effect. Drinking more water is another strategy that a nurse may employ to manage low blood pressure. Fluids are very important to the body and the intake of water has outstanding effects in the management of low blood pressure. Water increases blood volume and also prevents dehydration. The increase in volume and prevention of dehydration is very important to a patient with hypotension because it increases the blood pressure which helps in controlling low blood pressure (Veeser et al., 2012). Putting on compression stocking is another way of managing low blood pressure. A nurse may advise a person with low blood pressure to be wearing stockings since they help in relieving of pain and also ease swellings on the legs. This helps in controlling postural hypotension. The last but not least is medication. Medication is the other strategy that can be implemented to manage hypotension. For instance, to control orthostatic hypotension a drug called fludrocortisone is administered to the patient. In addition, other medications such as midodrine are used to raise the blood pressure to manage hypotension.
To manage kidney impairments there are several strategies that a nurse can implement. For instance, in the case where a patient suffers from allergic conditions and antibiotic medication is prescribed, a nurse may prescribe a change in medication to prevent allergic reactions in the body which may lead to kidneys impairment (Fainzang, 2014). Moreover, controlling high blood pressure helps in the management of kidney impairment. This can be done by ensuring one gets enough sleep, taking low sodium meals and ensuring one takes the prescribed medication properly (Gangavati et al., 2011) Monitoring blood glucose levels helps in controlling kidney impairment. Blood glucose levels are checked within a period of 3 months. Once the results of the tests carried out are out, the nurse also advises the patient to watch on how he or she eats and also encourages one to embrace physical activities. Being overweight contributes to more complications and to counter this a person should embrace physical exercises to burn excess fats in the body. Other strategies to manage kidneys impairment are healthy coping up with stress and depression, not smoking and being aware of over the counter drugs that may affect kidney impairment and worsen the condition.
Q2. The medical unit is extremely busy today with many of your patients requiring numerous medications. Apart from the “rights of medication administration” (right patient, medication, dose, route, time, the reason for administration and documentation), explain the safety measures that you will implement, to reduce the risk of medication errors while administering Mr. Laurent’s medications at 0800hrs this morning. You are not required to comment on his medications specifically in this question.
Proper medication administration needs to be emphasized to ensure medications are administered in the right way without abuse. To start with, education is very crucial in ensuring medication errors are prevented. Staff involved in the administration of medication should be educated and made aware of the risk factors and errors that may come up in the administration of a particular medicine (Satorre, 2017). Anesthetists need to receive a lot of education since they are the main handlers of medication from its preparation to its administration (Flin & Patey, 2010). They should also be the main propagators of cooperation to facilitate the proper administration of medication without making errors. For instance, administration of antibiotics should not be carried out since it is likely to bring about kidneys impairment. Moreover, the guiding principles in medication administration should be strengthened to ensure medication errors and risks are minimized (Schiff, 2015). On the same note, there are other measures that when implemented the issue of medication errors can be dealt with quite well. Some of these measures are, for instance, computerization of infusion pumps, an extension of working hours, standardization of protocols and regimes dealing with infusion and having support systems to deal with medical issues.
Despite the many recommendations that have been made in ensuring medical errors are reduced, in my view, they are low. More recommendations need to be put in place to ensure errors no matter how small they are dealt with. Consistency in documentation is one of the ways that will ensure safety is enhanced in the administration of medication. Moreover, computerization needs to be embraced since it is more accurate than humans and fewer errors are associated with it. Intuitively, communication forms the other vital tool of prevention medication errors to ensure safety. Communication entails proper dissemination of information pertaining to the usage of the medication by the patient (Westbrook et al., 2015). The use of abbreviations should be avoided and if they are to be used then the patient should be told what they stand for. Syringe labeling is another measure of safety that will ensure proper medication administration. Sometimes patients are injected with the wrong medication and in order to avoid such errors, syringe labeling should be embraced. In addition, standardization of medical administration is very important in ensuring errors are minimized (Davis, 2014). Example of a measure of standardization is double checking of medications. While double checking, the quality assurance team comes in place in ensuring the quality of the medication is not disputed. In case of disputes, the particular medication should be taken back to the quality assurance to be checked and if found to be substandard, it should be destroyed. By doing this, quality medication to deal with specific illnesses is administered.
Q3. Mr. Laurent is prescribed intravenous (IV) erythromycin and ceftriaxone. Explain the benefits of regular IV antibiotic administration using relevant pharmacokinetic concepts.
Intravenous antibiotics have some benefits. The first benefit of intravenous antibiotic administration is that the medication is administered directly into the blood circulatory system. The use of the zero-order process as applied in pharmacokinetic ensures the antibiotic is infused directly into the blood (Rowland et al, 2011). Therefore, the infusion of erythromycin and ceftriaxone as prescribed to Mr. Laurent has the benefit of direct infusion into the blood. Moreover, plasma concentrations are controlled by the use of IV antibiotics. To ensure the concentration of plasma remains constant, the drug is administered gradually. Since there was no drug in the body initially, the IV antibiotics are administered gradually so that the concentration of plasma is maintained in the body. In addition, regular IV administration enables maintenance or termination of drug therapy every time one needs using IV infusion (Meagher, 2015). Once the levels of antibiotic to be administered in the body are reached, termination is very easy but if the levels have not been attained yet, maintenance is facilitated. The other benefit of IV antibiotic administration is that it enables stoppage of infusion without affecting the plasma concentration (Neuhaus et al, 2010). Once the levels of the antibiotic have reached the required levels, the plasma concentration is not so much affected since the withdrawal of infusion takes a certain exponential curve hence making IV infusion very effective. Also, IV antibiotics administration facilitates proper absorption of the drug into the blood which helps in the systematic circulation of the drug in the body (Goncalves & Povoa, 2011). Through the blood, the antibiotics are able to reach most of the parts of the body without affecting the blood concentration. Through IV antibiotic administration, the patient is able to experience the effects of the medication due to the instant absorption into the blood system. Convenience is the other benefit of IV infusion since the infusion is closely monitored with proper time intervals which enable proper distribution of nutrients into the blood too (Struys et al., 2016). Therefore, IV antibiotics have a lot of benefits especially maintenance of plasma concentration, convenience and immediate absorption of the drug into the blood.
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