By S. Curtis. Ohio Wesleyan University. 2018.
If ordered twice daily or morn- their medications are given in liquid form generic toradol 10 mg with visa. Correct use of oral or nasal in- ications cheap toradol 10mg, or taking with ﬂuids other than water. Prescrip- halers, eye drops, and skin medications is essential for tion medications often include instructions to take on an therapeutic effects. If taking several medica- ✔ Report problems or new symptoms to a health care tions, ask a health care provider whether they may be provider. Do not antacid usually should not be taken at the same time as store them in a bathroom; heat, light, and moisture may other oral medications because the antacid decreases cause them to decompose. If a dose is omitted, the next dose should be taken capsules in one container. A dose cannot be measured accurately with house- ✔ Discard outdated medications; do not keep drugs for long hold teaspoons or tablespoons because they are differ- periods. Drugs are chemicals that may deteriorate over ent sizes and deliver varying amounts of medication. In ad- the liquid medication is packaged with a measuring cup dition, having many containers increases the risks of that shows teaspoons or tablespoons, that should be medication errors and adverse drug interactions. Additional characteristics mote continuity of care among agencies and health care include the following: providers. These client outcomes, and time frames (usually days) for guidelines may affect any step of the nursing process. With achieving the desired outcomes during the expected assessment, for example, the critical path may state, Assess length of stay. These sup- • Development and implementation of the critical paths plements are increasingly being used, and clients who take should be an interdisciplinary, collaborative effort. Thus, them are likely to be encountered in any clinical practice all health care professionals usually involved in the care setting. Herbal medicines, also called botanicals, phyto- of a client with a particular medical diagnosis should be chemicals, and neutraceuticals, are derived from plants; represented. The labels contain essen- Do not take a laxative if you have stomach pain, nau- tial information about the name, ingredients, indications sea, or vomiting, to avoid worsening the problem. Such products can raise blood pres- ✔ Do not take OTC medications longer or in higher doses sure and decrease or cancel the blood pressure–lowering than recommended. This could lead to severe ✔ Note that all OTC medications are not safe for everyone. Many OTC medications warn against use with certain ill- ✔ Store OTC drugs in a cool, dry place, in their original con- nesses (eg, hypertension, thyroid disorders). Consult a tainers; check expiration dates periodically and discard those that have expired. Some speciﬁc precautions include the following: ✔ Measure liquid OTC medications with the measuring de- Avoid alcohol if taking antihistamines, cough or cold vice that comes with the product (some have a dropper or remedies containing dextromethorphan, or sleeping pills. If such a device is not available, use a measur- of them with alcohol may result in excessive, potentially ing spoon. Accurate measurement of sedative-type drug (eg, for nervousness or depression). Older people are more likely to Ask a health care provider before taking other products have adverse drug reactions and interactions because of containing aspirin if you are already taking a regular dose changes in heart, kidneys, and other organs that occur of aspirin to prevent blood clots, heart attack, or stroke. Most testimonials from family members, friends, or celebri- products have not been studied sufficiently to evaluate their ties.
Re- flexes are involuntary responses to certain nerve impulses received by the spinal cord (eg 10 mg toradol overnight delivery, the knee-jerk and pupillary Pyramidal and Extrapyramidal Systems reflexes) purchase toradol 10mg visa. The pyramidal and extrapyramidal systems are pathways out of the cerebral cortex. In the pyramidal or corticospinal tract, DRUGS AFFECTING THE CENTRAL nerve ﬁbers originate in the cerebral cortex, go down the brain NERVOUS SYSTEM stem to the medulla, where the ﬁbers cross, and continue down the spinal cord, where they end at various levels. Impulses Drugs affecting the CNS, sometimes called centrally active are then carried from the spinal cord to skeletal muscle. As depres- premotor area of the cerebral cortex and travel to the basal gan- sion progresses, there is drowsiness or sleep, decreased 78 SECTION 2 DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM muscle tone, decreased ability to move, and decreased per- 3. Once a neurotransmitter is released and acts on receptors, ception of sensations such as pain, heat, and cold. What are the main functions of acetylcholine, dopamine, reﬂexes, respiratory failure, and death. Mild stimulation is characterized by wakefulness, men- reasoning, and learning? Increasing stimulation produces hyperactivity, excessive talking, nervousness, and in- 6. Excessive stimulation can cause convulsive seizures, cardiovascular centers? How would you expect a person with CNS depression to excessive, harmful CNS stimulation by these drugs, CNS look and behave? CLIENT TEACHING GUIDELINES Opioid (Narcotic) Analgesics General Considerations ✔ Do not smoke, cook, drive a car, or operate machinery ✔ Use nonpharmacologic treatments of pain (eg, exercise, when drowsy or dizzy or when vision is blurred from med- heat and cold applications) instead of or along with anal- ication. Injected drugs may cause narcotic analgesic (eg, acetaminopen or ibuprofen) may dizziness, drowsiness, and falls when walking around. If it is necessary to get out of bed, ask someone for ✔ For pain that is not relieved by a non-narcotic analgesic, a assistance. Use of a narcotic analgesic for ticipating surgery, ask how postoperative pain will be acute pain is acceptable and unlikely to lead to addiction. The maximum recommended Do not object to having bedrails up and asking for assis- daily dose, whether taken alone or in a combination prod- tance to ambulate when receiving a strong narcotic anal- uct, is 4000 milligrams (eg, 8 tablets or capsules con- gesic. These are safety measures to prevent falls or other taining 500 mg each or 12 tablets containing 325 mg injuries because these analgesics may cause drowsi- each). If unsure whether a combination product contains ness, weakness, unsteady gait, and blurred vision. It may be prevented or managed by eating high- as needed; for chronic pain, the drugs should be taken fiber foods, such as whole-grain cereals, fruits, and on a regular schedule, around the clock. For someone unable to take amount of the mildest drug that is likely to be effective in these preventive measures, Metamucil daily or a mild a particular situation. Do not increase the dose Self-administration and do not take medication more often than prescribed. The tablets are formulated to release the ac- dependence, and because analgesics may mask pain for tive drug slowly, over several hours. Combining drugs with similar effects may (eg, excessive drowsiness, difﬁculty in breathing, severe lead to excessive sedation, even coma, and difﬁculty in nausea, vomiting, or constipation) and report to a health breathing. Teach clients interventions to prevent or etiology of pain, fever, and inﬂammation.
What is red man syndrome order toradol 10 mg amex, and how can it be prevented premedication with an antihistamine generic 10mg toradol amex. What is the main clinical importance of the newer drugs, linezolid and quinupristin/dalfopristin? Nursing Notes: Apply Your Knowledge SELECTED REFERENCES Answer: Diarrhea is a side effect of many antibiotics. Antimicrobial agents: Protein synthesis inhibitors arrhea is severe, it is important to determine if the cause is and miscellaneous antibacterial agents. Limbird pseudomembranous colitis, which is caused when antibiotics (Eds. The drug-resistant pneumococcus: tis is often associated with the use of clindamycin. Hospital Infection Control Practices Advisory Committee (HICPAC) Treatment includes metronidazole (Flagyl) or oral vancomycin. What are adverse effects with erythromycin, and how may they be prevented or minimized? Discuss ways to increase adherence to anti- drug-resistant tuberculosis infections. Describe factors affecting the use of primary, implications of using primary antitubercular secondary, and other drugs in the treatment of drugs. Critical Thinking Scenario John Phillips, a homeless person with a history of drug and alcohol abuse, comes to the emergency depart- ment with a productive cough, complaints of night sweats, and fatigue. The physician suspects tuberculosis (TB) and orders a puriﬁed protein derivative (PPD) skin test, chest x-ray, and sputum for acid-fast bacilli. Reﬂect on: The necessary infection control measures to use before TB is conﬁrmed or ruled out. Factors that affect compliance with drug treatment for John Phillips and a plan to improve and monitor compliance. Phillips will require drug treatment, and how you can evaluate when the TB is cured. OVERVIEW Tuberculosis commonly occurs in many parts of the world and causes many deaths annually. In the United Tuberculosis (TB) is an infectious disease that usually affects States, active disease has waned to a historical low level. It is caused by Mycobac- include increased exposure during a resurgence of active terium tuberculosis, the tubercle bacillus. In general, these disease between 1985 and 1992, immigration from coun- bacilli multiply slowly; they may lie dormant in the body for tries where the disease is common, and increasing numbers many years; they resist phagocytosis and survive in phagocytic of people with conditions or medications that depress the cells; and they develop resistance to antitubercular drugs. The bacteria be- come inactive, but they remain alive in the body and There are four distinct phases in the initiation and progres- can become active later. Transmission occurs when an uninfected person in- not spread TB to others, usually have a positive skin hales infected airborne particles that are exhaled by an test reaction, and can develop active TB disease years infected person. Major factors affecting transmission later if the latent infection is not effectively treated. In are the number of bacteria expelled by the infected per- many people with LTBI, the infection remains inactive son and the closeness and duration of the contact be- throughout their lives. In others, the TB bacteria be- tween the infected and the uninfected person. About 6 to 8 weeks after exposure, those latent infection, although new infection can also occur. Both reactivated and new infections are more likely to Within approximately 6 months of exposure, sponta- occur in people whose immune systems are depressed neous healing occurs as the bacilli are encapsulated in by disease (eg, human immunodeﬁciency virus [HIV] in- calciﬁed tubercles. Among people with who become infected with TB bacteria, the immune LTBI, signs and symptoms of active disease (eg, cough Transmission Primary tuberculosis Latent tuberculosis "Reactivation" tuberculosis Progression after 2 years, 5% Skin-test Spontaneous conversion in healing in Progression 6 to 8 weeks 6 months within 2 years, 5% Progression with concurrent HIV infection, 10% each year Figure 38–1 Transmission of Tuberculosis and Progression from Latent Infection to Reactivated Disease.
Baldrige Criteria and Related Systems The Malcolm Baldrige National Quality Award—named for Malcolm Baldrige cheap 10mg toradol with visa, who served as Secretary of Commerce from 1981 until his death in 1987—was created by Public Law 100-107 generic toradol 10 mg on line, signed in 1987. The Baldrige criteria were originally developed and applied to busi- nesses; however, in 1997, healthcare-specific criteria were created to help healthcare organizations address challenges such as focusing on core com- petencies, introducing new technologies, reducing costs, communicating 68 The Healthcare Quality Book FIGURE 4. The criteria can be used to assess performance on a wide range of key indicators: healthcare outcomes; patient satisfaction; and operational, staff, and financial indicators. The criteria can also help organizations to align resources and initiatives such as ISO 9000, PDSA cycles, and Six Sigma; improve communication, productivity, and effectiveness; and achieve strategic goals. The Baldrige healthcare criteria are built on the following set of interrelated core values and concepts: • Visionary leadership • Patient-focused excellence • Organizational and personal learning • Valuing staff and partners • Agility • Focus on the future • Managing for innovation • Management by fact • Social responsibility and community health • Focus on results and creating value • Systems perspective Quality Im provem ent System s, Theories, and Tools 69 The criteria are organized into seven interdependent categories (National Institute of Standards and Technology 2003): 1. Organizational performance results Similar models are in place in Europe and in individual U. Paul Batalden formed the Quality Resource Group, part of the Hospital Corporation of America, as an internal consulting division in the application of continual improvement. IHI Breakthrough Series Model The Institute for Healthcare Improvement (IHI) has designed a model to support its breakthrough collaborative series. A collaborative consists of 20 to 40 healthcare organizations working together for six to eight months on improving a specific clinical or operational area. Under the guidance of an IHI panel of national experts, team members study, test, and implement the latest knowledge available to produce rapid improvements in their organizations. A collaborative represents an intensive effort of healthcare professionals making significant changes that improve clinical outcomes and reduce costs (IHI 2003). ISO 9000 The International Organization for Standardization (ISO) is a non- governmental entity founded in 1947 by 25 countries to develop volun- 70 The Healthcare Quality Book FIGURE 4. Its intent was to pro- vide consensus for an approved methodology that would ensure consis- tency in manufacturing through standardization of processes and services to conform with and fulfill world-market customer requirements. The ISO 9000 Quality Management System was created in 1987 to provide a nonprescriptive management system quality standard for non- technical business functions. It was further improved in 1994 and released as three distinct standards (ISO 9001, 9002, and 9003). ISO 9000 has been more widely accepted and applied in countries other than the United States but appears to be the focus of increased interest as a model for organizing quality improvement activities (Tsiakals, Ciavrani, and West 2002). The kaizen philosophy assumes that our way of life (work, social, home) deserves to be constantly improved. The kaizen concept includes a num- ber of improvement practices (Imai 1986), including the following: Quality Im provem ent System s, Theories, and Tools 71 • Customer orientation • TQC • Robotics • Quality control circles • Suggestion system • Automation • Discipline in the organization • Total productive maintenance • Kamban • Quality improvement • Just-in-time • Zero defects • Small-group activities • Cooperative labor-management relations • Productivity improvement • New-product development Lean Thinking Lean thinking, sometimes called lean manufacturing or the Toyota Production System, focuses on the removal of waste, which is defined as anything not necessary to produce the product or service. One common measure is touch time—the amount of time the product is actually being worked on, or touched, by the worker. Frequently, the focus of lean thinking is manifested in an emphasis on flow (Nave 2002). Its starting point is value, and the ultimate customer defines what value is; anything in excess of this value is waste. While lean thinking focuses on removing waste and improving flow, it also has some secondary effects. The product spends less time in process, reducing the chances of damage or obsolescence. Simplification of processes results in less variation, more uniform output, and less inventory (Heim 1999). As the company looks at all the activities in the value stream, the system constraint is removed and performance is improved. Many small improvements in rapid succession are more beneficial than analytical study.