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Unit 18-2.pptx

  1. Unit 18 SAGUN LOHALA
  2. Role of nurse in Medication Administration  Learn about the diagnosis, drug, other therapies and treatment for the patient.  Administer medications and treatments and perform procedures safely.  Properly monitor, document and report responses to medication, treatment and procedures and communicate the same to other health care professionals clearly and accurately.
  3. Cont’d…  Learn about the rational for medication prior to administration, the effect of medication, and treatment and should administer correctly at the same time.  Accurately and completely report and document administration of medication and treatment.
  4. Cont’d…  Clarify for accuracy, then about non-efficiency and contraindication by consulting with the doctors and notify the ordering doctors when the nurse makes decision not to administer the medicine or treatment.
  5. Cont’d…  While doing medication, nurses should consider for:  Follow institutional policy  Consider client’s desire and abilities  Foster compliance  Correctly document all the actions related to medication administration and medication errors
  6. Cont’d…  Aseptic technique should be followed while giving injections  Care should be taken to avoid needle-stick injuries, which may transmit infectious diseases.
  7. Care of medicine and medicine cupboard  Wards should have medicine cabinet for proper care of medicines  Cabinets should be large enough that it can accommodate all medicines and should have separate compartment for tablets, powders and ointments.  Cabinets should be in separate room near to nurses’ room as far as possible. The room should be facilitated with sink and running water.
  8. Cont’d…  There should be proper lock system in the cupboards and the key should be in easy access for doctors and nurses  Bottles should be arranged alphabetically.  Poisonous medicines should be kept in separated cupboard with separated lock and key. Senior sisters is responsible for all those medicines
  9. Cont’d…  Register should be maintained to keep the account of poisonous drugs  Drugs with unusual colour, ordour and consistency should be returned to pharmacy to discard.  Oils such as Castrol oil, serum, vaccines and antibiotics such as penicillin should be kept in fridge.
  10. Cont’d…  Emergency drugs should be kept separately in a tray or a box which are portable in emergency.  When indenting for drugs, indent only the required quantity.  Medicine cabinet should be kept neat and clean.  Equipment should be cleaned and replaced after use.
  11. Cont’d…  All inventory of drug should be maintained in each shift. On daily basis check, verify and document the proper temperature  Date of manufacture and expiry should be checked periodically.  The storage should not hinder the cleaning and should have sufficient space for movement of stocks and handling.
  12. Cont’d…  “Protected from light” the product is to be stored either in a container made of material that absorbs actinic light sufficiently to protect the contents from change induced by such light.  The area used for storage of IV fluids should have adequate space and to prevent exposure to direct sunlight.
  13. Oxygen Inhalation  Oxygen is a colorless, odorless and tasteless gas that is essential for the body to function properly and to survive.
  14. Oxygen Inhalation Oxygen therapy:  Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere.
  15. Cont’d… Purpose:  The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.
  16. Cont’d… Basic Terminology:  Hypoxia: Lack of oxygen availability  FiO2: Fraction of O2 in inspired gas  SpO2: Oxygen Saturation measured by pulse oxymetry  SaO2: Arterial Oxygen Saturation
  17. Cont’d… Pulse oximetry:  The most accurate non-invasive method for detecting hypoxia. It is used to measure the percentage of oxygenated hemoglobin in arterial blood.
  18. Cont’d… Blood gas analysis:  It is another very accurate method for detecting hypoxia. It is used to measure the partial pressure of oxygen (PaO2) and carbon dioxide in blood and also blood pH and the concentration of the main electrolytes.
  19. Indication for oxygen therapy:  Blue coloring of the tongue and gums (central cyanosis).  Documented hypoxia  Nasal flaring  Inability to drink or feed (when due to respiratory distress)
  20. Cont’d…  Grunting with every breath and depressed mental status (i.e. drowsy, lethargic)  Short-term therapy (e.g. carbon monoxide poisoning) or surgical intervention (e.g. post anesthesia recovery)  Insufficient oxygen in atmosphere  Congestive heart failure or impaired circulation to the lungs
  21. Normal Values and SpO2  Partial pressure of arterial oxygen (PaO2)  80 -100 mmHg - children/adults  50 - 80 mmHg - neonates  Partial pressure of arterial CO2 (PaCO2)  35 - 45 mmHg children/adults  pH = 7.35 -7.45
  22. Cont’d…  The normal range of oxygen saturation is 97-99%. The main carrier for oxygen is hemoglobin. Each hemoglobin carries 4 molecules of oxygen.
  23. Methods of Oxygen Therapy  Nasal prongs  Face masks  Venturi mask  Reservoir mask  High flow nasal prong therapy  Mechanical ventilation  Mask- BiPap or CPAP
  24. Nasal Prongs The prongs protrude 1 cm into nares Used for low concentrations of Oxygen 24- 44% at 1-6L/min (4%every liter /min)
  25. Cont’d… A nasal cannula is a device that consists of a plastic tube that fits behind the ears, and a set of two prongs that are placed in the nostrils. Nasal cannula is connected to an oxygen tank, a portable oxygen generator or a wall connection in the hospital
  26. Cont’d… Advantage Provides 28-100% O2. Face tents are used to provide a controlled concentration of oxygen ad increase moisture for patients who have facial burn or a broken nose, or who are claustrophobic Disadvantage Difficult to achieve high levels of oxygenation
  27. Face Mask (Hudson)  Most Commonly used Mask.  Indicated for higher concentration than nasal prongs  Usually applied short term  Patient exhales through ports on sides of mask  It delivers 35% to 60% oxygen at 6-10 L/min.  Flow must be at least 5 L/min
  28. Cont’d… Advantage Provides 40 to 60 % O2 concentration Used to provide moderate oxygen concentration It’s efficiency depends on how well mask fits and patient’s respiration demands Readily available on most hospital units and provides higher oxygen for patients
  29. Cont’d… Disadvantage Difficult to eat with mask Mask may be confining for some patients, who may feel claustrophobic with the mask on
  30. Venturi Mask  Indicated for precise concentration of O2  Flow rates from 2- 14L/min  Often used in patients who retain CO2  The only O2 delivery device that delivers a specific percentage of oxygen
  31. Oxygen Tents  The mask covers the nose and does not create a seal around the nose
  32. Oxygen Concentrator  Home O2  Converts nitrogen from air into oxygen  Suitable for low flow of O2 1- 4L  Unable to be used for O2 flow over 5L
  33. Reservoir mask Non‐rebreathing masks are similar to the simple semi‐rigid plastic masks with the addition of a reservoir bag, which allows the oxygen to be delivered at concentrations between 60% and 90% when used at flow rates of 10–15 L/min
  34. High flow Nasal Cannula  Similar to nasal cannula  High‐flow oxygen therapy allows the accurate delivery of oxygen therapy of up to 100% FiO2 at a flow rate of up to 60 L/min
  35. Non-Invasive Ventilation  Avoids intubation  Flow : 20 – 40 L/min  Fio2 : Up to 100%
  36. A machine that generates a controlled flow of blended air and oxygen into a patient’s airway. Ventilators
  37. Article required 1. Oxygen cylinder with regulator 2. Opening key 3. Humidifier with sterile distilled water 4. Nasal prongs/ face mask 5. Rubber tubing 6. Lubricant lotion 7. Gauze pads/ pieces 8. Cylinder strep 9. Cotton balls 10. A bowl of water
  38. Steps of Oxygen Therapy  Verify the prescription for O2 administration by the doctor  Check for patient’s identification and confirm the patient  Explain the procedure and purpose of oxygen therapy  Perform complete respiratory assessment for hypoxia, monitor respiratory rate, rhythm and strength and also assess SpO2
  39. Cont’d…  Perform hand hygiene  Fill the humidifier with sterile water for injection up to the label line.  Join the oxygen tubing and nasal cannula/ face mask to flow meter to source. Use extension tubing for ambulatory clients for easy movement.
  40. Cont’d…  Turn the flow meter on at the prescribed flow rate. If a patient has COPD, check doctor’s order for the amount of required oxygen and the expected saturation level.  Check for bubbling in the humidifier
  41. Safety Precautions  Should not be given without prescription of doctor as oxygen is a medicine  Place the oxygen cylinder in upright position and chain it properly or in the oxygen holder.  Ensure adequate amount of water in humidifier, at least one third.
  42. Cont’d…  Avoid changing the flow rate with the nasal prong in patient’s nose.  Oxygen can catch fire. So, avoid any sparks and fire and no smoke near the oxygen cylinder.  Oxygen delivery systems should be placed 1.5 meters from the heat source
  43. Cont’d…  Secure the electric equipment at home and in hospital as a small spark can also cause fire accidents.  High flow oxygen therapy should be closely monitored with formal assessments  Fire extinguisher should be placed close to the room.
  44. Cont’d…  Cylinder should be checked for not to be empty as it may cause dangerous effect as oxygen supply to the patient.  Assess patient for oxygen toxicity
  45. Nebulization
  46. Introduction  It means administration drugs by inhalation and directly deliver therapeutic dose into lungs.  It uses nebulizer which transports medications to the lungs by means of mist inhalation
  47. Nebulizer • Device used to convert liquid drugs into aerosol droplets suitable for the patient to inhale. • Uses oxygen, compressed air or ultrasonic power to break up medication solution
  48. Purpose • To add moisture to oxygen delivery system • To soften thick sputum and prevent mucus plugging • To administer various drugs to the airways • To relief respiratory insufficiency • To relieve inflammation and allergic responses • To relieve post-operative complications
  49. Indication • Bronchospasms • Chest tightness • Excessive and thick mucus secretions • Respiratory congestions • Pneumonia • Atelectasis • Asthma
  50. Contraindications In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as: • Patients with unstable and increased blood pressure • Individuals with cardiac irritability (may result to dysrhythmias) • Persons with increased pulses • Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low)
  51. Advantage of nebulization  A convenient way of delivering high doses of inhaled medication  In acute severe asthma, oxygen can be used to nebulize the drug  It can be used by any age group
  52. Equipment • Medicine cardex • Nebulizer and • Nebulizer connecting tubes • Compressor oxygen tank • Mouthpiece/ face mask • Respiratory medication to be administered • Normal saline solution • Medicines prescribed by the physician • Kidney tray • Sputum mug • Cotton balls • Clean water
  53. Procedure  Check for doctor’s order for the medicine  Prepare equipment and assemble at bed side  Explain the procedure and position the patient appropriately (sitting or semi-fowler’s)
  54. Cont’d…  Assess and record breath sounds, respiratory status, pulse rate and other significant respiratory functions  Teach patient the proper way of inhalation  Slow inhalation through the mouth via the mouth piece  Short pause after the inspiration  Slow and complete exhalation  Slow resting breaths before another deep inhalation
  55. Cont’d…  Place the medication in the nebulizer while adding the amount of saline solution ordered.  Attach the nebulizer to the compressed gas source  Attach the connecting tubes and mouthpiece to the nebulizer  Turn the machine on (notice the mist produced by the nebulizer)
  56. Cont’d…  Offer the nebulizer to the patient, offer assistance until he is able to perform proper inhalation (if unable to hold the nebulizer (pediatric/geriatric/special cases], replace the mouthpiece with mask  Continue until medication is consumed. It usually takes 15 minutes.  Clean the face of the patient with clean face towel.  Encourage patient to cough after several deep breaths.
  57. Cont’d…  Reassess patient status from breath sounds, respiratory status, pulse rate and other significant respiratory functions needed. Compare and record significant changes and improvement. Refer if necessary
  58. Cont’d…  Attend to possible side effects and inhalation reactions  Dissemble, clean and replace articles  Wash hands  Record and report the finding the condition of the patient
  59. Complication  Palpitation  Tremors  Tachycardia  Headache  Nausea  Bronchospasms
  60. Nurse’s roles 1. Closely monitor all clients receiving bronchodilators for signs of increased heart rate, nervous agitation and restlessness 2. Patient Teaching • proper way of doing the therapy to facilitate effective results and prevent complications (demonstration is very useful • Emphasize compliance to therapy • report untoward symptoms immediately for apposite intervention.
  61. Definition ⚫A Blood transfusion is the infusion of whole blood or blood components such as plasma, RBCs, or platelets into the venous system.
  62. PURPOSES To increase blood volume aftersurgery, trauma, or hemorrhage. To increase the numberof red blood cells in a patientwith severe chronic anemia. To provide platelets to patients with low platelet counts due to treatmentwith chemotherapy.
  63. Cont’d… To provide clotting factors in plasma for patients with hemophilia or disseminated intravascular coagulopathy (DIC). To replace plasma proteins such as albumin. To replace fresh frozen plasma in case of DIC.
  64. Indications Hemorrhage Trauma Burns Severanemia Plasma proteins orclotting factordeficiency. Leukopenia Pathological conditionswhich result in decreased blood cells.
  65. Contraindications Decreased cardiac output Active infection Fluid overload Renal failure
  66. Rate of infusion for components of blood PRODUCTS INFUSION RATES Whole blood and red blood cells 1 unit over 2-3 hours Platelets 30- 60 minutes Fresh frozen plasma 200ml/hourorslowly Cryoprecipitate 1-2 ml/min
  67. ⚫ Whole blood and Packed Red blood cells:- ⚫ For acute blood loss with hypovolemia ⚫ Exchange transfusion ⚫Platelets:- ⚫ Thrombocytopenia ⚫ Untreated DIC ⚫ Thrombotic Thrombocytopenic purpura
  68. ⚫Fresh frozen plasma:- ⚫Coagulation disoreder ⚫Cryoprecipitate:- ⚫Haemophilia ⚫Coagulation disorder
  69. Preparation of Equipemnts ⚫ A Clean tray containing,  A blood request form, blood group and cross match report  Blood product in the containerfor transfusion along with the compatibility forms and blood details.  Blood administration setwith filter  Disposablegloves  Normal salineor heparin flush to flush in caseof block in the line.  IV cannula  Adhesive tape to secureIV line  Kidney basin  Iv pole  A sterile traycontaining emergencymedications
  70. NURSING PROCEDURE Verify the physicians order forthe transfusion.  Explain the procedure to the patient. Ensure that theconsent formsaresigned.  Informabout the side effects (dyspneoa, chills, headache, chest pain, itching) to the patient and ask him/her to report to the nurse. Obtain baselinevital signs.  Obtain the blood product from the blood bank and ensurethat it is initiated within 30 minutes.  Verifyand record the blood productand identify the patient with anothernurse.  Patient name, blood group, and Rh type  Cross – matchcompatibility
  71. Donor blood groupand Rh type Unit and hospital number Expiration date and timeon blood bag Type of blood product compared with physicians or qualified practitioners order Presenceof clots in blood Instruct the patient toempty the bladder. Monitorvital signs. Wash hands and puton gloves. Open blood administration kit/set and move roller clamps toa closed position and administer prescribed medicines.
  72. for single- tubing set: Spike blood unit. Squeeze drip chamberand allow the filter to fill with blood. Open roller clampsand allow tubing to fill with blood to the hub. Prime another IV tubing with normal saline and piggyback it to the blood administration setwith a needleand secure all connectionswith tape. For dubble-tubbing set: Spike the second into the normal saline bag or bottle. Squeeze thedrip chamberand allow the filterto fill with normal saline.
  73. Attach tubing tovenous catheterusing sterile precautions and open lowerclamp. Infuse the blood ata rate of 2-5 ml/min according to the physicians order. Remain with the patient for the first 15-30 minutes, monitoring vital sighs every 5 minutes for 15 minutes, theevery 15 minutes for 1 hour, and then hourly until 1 hourafter the infusion iscompleted. After the blood has been infused, allow the tubing to clearwith normal saline. Appropriately dispose off bag, tubing and gloves. Wash hands. Document the procedure.
  74. RECORDING AND REPORTING ⚫Record thedate and timeof blood transfusion. ⚫Mention the details of the transfusion including type of blood, blood group, bag number, starting time, ending time, flow rate, and any adverse reactions during the transfusions. ⚫Record thevital signs before, during and after the transfusion.
  75. NURSES RESPONSIBILITES A. Observe for signs of transfusion reaction. B. Observe the patientand laboratoryvalues to determine response to transfusion. C. Monitor IV siteand statusof infusion each time when vital signsare taken.
  76. COMPLICATIONS COMPLICATIONS SIGNS AND SYMPTOMS NURSES MANAGEMENT 1. Allergicreactions Rashes, flushing, hives, pruritis, laryngealedema, and dyspnea • Stop the infusion immediately. 2.Nonhemolytic febrile reaction Sudden chills, fever , flushing, headacheand anxiety • Keepvein open with the normal saline 3. Septic reaction Rapid onset of chills, vomiting, hypotension, and fever • Notify the physicians immediately 4. Circulatoryoverload Cough, dyspnea, distended neck veins, cracklesand elevated blood pressure • Administer antihistamine parenterallyas needed and as perorder. 5. Hemolytic reaction Low back pain, tachypnea, hypotension
  77. SAMPLE DOCUMENTATION ⚫11.03.2021 , 10.00 am ⚫Explained the procedure to the patient. Ensured that the consent form was signed. Instructed the patient to empty the bladder. Checked for bag number, grouping and cross-matching. ⚫After premedication, whole blood (as prescribed) B+ve, bag no.****was transfused to Mr. X at ……am. Vitals were monitored frequently and the patientwas observed for transfusion reactions. The transfusion ended at ….pm. Patient felt comfortable.