LINK TO COMMON CAUSES OF MEDICATION ERRORS

 Dear nurses,

There seems to be a problem with the old
link to: Common causes of medication errors.

The one above is new and should work well.

Common causes of medication errors

COMMON CAUSES OF MEDICATION ERRORS

 

When a patient is admitted to a healthcare facility, 
 information such as allergies, past medical history,
 height, weight and medications taken, are all recorded.

This type of information is very important, as it will help
 the doctor when prescribing medications. It will also be
of use to the pharmacist with providing correct drug dosages.

Regardless of where a nurse works, medication administration 
 is done.The nurse who gives drugs of any kind, should take time, 
to ensure that everything is done correctly.

 Learn more: Nursing fundamentals

Helpful information for the clinical nurse
                                         

                                  

                                         

 

                               Clinical judgement         

Here are some of the ways in which medication
errors may occur:
-Misreading MD orders. If the nurse is uncertain
about an order , it is best to communicate with the
doctor or pharmacist.   
-   Poor communication of information, for example,
   when a patient is  transferred from one unit to
  another.
  - Improper dilution of medication ( always check
  the manufacturer's instructions for proper dilution). 
 - Drug incompatibility: An example - Dilantin
   can only be mixed with  Normal Saline.
- Confusing one drug with another, as some
    drugs have similar names.

CLINICAL NURSING SKILLS ARE IMPORTANT AND SPECIAL

 

A nurse develops her skills in the clinical areas
that he/she is assigned to.For example, the Emergency
Room, the ICU, the Post Anesthesia Care Unit ( PACU),
and the Operating Room, are all wonderful areas to
develop nursing skills.

Learn more about : Nursing communication

It takes "all hands on deck" to complete the work.

It is important to recognize that classroom skills
are different from clinical skills. A nurse's
performance in the work place takes on a different 
challenge from the classroom.

 IV infiltration may cause damage to the skin and
surrounding tissue.Learn more about: IV site care

Patient assessment is a very important tool. 
The patient having chest pain, would have 

an assessment done by the nurse.

A description of the pain, as well as pain
scales assessment ( 1-10) is usually done.

Documentation of intervention is also 
necessary. 

Below are more assessment links:
 Neurological assessment
Abdominal assessment 

Stroke assessment

ADDRESSING THE SKIN AND ITS PURPOSE - PART 3

The skin and its purpose- Part 3

Part 3 - concludes the Skin and its Purpose.

Aging is a normal part of life. An elderly person,

tends to have skin that is drier and more fragile. 
Poor skin turgor may be seen in the elderly,
especially if they lack fluids.

Elderly people are more prone to dehydration.
This may range from mild to severe, depending
on the situation. Some elderly people live alone
and may tend to neglect taking adequate fluids.
Fluid and electrolyte replacement are beneficial
when combating dehydration.

Learn more by clicking on the link:

Sessions 57:Hydration vs.Dehydration

Learn more about: Pediatric facts

A baby has more sensitive skin  than an adult.
We know all too well about diaper rash in infants. 
Frequent diaper changer and using a barrier cream,
can prevent this happening.

 

 How can these animals survive these subfreezing temperatures?
 Easy! They have naturally built in insulation called blubber.An
 extra layer of fat, beneath the skin, provides incredible warmth
to make whales, penguins  and seals stay alive in such frigid conditions.

Learn more about: Organ failure and transplantation

ADDRESSING THE SKIN AND ITS PURPOSE - PART 2

The Skin and its Purpose - Part 2

Anasarca

Anasarca, which is also known as generalised edema,
may be caused by a number of conditions. These include:
- Heart, renal or liver failure. 
Learn more about: Anasarca 

In Anasarca, the skin is stretched and there is swelling.

Skin breakdown may occur in the patient confined to
bed. An air mattress may be ordered by the doctor, to 

prevent this from happening.

What is the Braden Scale used for ?

The Braden Scale is used for predicting
pressure ulcers on the skin.These may
develop in patients who are confined to
bed for long periods of time. Turning , 
positioning and good body alignment
are ways in which this can be prevented. 

Burns and the skin:

Scenario: Sam is a cook in a restaurant. He was

not prepared for his sleeve catching on fire. He 

suffered second and third degree burns. Sam was

transported to the Emergency Room.

Skin grafting is sometimes done to cover the 
burnt area. Healthy tissue is taken from another 
part of the body, to cover the damaged area. The
grafted area, eventually becomes fused with the 
tissue around it.

Most people who anticipate taking a long plane

flight may hardly stop to think about dehydration
and its consequences. 

This topic continues here : Dehydration

The skin gives clues to many problems

In the image above, a patient is in possible sepsis.
There is abdominal tenderness and redness at the
wound site. High fever and increased respirations
are also noted on assessment. The doctor's orders
include lab values : 

( WBCs, ABG, electrolytes and PT/ PTT ).

Learn more about : Sepsis

IV infiltration may cause damage to the skin and 

surrounding tissue.Learn more about: IV site care

The nurse should take
 the time to  assess an
IV site that is swollen
and painful. It may be
necessary to  change
the site, in order to
prevent further tissue
damage.

ADDRESSING THE SKIN AND ITS PURPOSE - PART 1

 ADDRESSING THE SKIN

The skin as we all know it , covers the body and 
appears to be of little importance. It is used to put
on makeup and improve appearances.

However , the skin can give clues to many things
happening to the body. 

Here are examples of the uses of the skin:
- It helps to regulate body temperature
through sweating , blood flow like vasodilation
( heat loss) or vasoconstriction ( heat retention).
- used for IV sites, checking blood glucose
- checking oxygen saturation
Learn more about:The skin

The skin creates a barrier to keep out infection.

It is the entry port for most surgical procedures.
It helps to regulate temperature.

The clinical scenario above, shows a patient
in Hypovolemic Shock. The skin is cool and
clammy. This is caused by blood loss. In an
attempt to preserve the body's temperature,
vasoconstriction occurs. 

The blood vessels narrow and blood is shunted
to the most vital organs like the heart , brain and
kidneys. This results in cool , clammy skin.

An assessment reveals:
- decrease in oxygen saturation
- decrease in BP, cool, clammy skin

- rapid respirations and heart rate

- decreased level of consciousness

 enjoy watching the videos:

 Sessions 43

Hypovolemic Shock  

Diabetes Mellitus may be Type 1 or Type 2. 

Peripheral vascular disease and gangrene

In the image above, a patient has PVD
( Peripheral vascular disease). The skin gives
clues to poor circulation. It becomes discolored
 and painful. Diabetes and cigarette smoking are
 some of the causes. His toes are gangrenous.

Learn more about: Diabetic complications

The patient with DKA has flushed skin. Checking
blood glucose frequently, will be done through the
skin. IV site used for fluid replacement, will be done
through the skin.

Learn more about : Diabetic education and

DKA ( Diabetic ketoacidos

INTERESTING FACTS ABOUT HEPARIN AND TPA ( THROMBOLYTIC PLASMINOGEN ACTIVATOR)

In the image above, a new nurse seeks information
about Heparin, an anticoagulant drug.

Heparin is an anticoagulant drug. It is used to
prevent clot formation in conditions such as 
Atrial fibrillation and DVT ( deep vein thrombosis).
Learn more about :Heparin Therapy

Heparin is given IV or SQ, but never via the intra-
muscular route. Side effects of anticoagulant therapy
include: bleeding of gums, hematuria, bleeding from IV
and dressing sites. Protamine Sulfate is the drug used to

counteract the action of Heparin.

A patient on Anticoagulation Therapy may experience 
bleeding of the gums, at dressing sites, in the urine, or
at IV sites. It is important for the nurse to assess and 
document any bleeding.

Poor circulation may occur for a number of reasons.
Any obstruction to the flow of blood may lead to conditions
such as stroke, heart failure, and or renal failure .The 
diabetic patient is also at risk.

Learn more about : ARDS, DVT and PE

What is a stroke?

A stroke is also known as a brain attack.

Identifying strokes and treatment

A stroke may be hemorrhagic (caused by bleeding) or
ischemic (embolic) caused by a clot or plaque in a blood
vessel. 

Bleeding ( hemorrhagic) into the brain may be caused
by trauma or rupture of a blood vessel due to high
blood pressure. ICP monitoring may be necessary for 
the patient with a hemorrhagic stroke.

In the case of an embolic stroke, a blood clot may
obstruct the flow of blood in the brain. This will also
affect oxygen to the brain.

Embolic strokes are usually treated with drugs such
as TPA ( Tissue Plasminogenic Activator). Antihypertensive
drugs and anti- seizure medications may also be ordered.

Reperfusion Therapy and its uses

Reperfusion Therapy is a form of treatment that
is used for patients who have a myocardial infarction

(MI) with STEMI. Typically, the patient with a
completely blocked coronary artery, would
demonstrate STEMI on the EKG.

TPA ( Thrombolytic Plasminogen Activator)
is not only used for reperfusion in patients
who had a myocardial infarction, it is also
used in the treatment of embolic strokes.