Discuss about the Quality Use of Medicine for Fatigue and Breathlessness.
The current study focuses upon the health contra-indications of a 68 year old man Mr. Laurent. who had been transferred to the medical unit from the emergency department. The man had been previously admitted with fatigue, breathlessness and an expiratory wheeze which occurred due to chest infection for the purpose of which he was out on a course of oral antibiotics. The patient had a past medical history of hypertension, dislipidemeia and type 2 diabetes. The patient also suffers from asthma for which he often takes medications such as ventolin. The patient had been admitted to the hospital for assistance with his activities of daily living. Some of the vital signs which had been noted for the patient are a heart rate of 112 beats per minute, a respiratory rate of 29 breaths per minute, a blood pressure of 105/70 mmHg and an oxygen saturation rate of 91%. The blood Urea and Creatinine range for the patient was also found to be high.
The patient had been provided with a list of medications such as hydrocortisone prescribed for the treatment of asthma, ceftriaxone and erythromycin prescribed for the treatment of chest infection, salbutamol prescribed for the treatment of asthma, perindopril arginine , propoanolol prescribed for the treatment of hypertension. Some of the other medications which have been prescribed to the patient are atrovastatin for the treatment of hypercholesterolaemia, metformin and glargine insulin for the treatment of type 2 diabetes. There may be a number of risks associated with the uptake of some of the medications.
The hydrocortisone is generally prescribed for the treatment of endotoxemic shock caused due to the release of bacterial endotoxin during antimicrobial treatment. As suggested by Nightingale, Hajjar, Swartz, Andrel-Sendecki and Chapman (2015), the endotoxin and hydrocortisone could increase the risk of nephotoxicity. It had been noted that the patient had already reported high range of urea and creatinine. Therefore, increase in the renal toxicity could lead to further lead to increase in the concentration of urea.
The ceftriaxone had been suggested to the patient for the treatment of chest infection. The use of ceftriaxone may cause complications within the patient in case the patient suffers from additional health issues such as type 2 diabetes (American Diabetes Association, 2014). Since the patient was put on route IV medications for it could results in the development of conditions within the patient such as deep venous thrombosis. Hence , the prescription of ceftriaxone could interfere with the working mechanism of some of the anticoagulants such as warfarin which had been prescribed to the patient as a prevention against venous blood clotting.
The intake of perindropil has been associated with a number of complications such as low blood pressure and breathing difficulties. It had been seen here that the patient was admitted to the emergency department with chest infection. The chest infection produced breathing difficulties and wheezing within the patient (Alkhenizan & Shaw, 2011). Hence, the overuse of perindropil could further complicate the breathing mechanism within the patient. The ventolin has been associated with a number of other complications such as irregular heartbeat, confusion and rapid breathing etc. Since, the patient has been seen to suffer from a range of complications the continued use of ventolin could be stopped in the patient.
Some of the risks which have been identified over here are increase in the uric acid concentration which could lead to nephrotoxicity within the patient. As mentioned by Ohashi, Dalleur, Dykes and Bates (2014), increase in nephrotoxicity has been linked with renal failure within the patient. Therefore, hydrocortisone doses need to be effectively controlled within the patient, as the patient had been prescribed the medication at an interval of six hours two times a day. Some of the other risks which had been identified previously are complications with type 2 diabetes, breathing difficulties and heart beat irregularities within the patient (Rengert, 2018).
Some of the nursing strategies which could be implemented over here for reducing the contraindications of the patient are prescribing healthy diet to the patient, including of more physical exercises within the daily care routine of the patient, intake of more fluids. The intake of healthy diet such as fresh fruits and vegetables has been seen to balance the level of blood sugar level, which could keep the diabetes in control within the patient. The fresh fruits and vegetables have also been seen to regulate the level of bad cholesterol in the blood.
The intake of more fluids has been related with good drainage within the patient. As mentioned by Parry, Barriball and While (2015), more intake of fluid have been make urination better which flushes out the unnecessary toxins out of the body. The physical exercises incorporate by the nurses within the daily care regimen of the patient have been seen to make the patient more self dependent and have better autonomy over their health. The physical exercises have been seen to relate to a good and healthy heart. Additionally, one of the most important steps which could be taken over here is following an effective documentation. The effective documentation procedures prevent the erroneous administration of medication to the patients (Hall, Johnson, Watt, Tsipa & O’Connor, 2015).
In this respect, a number of safety measures could be taken to reduce the medication errors. Some of the effective guidelines which could be followed over here are following the five rights of medication administration. It means provision of the right medication to the right patient at the right time through the right route in the right doses. The hospitals should follow proper medical procedures when transferring a patient from one hospital to the other or from one ward of the hospital to the next. The precautionary measures need to be stringently applied during shift change as the handover nurse doesn’t have sufficient information regarding the health condition of the patient. One of the most efficient manner in which the medication errors such as administration of wrong medications of overdoses of medicines could be prevented within the patient is through effective note taking. In order to avoid further errors the nurse could read back an order to the prescribing physician. This helps in ensuring that the correct medication in the right amount has been transcribed by the attending nurse. As reported by Parry, , Barriball and While (2015), placing a zero infront of a point can prevent errors within the medication dosage. For instance, a .25 mg dosage of a medication could easily be misunderstood to be 25 mg. Therefore, maintaining some of the basic precautionary measure can reduce the chances of medical errors. Additionally, the nursing professional looking after the health of the patient should take into consideration proper and effective storage of medicines. As suggested by Westbrook et al. (2015), keeping the medicine at relatively high temperatures can destroy the enzymatic properties of the medications. Hence, effective storage procedures need to be applied over here. In this respect, abiding by the policies, guidelines and regulations of an institution can also reduce the chances of incidences of wrong administration of medicine doses.
The patient Mr. Laurent had been prescribed medicines such as ceftriaxone and erythromycin though channel IV route for the treatment of chest infection. As suggested by Monogue, Kuti and Nicolau (2016), channel IV route of drug administration within the patient helps in quick absorption and faster action. The intravenous route of medicine delivery has been seen to be effective in the treatment of acute asthmatic episode. As mentioned by Blot, Pea and Lipman (2014), the administration of the drug though the channel IV route results in effective concentration in the plasma. Hence, the peak in the drug concentration is reached soon which facilitates faster action and a quick remedial response. The drugs which have narrow therapeutic indices administered through slow drip results in quick action (Grupper, Kuti & Nicolau, 2016). The drug pharamacokinetics are very important to understand the mode of action. It is further dependent upon three crucial factors which are absorption, distribution and elimination (Monogue, Kuti & Nicolau, 2016). In route IV administration the medicines are supplied directly into the blood stream which results in faster distribution. Since, the medicines are directly supplied into the blood it ensures that the action remains for a relatively longer period of time. Some of the pharmacokinetic parameters, which could be taken into consideration over here are the apparent volume of distribution of the drug, the time taken to eliminate half of the drug, the bioavailability etc. The bioavailibity is crucial factor over here, as it determines the extent to which an active drug component is available in the blood (Steele et al., 2015). The lesser the half-time the less is the bioavailability. The more the half-time the more is the time taken by the drug to act on a specific site.
Conclusion
The current study focuses upon the quality use of medications within healthcare. Here, the patient has been presented with multiple health issues and had been prescribed with a number of medications. The assignment focuses upon design of effective nursing strategies for dealing with the complications within the patient. Some of these are based on following of effective legislations and guidelines which are aimed at safe medication practices. Through the study the importance of channel IV drugs and medications has also been highlighted. They ensure that the drugs are absorbed quickly within the blood and have faster mode of action.
References
Alkhenizan, A., & Shaw, C. (2011). Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine, 31(4), 407. doi: 10.4103/0256-4947.83204
American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80. Retrieved from: https://doi.org/10.2337/dc14-S014
Blot, S. I., Pea, F., & Lipman, J. (2014). The effect of pathophysiology on pharmacokinetics in the critically ill patient—concepts appraised by the example of antimicrobial agents. Advanced drug delivery reviews, 77, 3-11. Retrieved from: https://doi.org/10.1016/j.addr.2014.07.006
Grupper, M., Kuti, J. L., & Nicolau, D. P. (2016). Continuous and prolonged intravenous β-lactam dosing: implications for the clinical laboratory. Clinical microbiology reviews, 29(4), 759-772. doi:10.1128/CMR.00022-16.
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PloS one, 11(7), e0159015. Retrieved from: https://doi.org/10.1371/journal.pone.0159015
Monogue, M. L., Kuti, J. L., & Nicolau, D. P. (2016). Optimizing antibiotic dosing strategies for the treatment of gram-negative infections in the era of resistance. Expert review of clinical pharmacology, 9(3), 459-476. Retrieved from: https://doi.org/10.1586/17512433.2016.1133286
Nightingale, G., Hajjar, E., Swartz, K., Andrel-Sendecki, J., & Chapman, A. (2015). Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. American Society of Clinical Oncology. DOI: 10.1200/JCO.2014.58.7550
Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug safety, 37(12), 1011-1020. Retrieved from: https://link.springer.com/article/10.1007/s40264-014-0232-1
Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420. Retrieved from: https://doi.org/10.1016/j.ijnurstu.2014.07.003
Rengert, G. F. (2018). The geography of illegal drugs. Routledge. Retrieved from: https://www.taylorfrancis.com/books/9780429965074
Steele, A. N., Grimsrud, K. N., Sen, S., Palmieri, T. L., Greenhalgh, D. G., & Tran, N. K. (2015). Gap analysis of pharmacokinetics and pharmacodynamics in burn patients: a review. Journal of Burn Care & Research, 36(3), e194-e211. Retrieved from: https://doi.org/10.1097/BCR.0000000000000120
Westbrook, J. I., Li, L., Lehnbom, E. C., Baysari, M. T., Braithwaite, J., Burke, R., … & Day, R. O. (2015). What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International Journal for Quality in Health Care, 27(1), 1-9. Retrieved from: https://doi.org/10.1093/intqhc/mzu098
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