Nursing Practice: Medication Administration, Drug Allergies, And Exudates

Importance of accurate medication dosages

1. When the therapeutic range of a drug is narrow, what should the nurse expect?

Blood levels of the drug would be monitored throughout therapy

The drug would produce the desired effect at low doses

The drug would produce many adverse effects at low doses

The drug would only be used in an emergency

I believe option 1 is true. My rationale for this is:

[Narrow Therapeutic Index (NTI) drugs are capable of generating adverse drug reactions or serious therapeutic failures due to small differences in their doses or blood concentrations. Therapeutic drug monitoring is necessary for such drugs to avoid such negative outcomes because of dose dependent therapeutic administration of those narrow window drugs (Gentry 2017).]

I believe option 2 is true. My rationale for this is:

[Low dose drugs are considered to be highly potent where the desired effects are produced at lower concentration. However, in case of the narrow therapeutic range of the drug, this is even more relevant as minor difference in the median lethal dose and median effective dose may cause adverse effects (Tripathi 2013).]

I believe option 3 is false. My rationale for this is:

[Drugs having narrow therapeutic index only produce adverse effects when the difference is small for the dose applied or the measured concentration of the drug in blood. Lower or higher doses of the drug do not corroborate to the effectiveness of the drug instead therapeutic index is crucial for administration.]

I believe option 4 is false. My rationale for this is:

[Emergency medications are generally applicable for producing the immediate effects in critical conditions. However, narrow therapeutic index drugs require constant monitoring as it might act differently on patients because of individual variations and hence would be inappropriate. The lack of producing direct actions makes these drugs unsuitable for emergency use.]

2. Nurses administer medications to patients in a variety of settings. Which of the following statements is true.

Nurses must be able to accurately calculate medication dosages, and be aware of normal dosages and administration routes in order to safely administer medications.

Nurses won’t be held accountable for medication errors, because only doctors can write medication orders. Nurses just need to sign for medications.

Nurses only need to follow the orders on the medication chart and observe the 10 rights of medication administration to give medications safely.

Modern medications are safe and effective and it is unfair that students are expected to learn about why medications are being given, how the medications will act and possible side effects.

I believe option 1 is true. My rationale for this is:

[Nurses are legally accountable for applying the prescribed medications to the patients in a competent and ethically abided manner. Knowledge and training about the correct dosage and route of administration is imperative to ensure the safety of the patients. Drug administration in an acceptable manner is a prerequisite of the profession (Choo, Johnston and Manias 2013).]

I believe option 2 is false. My rationale for this is:

[Doctors are the authorized personnel for prescribing medication orders. However, the nurses are responsible for carrying out their duty of carrying out their orders; therefore, they need to monitor and undertake the medication orders and in case of errors may be held accountable for breach of duty and medication error.]

Identification and management of drug allergies

I believe option 3 is false. My rationale for this is:

[The observance of the 10 rights of medication administration is crucial in the nursing profession for administering medications to patients correctly apart from following the orders on the medication chart. However, nurse must cross verify and routinely monitor the drug administered to ensure safety to the patient through pragmatic approach.]

I believe option 4 is false. My rationale for this is:

[Drugs are endogenous substances that posses certain therapeutic effects for rendering clinical benefits. However sound knowledge and understanding about the pharmacologic properties and other necessary details, side effects of the drugs will enhance the efficacy of administration thereby allaying the possibility of potent adverse reaction due to individual variation in patients’ responses to medications.] 

3. It would be a priority for the nurse to withhold a medication and contact the prescriber if a patient reported an allergy to the medication with which symptom that occurred shortly after the last time they took the medication?

Constipation

Dry mouth

Vesicular rash

Wheezing

I believe option 1 is false. My rationale for this is:

[Constipation is a common complaint among patients suffering from bowel disorders and in some cases may occur due to overuse of antacid medications and laxatives or due to other pathological conditions. However, in normal dose, this does not happen and hence allergy in response to constipation is not possible under such circumstances.]

I believe option 2 is false. My rationale for this is:

[Dry mouth is reported in conditions where symptoms mostly occur due to side effects of certain medications, diseases and infections in addition to medical treatments such as radiation and chemotherapy. However, allergic responses due to medications with symptoms of dry mouth are not documented to withhold medication as priority (Rigby 2014).]

I believe option 3 is true. My rationale for this is:

[Vesicular rash are blisters that appear on the skin due to immunological responses to inflammatory conditions and has the capacity to spread rapidly. Therefore, report of allergy to medication with symptom of vesicular rash must be addressed on a priority basis to avoid further spreading and recurrence (Patheja, Weaver and Morris 2016).]

I believe option 4 is true. My rationale for this is:

[Wheezing tend to occur due to respiratory distress and under conditions where the narrowing of the respiratory tract occurs or inflammation takes place. Various respiratory disorders and infections underpin such symptoms. Therefore, if this is reported following administration of medication, it is vital to withhold the medication and communicated to the physician for an effective resolution (Galobardes et al. 2015).]

4. A patient has clear, watery fluid leaking from the site of inflammation. The nurse would document this type of exudate as:

Serous

Suppuratives

Fibrinous

Haemorrhagic

I believe option 1 is true. My rationale for this is:

[Serous exudates is characterized by thin, clear and watery fluid having low protein content and is generally noticed at the site of inflammation of acute or mid type. It occurs mainly due to response reaction to tissue repair having an inflammatory phase (Buckley et al. 2013).]

I believe option 2 is false. My rationale for this is:

Types of exudates and their characteristics

[Suppurative exudates are commonly referred to as pus and generally occur in condition of severe infections and comprise of plasma having both active and dead components such as those of neutrophils, necrotic parenchymal cells and fibrinogen. Higher concentration of leucocytes is a defining feature of such exudates.]

I believe option 3 is false. My rationale for this is:

[Fibrinous exudates may appear as both pus like or clear fluid and occurs in conditions when injury causes the skin to be exposed thereby leaking out from the blood vessels to the neighboring tissues. Serum, fibrin and white blood cells typically constitute such exudates.]

I believe option 4 is false. My rationale for this is:

[Haemmorhagic exudates occur in conditions when the rupture of the blood vessels prompt the blood to ooze out containing a large number of red blood cells. The color appears to be red because of the presence of the iron containing hemoglobin inside the erythrocytes or red blood cells of the blood. The site of inflammation does not generally ooze out such exudates.]

5. How do you reduce fluctuations in drug levels in the body?

Give at the same time each day

Give medications with food

Administer medications by continuous infusion, administer a slow release preparation, or administer smaller doses more frequently

Give enteric coated medications

I believe option 1 is false. My rationale for this is:

[Drugs given at the same time each day are generally prescribed to adhere to the biological clock set within our body that is generally refers to as chronotherapy. Drugs taken at different hours of the day may not produce the optimum effects as suggested in the definite time of the day. However, fluctuations in drug levels cannot be minimized by this measure, it will only ensure increased compliance to the recommended drug.]

I believe option 2 is false. My rationale for this is:

[Drugs are generally advised to be taken 1 hour before meal or 2 hours post meal condition in order to eliminate the chance of food-drug interactions. It might give rise to side effects; worsen the side effects of the ensuing medications apart from preventing the mode of action of the medication. Thus, such practice will not improve increased medicine efficacy.]

I believe option 3 is true. My rationale for this is:

[For the sake of decreasing the fluctuations in drug levels, administration of drugs by continuous infusion, depot preparation and reducing both the size of each dose along with decreasing, the dosing intervals have been found to be effective. Care must be taken to keep minimum concentrations when the toxic concentration and minimum effective concentration differ minutely (Rosenthal and Burchum 2017).]

I believe option 4 is false. My rationale for this is:

[Enteric coated medications renders protection against the effects of gastric juice thereby preventing the interaction, destruction and degradation of the drugs. It is generally applied to oral medications to travel through the stomach and get absorbed in the intestinal tract. Thus, the active ingredient of the drug are only released when the medication enters into the small intestine. Drug level fluctuations are not related to such measure.]

1. Medication errors may occur because: The correct answer is
2. The nurse cannot calculate the correct dose
3. The is an error in the medication order and the nurse does not recognise it
4. The nurse does not identify the patient correctly
5. The right medication is given by the wrong route

I believe option 1 is true. My rationale for this is: My rationale for this is: The first answer is correct because administering the correct dose of medicines are extremely important because under-dose may not bring out the effect of the medicine and overdose may bring out adverse effects. Different doses are prescribed depending upon the condition of the patients at that particular time (Hayes et al. 2015). Therefore a particular dose which may bring out the best effect in one can bring out the worst effect in other individuals as the condition of their physiological system may be different at different instances.

I believe option 2 is true. The second answer is also considered to be true. While providing the medication, it is extremely important for the nurse to understand the correct order because there are many medicines that needs to be taken before meal, after meal or in empty stomach in order to display their best effects. Besides, many drugs are also provided in a sequential manner to keep the particular medicine working in a patient at a constant rate (Vaismoradi et al. 2014). By breaking the order of the dose, it may affect the entire chain of the effect produced by the medicine.

I believe option 3 is true. My rationale for this is: The third answer is also true. If the nurse is administers a medication to a wrong patient, the patient may face adverse effects as the medication may harm his physiological process as it was not originally prescribed to meet his condition.

I believe option 4 is true. My rationale for this is: The fourth option is true because the there are different medications that must be administered through specific routes to bring out their potential effects. A medicine which must be administered orally must have more benefit in comparison to when it is administered intravenously. Therefore level of activity and the rate of activation may vary. Hence correct route is to be followed by nurses while administering medication.

1. When do adverse drug reactions occur more often? (Document all that apply)
2. When patients take multiple drugs
3. When patients take potent drugs
4. When a drug error occurs
5. When patients have multiple chronic diseases

I believe option 1 is true. My rationale for this is: The first answer is true because when a patient is taking multiple drugs, there is a high chance that the components one drug may react with components of other drug resulting in adverse drug- drug interaction. Hence the medications that should be administered should be rechecked of its chemical components before administering.

I believe option 2 is true. My rationale for this is: The second answer is also considered to be true. Nurses tend to be very careful while administering potent drugs. Drug with higher potency should be given in low doses. Drugs with lower potency should be given at high doses. If the nurses make any errors in understanding the potency of the medication, it may lead to harmful impacts on patients (Keers et al.  2013).

I believe option 3 is true. My rationale for this is: The third answer is also true because when a drug error occurs in any ways like wrong route, wrong dose, wrong patient or others, the medicine may react within the components of the physiological system in a way which was not destined to be given to that patient. Often in such cases of drug errors, the medicine may enter in wrong patients, or in wrong route and case adverse drug reaction (Orbaek et al. 2015).

I believe option 4 is true. My rationale for this is: The fourth answer is also true. When a number of chronic disorders are present, one prescribed drug for one particular may react with another medicine given for the other chronic diseases creating drug error. Hence, while prescribing medicine critical analysis of the prescribed drugs should be done.

1. Respiratory distress in infants and small children involves:
2. Sternal and chest wall retractions, grunting, stridor and wheezing
3. Grunting, stridor, wheezing and sneezing
4. Sternal and chest wall retractions, grunting
5. Sternal and chest wall retractions, grunting, wheezing and sneezing

I believe option 1 is true. My rationale for this is: all the disorders are found in children. Grunting respirations are often recognized as signs of serious illness for newborn infants but they are not studied yet in children. Chest wall retractions are also common in children where they have to use their chest muscles to breathe that they usually do not use under normal conditions to get air into lungs. Stridor is an inspiratory sound and wheezing is the expiratory sound that shows that child is having distress in breathing. Sterna retractions mainly the substernal as well as the suprasternal retractions also helps the nurse to indentify whether the babies are having issues in breathing or not.

I believe option 2 is true. My rationale for this is: grunting, stridor and wheezing occur in children and has been already discussed. Sneezing also occurs in them due to certain allergy.

I believe option 3 is true. My rationale for this is: Sternal and chest wall retractions are a severe issue which shows that the child has to use his chest muscles to breathe which is usually not used by them. Grunting mainly occurs in babies with lower respiratory system infection in babies (Piastra et al. 2014).

I believe option 4 is true. My rationale for this is all the symptoms show that the baby or the small child had developed respiratory distress and the kind is discussed in the above questions.

1. The cells involved in the immune response are:
2. Lymphocytes, erythrocytes and neurons
3. Osteocytes, osteoblasts and T helper cells
4. Lymphocytes, granulocytes and erythrocytes
5. Type 2 T helper cells, Mast cells, B cells, eosinophils

I believe option 1 is true. My rationale for this is: that lymphocyte include natural killer cells helping in cell mediated cytotoxic innate immunity, t cell which has cell mediated adaptive cytotoxic immunity and also B cells which provide antibody driven humoral, adaptive immunity (Parham 2014). The erythrocytes also take part in immune system by killing pathogens with the help of macrophages in the spleen. Neurons are nowadays believed to induce mast as well as the dendritic cells that ultimately help in fighting the infections. Pain fibers are found to directly signal white blood cells and thereby alter immune response.

I believe option 2 is false. My rationale for this is: although osteoblast and osteoclast are interconnected with immune system but they don’t play a role directly in producing an immune response. Osteoclast comes from the myeloid precursor cells which create macrophages. Osteoblast regulates the hematopoietic stem cell niches which is responsible for preparation of different blood and immune cells. However they directly do not take part in any immune activities helper T-cells activate macrophages and cytotoxic T cells to kill pathogens (Abbas, lichtman and Pillai 2014). They help the B cells to produce antibodies.

I believe option 3 is true. My rationale for this is: that the function of lymphocytes and erythrocytes are already discussed. Granulocytes also take an active part in immune sytem and consist of basophils, eosinophil and neutrophil each of which have important function in the killing and destruction of antigen. They are mainly a part of the white blood cell with granules in their cytoplasm.

I believe option 4 is true. My rationale for this is: Helper t cells and eosinophils are already discussed. B cells provide antigen driven humoral adaptive immunity. Myeloid cells contain histamin and heparin that take part in allergy reactions and anaphylaxis.

1. Which medication is used to prevent platelet aggregation?
2. Tirofiban
3. Vitamin K
4. Clopidigrel
5. Warfarin

I believe option 1 is true. My rationale for this is: it is an anti platelet drug and belongs to the class of antiplatelet called the glycoprotein IIb/IIIa inhibitors helping in reducing the rate of thrombotic cardiovascular conditions in patients who suffer from non-ST elevation acute coronary syndrome Mega and Simon 2014)

I believe option 2 is  false. My rationale for this is: vitamin k helps in platelets aggregation by initiating the cascade of coagulation. Proteins get activated in a chain to result in activation of fibrinogen. This is exactly opposite to antiplatelet drug function.

I believe option 3 is true. My rationale for this is: that clopidogrel act as antiplatelet drug and acts on  P2Y12 platelet ADP receptor decreasing the rate induced aggregation of platelets.

I believe option 4 is false. My rationale for this is: warfarin acts as anticoagulant drug and thereby inhibits the vitamin K-dependent synthesis of various kinds of clotting factors like I,VII, IX and X and inhibits thrombus formation. It actually lengthens the time to take to form clots by altering the chemical reactions. It is not antiplatelet drug which acts by prevention in forming clumps by platelets and so do not form a clot.

References

Abbas, A.K., Lichtman, A.H. and Pillai, S., 2014. Basic immunology: functions and disorders of the immune system. Elsevier Health Sciences.

Buckley, C.D., Gilroy, D.W., Serhan, C.N., Stockinger, B. and Tak, P.P., 2013. The resolution of inflammation. Nature Reviews Immunology, 13(1), pp.59-66.

Choo, J., Johnston, L. and Manias, E., 2013. Nurses’ medication administration practices at two Singaporean acute care hospitals. Nursing & health sciences, 15(1), pp.101-108.

Drago, B.B., Kimura, D., Rovnaghi, C.R., Schwingshackl, A., Rayburn, M., Meduri, G.U. and Anand, K.J., 2015. Double-blind, placebo-controlled pilot randomized trial of methylprednisolone infusion in pediatric acute respiratory distress syndrome. Pediatric Critical Care Medicine, 16(3), pp.e74-e81.

Galobardes, B., Granell, R., Sterne, J., Hughes, R., Mejia-Lancheros, C., Smith, G.D. and Henderson, J., 2015. Childhood wheezing, asthma, allergy, atopy, and lung function: different socioeconomic patterns for different phenotypes. American journal of epidemiology, 182(9), pp.763-774.

Gentry, E.P., 2017. Empirical Evidence of Risk Penalties for NTI Drugs.

Hayes, C., Jackson, D., Davidson, P.M. and Power, T., 2015. Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), pp.3063-3076.

Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2013. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2), pp.237-256.

Mega, J.L. and Simon, T., 2015. Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments. The Lancet, 386(9990), pp.281-291.

Orbæk, J., Gaard, M., Fabricius, P., Lefevre, R.S. and Møller, T., 2015. Patient safety and technology-driven medication–A qualitative study on how graduate nursing students navigate through complex medication administration. Nurse education in practice, 15(3), pp.203-211.

Parham, P., 2014. The immune system. Garland Science.

Patheja, R.S., Weaver, T. and Morris, S., 2016. Unique case of orbital myositis and dacryoadenitis preceding the vesicular rash of herpes zoster ophthalmicus. Clinical & experimental ophthalmology, 44(2), pp.138-140.

Piastra, M., De Luca, D., Costa, R., Pizza, A., De Sanctis, R., Marzano, L., Biasucci, D., Visconti, F. and Conti, G., 2014. Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: nested study. Journal of critical care, 29(2), pp.312-e1.

Rigby, D., 2014. Medication in review: Dry mouth and HMRs: A case study. AJP: The Australian Journal of Pharmacy, 95(1132), p.62.

Rosenthal, L. and Burchum, J., 2017. Lehne’s Pharmacotherapeutics for Advanced Practice Providers-E-Book. Elsevier Health Sciences.

Tripathi, K.D., 2013. Essentials of medical pharmacology. JP Medical Ltd.

Vaismoradi, M., Jordan, S., Turunen, H. and Bondas, T., 2014. Nursing students’ perspectives of the cause of medication errors. Nurse education today, 34(3), pp.434-440.