Discuss about the case study Clinical Practice for Cystic Fibrosis.
The decision making part plays a vital role in overall appropriate medication which help the patient to recover as soon as possible. The challenge in the given case study is to analyze and provide a routine medication based on the proper scheduling of the drug and the amount of dosage base on the patient clinical record. The criteria in the first decision is that am I ready to go further with the preparation of the Kaseys AM medication, on the analysis it is found that the Kasey is under medical regime and it is very much necessary for the patient to remain in hospital to avoid any future emergency condition (Zuvekas, 2006). Regime preparation for the patient suffering from cystic fibrosis considered of having one of the complex medication, which is why it is very much essential for the administration to organize the overall medication regime in such a ways that is considered to be workable and effective for their overall care and cure. The preparation of Kasey’s AM medications in order to determine the treatment of the cystic fibrosis includes the pancreatic enzymes supplements, multivitamins with the consideration of the fat-soluble vitamins, mucolytics and the antibiotics with the inclusion of the inhalation, oral or the parental, bronchodilators and the anti-inflammatory agents with CFTR potentiators (Suzuki, 2016). The preparation of the AM medication for kasey also provides the information of the drugs available on the NP with the management of the patients. The amendment of the DTP is shown with the approval of the scope of the practice. It also helps in the creation of the treatment.
As the patient Kasey’s is merely 5 years old and she has already gone through several test and medication regime so it is very much crucial for the RN to prepare a regime of medication for the patient suffering from cystic fibrosis. The decision depends on the medication chart of the Kasey s it is said to never administer a medication without knowing or if the medication chart contain error. This will lead to the poor care rate and the overall cure of the patient hampered. The decision is very much based on several key aspects as the age of the Kasey is five year only and she does not have any control on her language and skill and also willing to take control on everything (Pollack, 2007). The age is one of the biggest factors in determining the medication regime for the patient. Secondly with the help of the registered nurse the patient thoroughly analyses based on the routine medication. The Registered nurse is primarily analyzing the patient overall cognitive ability which is probably considered to be a preschool aged child. Communication with the patient ass the age of the patient is five year old and the ability to understand and manage a rapport with her will be one of the biggest challenges which will eventually lead to the better and prospective care for the patient which will help them to heal as quickly as possible. The complexities of the dosage regime are considered to be playing a important role in managing and maintaining the overall drug and usage control (Patrick and Li, 2010). Present medication of the registered nurse, the dosage regime Kasey has 2IV lines in situ which is considered to be both in situ as it is continuously which is presently present into a port-a-cath as well as the nasogastric tube. With the help of pharmacist the medication is considered to be playing a important role in the medication for the CF patient care. Patient with cystic fibrosis is considered to be having most complex and critical medication regimes. When preparing the patient regime it is very much important for the decision makers that it leads to the overall reviewing of the entire medication carefully. Being only five year old which is considered to be a pediatric is completely based on the weight of the patient (Mohammad, Aljasser and Sasidhar, 2016). To make the regime more effective and evasive for the patient aged less several test are being done to minimize the impact of the medicine on the patient. The RN is essentially needed to take a regular note on the overall medication procedure to meet the guideline. Other medication is also being analyzed and need to be checked if a patient is taking drug. The pediatric patient become irritated much often due to the regular medication so therefore it is also considered to be one of the major concern before making a decision. Pancreatic enzyme replacement therapy (PERT is considered to be necessary for the children and for the young people with cystic fibrosis. PERT theory helps the patient to digest and absorbed the vital nutrient into the body and thus helps them to immune themselves from several other diseases (Kiguba et al., 2015). Without PERT pediatric patient are at risk. In case of Kasey PERT is considered to be one of the major medication regimes. Kasey varied in the overall intensity of the pancreatic deficiency which lead to the dosage of the medication differs for different patient. RN helps to determine the regime of the medication or the patient. On the basis of the medication chart of the patient the guideline of the enzyme dosing is,
1 scoop of Creon Micro per 5g of fat
1 Creon 10000 capsule per 8 g of fat
1 Creon 25000 per 15 g of fat
It is considered to be effective if the amount of the enzyme is given a little more as it helps to provide more effectiveness to the patient (Hung et al., 2016). It is advised to take the pancreatic enzyme right after the meal or snack. Enzyme is considered to be lasted in the small intestine for around 30 minutes. If the child is considered to be regularly taking time to eat the food that it is considered to have the half of the dose at the initial of the feed and the rest of the enzyme is given after the completion. Therefore on the basis of overall assumption and factor that the decision for preparation of Kasey AM medication is ready and attainable.
The preparation of medication appropriately is very much important to its effectiveness. The antibiotics should be taken that would be prepared for Kasey. The weight of Kasey is 14 kgs only and Tobramycin would be the most powerful medication. The probability of error is low and the CF drug therapy protocols are followed by Kasey that slightly varies from the Mims recommendations. However, it is significant that kasey should receive appropriate amount of dose at correct time in correct dilution. The levels of peak serum do not exceed the 12 microgram/ml (Aspden 2007). therefore, it is very important that the levels of tobramycin serum should be checked appropriately before giving next dose. The Kasey receives inhalants such as ventolin should be administered by the spacer. The preparation of medication is very much important and should be appropriately aware of the process. The medication give to children is based on their weight. As per the age of Kasey she is very light and it is important to give specific dosage at times to be suited her. For an example, Tobramycin should be given on the basis of her weight (Cohen 2007). Tobramycin should be diluted before the administration. The administered concentration should not be exceeded from 1mg/ml and also should be administered over the period of 30 minutes at least.
The dosage should be estimated appropriately on the basis of age and weight of kasey.
Volume (mls) to be given = Dose ordered / stock strength * volume of stock solution
The calculation of the liquid meds is based on the injectable meds and oral route given IM, ID or SC. The ordered dose is the drug amount that to be prescribed for the patients. The strength of stock is the durg amount that is included in the solution. The volume of the stock solution is referred to the total solution volume in the amploule/vial, eg. 2 mL, 1 mL etc. An elderly patient with the pulmonary odema needs rapid diuresis (Koutkias 2011). The administration of oral is not possible and frusemide is specified. The patient is commonly prescribed the IV Frusemide 40 mg salt if necessary to be reaped after 20 minutes till output is adequate. Lasix ampoules contain 20mg/2mL.
Volume (mLs) = 40 mg / 20 mg * 2 mL
= 4 mL
The “IV Push” is necessary while performing that the prescribed medication has been recommended need to be given as push. The following things should be outlined in the recommendations of manufacturer and MIMs. It is important to note a particular time period in order to administer the drugs by using IV bolus injection (Medication 2008). The decision ‘not to push’ or ‘to push’ drugs is based on large number of factors that includes the condition of patients, urgency situation.
The administration of oral medications in the TABLET forms the following formula:
Number/amount of tablets= Dose ordered/stock strength
The ‘ordered dose’ is the medication amount that has been prescribed. The strength of the stock is the amount available. However, the medication can be located in Imprest/Drug cupboard or in the medication cupboard of the patient or on med trolley. It is important to determine and evaluate the process of medication which includes:
Identifying the potential risks
- Checking the written prescription is within the prescribed guidelines that is set out under hospital policy and legislation
- Checking the order legibility and name of the drug that has been written with correct route, time and dosage as well as start date (NR 2013).
- Checking that the patients has any documented allergies
- Checking that the patient has appropriate chart and the sheet of medication has been labeled correctly with their identification
- Assessing the patient for the contraindications that to the medication prescribed
- Assessing for incompatible drug in relation to other non prescribed/prescribed therapies that the patient is receiving currently.
Preparing the medications safely
- Accurately calculating the dosages of medication and doubled checking by RN
- Gathering all supplies and equipment needed to prepare the medication
- Checking all the labels that are legible and the medications that have been correctly stored.
- Appropriately checking expiry date of the medications (Parker 2013).
- Using no touch techniques while preparing medications
- The preparation of medications that would be consistent with the organizational protocols and legal requirements
- Ensuring that all the medications are checked thoroughly by second RN.
Administrating of the medication is one of the most important tasks as it plays vital role in the recovery of the patients, specially the critical patients are greatly dependent on the proper administration of the medication. (Andersen et al., 2016). Therefore, for proper administration of the medications the responsible nurses should have proper knowledge of administrating the medicine to the patients. They have to acquire the knowledge about the correct routes of administrating the medicine to the patient especially to the critical patients. Proper medication is most important for the treatment of the patients. Besides this, the concerning nurses have to know about the proper methods of non-touch and aseptic techniques in order to administrating medications to the patients and know about the importance of non-touch and aseptic techniques (Besenius, Bradley and Nolan, 2012). Apart from this, the record keeping is also an important task, the concern nurse has to keep the record of the medications administrating to the patients properly so that the subsequent nurses who will take the responsibility can easily understand about the patients conditions and the medications given to the patients. Therefore, decision making in order to administrate medications to the patients might be crucial and as per the condition of the patients the nurses or medicine practitioners use to take the decisions of administrating the medicine. Moreover, as per the condition of the patients the nurses use to take decision that in which route the medications should be provided to the specific patient (Nelson, 2010). The medicine can be administrated via mouth of the patient as well as by injection for critical patient the medication use to be provided by the IV channel. The medicine should be provided in accurate measure and in the time of administrating the medication the nurse should take care of proper hygiene of the patient and also him/her. The nurse should take care of hand hygiene. The interaction of the medication can be merely complicated and inappropriate interaction lead to adverse result for the patients (Rossignon, 2002). In the undertaken case of Kasey, the patient is a five years old baby girl suffering from decreased appetite, abdomen pain as well as contentious nausea along with anorexia. Besides this, she has Cystic Fibrosis and she is suffering from continue respiratory and gastro problems. Her diagnosis shows that she has distal Obstruction Syndrome owing gastro mal absorption, pancreatic insufficiency along with inadequate salt and fluid intake. The investigation by X-ray shows that she has dilated bowel with fluid loops (Tongtong, 2010). The physician has medical assessment about Kasey that she has medium dehydration along with sign of malnutrition as she has only 14 Kgs weight which placed her at the third percentile as well as her height is at the percentile on her growth chart. She is a critical patient and the concern nurse has to take care at the time of administrating medication to the patient. In order to administrate medication to the patient some important things should be watched by the concerned nurse that she is taking care of proper hygiene, proper hand hygiene, so that the patient can be restricted from the infections that possibly ruined the treatment of the patient. The route of the medication is also important for the patient because proper route of the medication help in improving the condition of the patient more swiftly. Proper administration of the medication is most important for the quick improvement of the patient. And here as the patient is critical then she require more care at the time of administrating the medication for her.
Recording and Reporting Medication Administration Outcomes
As per the reporting and the medication of the outcomes, provides the overview of the medical outcomes that must be represented in the case of the medication and thereby the approaches are potentially included for the enhancement of the improvements (Andrew and Mansour, 2013). The recording and the reporting’s of the drugs includes the involvement of the nurses which are included for the involvement of both dispensing and the preparation of the medications. The medications also include crushing pulls and drawing the measurement of the injections that are essential roles which are played by the nurses. The most common type of the error is the administration errors that are generally related to the wrong time, wrong rate and the wrong dose. With the nurses, the physicians, certified medication technicians, miscommunication with the family members also helps in the consideration of the part of the challenge and thereby becomes the most common cause for the creation of the impact on the administration medication (Armutlu et al., 2008). Several studies are made for the consideration and the reporting of the research which helps in the administration of the medications and thereby the need of the research clearly differentiates the errors of several non-nurses with the inclusion of the impact on the nursing. Among many reasons the medication administration also helps in the indication of the problems that are required to be resolved with the consideration of the errors. With the recording and the reporting of the medication administration outcomes provides Kasey with the increment of the needs and it also ensures the patient’s medication.
Monitoring Patients' Responses to Medications
With monitoring the Patient’s response, it also ensures effect of the mechanism with monitoring the effects of the medication and it also ensures the drug therapy with the creation of adverse events is seemed to be minimized. With monitoring the first doses of the medication, it includes the monitoring of the fluid and the electrolyte with the consideration of the electrolyte imbalance (BERGANTIÑOS and VIDAL-PUGA, 2009). It also provides impact on the creation of the risk and thereby it also helps in the creation of the electrolytic balance monitoring. Monitoring the patients with high alerts also helps in the creation of the identification of the policies and the procedures related to the High-alert Medication. Reassessing the patient for the medication administration also helps in the creation of the appropriate evaluation of the response and thereby the patient develops the adverse event of the report with according to the observed reaction. Monitoring the frequencies of the treatment with the process of the creation of the appropriate duration of monitoring the methods are seemed to be crucial part for the monitoring methods with the creation of the Opiod Therapy and thereby the adverse effects of the patient is seemed to be reduced (Chen-Tung Chen, 2008). With the creation of the perceived efficiency and the clinical conditions of the patient, the monitoring response can be identified with the falling of the risk factors and thereby the monitoring process shows the improvement of health of the patient Kaesy.
Educating patients, family members and/or others, as appropriate, about medications, treatment & disease process
These factors provide the necessary and the crucial role for the creation of the appropriate environment for the patient Kaesy which seems to be very much essential. It also helps in taking appropriate decisions with the creation of the enhancement of the reflection of the developments made in the patient. It also provides the overview of the administration outcomes and the monitoring made by the parents helps the patient to shows the improvement in the stages of curing (Force et al., 2006). Appropriate planning with the implementation of the doses helps the patients to improve the effects of the medications in the ways of the enhancements and thereby the effects of the medication are also focused with the enhancement of the planning for the decrement of the side effects for the further development of the patient. Familiarity is also seemed to be raised in the minds of the patient as it helps the person to fight with the disease with inspiration and motivation (Hicks and Becker, 2006).
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