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Fei Fong is a 60 year old lady from a Chinese background. She has a hearing and sight impediment and is showing some early signs of dementia. She speaks little to no English. You are caring for Fei Fong during her recent hospital admission; she is scheduled to undergo a hip replacement under the care of Dr Patel after a recent fall. She has Type 2 Diabetic and Hypertension. The doctor has charted Mrs Fong medications for her Diabetes and Hypertension.

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Assessment Criteria

Question 1.1

What are the eight (8) rights of medication administration that you will use to safely administer medications?  Provide a brief description of how each right is undertaken.

Response:

Right

Description

1. Right Patient

Ascertains that a patient who is being treated is the correct and appropriate recipient for the prescribed medication. This is practiced by nurses by asking patient about their full name and asking for ID (Squires, 2018).

2. Right Drug

Ensures that administered medication is similar to prescribed drug name. This is to reduce confusion between some similar sounding brand names and generic names.

3. Right Dose

Confirms the prescription and appropriateness of the prescribed dose using local guidelines. Calculation of dose is also under this right.

4. Right Route

Checks order and appropriateness of route prescribed. To confirm if the patient is able to receive medication by ordered route.

5. Right Time

Checks the approximate frequency of prescribed medication, double checking the time that was intended by prescriber and giving special attention to duration of prescriptions.

6. Right Patient Education

Checks the understanding level of patient about prescribed medication and making them aware about contacting healthcare professional while experiencing any side-effects of medications (Hanson & Haddad, 2021).

7. Right Documentation

Ensures that patient have signed for medication only after its administration and to ensure if the prescription of medication is correct with appropriate starting and ending date.  

8. Right to Refuse

Ensures having the consent of patient for administrating medications and should also remain aware that patients can refuse for medication as they might have right to do so.

 Reference:

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Assessment Criteria

Question 1.2

You note that your patient speaks little to no English and furthermore shows some early signs of dementia. Provide at least two strategies that you can use to ensure that the patient understands her medication regime and the importance of taking her medications?

Response: To overcome the language barriers of patients, nurses can use the organisation’s provided interpreter sources which include in-person interpreters or technology based interpreter facilities (3). Nurses must speak slowly and clearly while talking to patient and must maintain eye contact and giving them appropriate time to respond to questions (Squires,2018).

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Assessment Criteria

Question 1.3

One of the responsibilities of the nurse administering medications is to ensure that medications are kept secure during medication administration. What are some strategies that you would use to ensure this? Provide three (3) examples.

Response: (i) Nurses must be vigilant while preparing for medications. They should avoid distractions and interruptions.

(ii) Must check for allergies- Nurses must always inquire about their allergies, reactions types and its severity (4).

(iii) Nurses must always use two patient identifiers always while medication administration (Fredrico, 2022).

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Assessment Criteria

Question 1.4

You are attempting to administer Mrs Fong’s regular medications including those for Diabetes and Hypertension when the patient refuses their morning medication. Provide at least three actions that you would take as an Enrolled Nurse in this situation.

Response: The first responsibility of a nurse is to check if the patient has been informed about possible outcomes of their decision to refuse treatment. In this case, the patient is not a native English speaker so nurses must use translator. Patient must also be informed and made aware of the medical documentation which will include the terms and conditions for patient on which nurse and primary care provider both agreed about like the problem or disease will require proper treatment or diagnosis, proposed treatment or diagnostic tests. Informed refusals by patients are also dependent on their ability to make appropriate decisions.

Mrs Fong is transferred to the operating theatre to undergo her surgical procedure - Right total hip replacement (R) THR. Whilst in the operating theatre, she has an Intravenous (IV) Cannula inserted for post-operative fluids. There was a small to moderate amount of blood loss during the procedure and a Full Blood Count (FBC) has been taken to assess whether she will need a blood transfusion. She is also experiencing post-operative pain

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Assessment Criteria

Question 2.1

Describe three (3) indications for undergoing IV Therapy.

Response:

1. Intravenous therapy is used when patient faces extreme dehydration in the case of staying outdoors for long time, losing water through extreme sweating or urination or physical exertion (IVWatch, 2020).

2. While performing inpatient and outpatient procedures while surgery and IV is a major component in surgical procedures.  It helps the providers to deliver the emergency drugs and medications quickly when needed.

3. The IV therapy can be used to improve the ability of red blood cells to carry oxygen and to replace the blood components which are deficient in body.

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Assessment Criteria

Question 2.2

Describe three (3) risks that may be associated with IV Therapy in addition to one (1) strategy per risk that the Nurse can use to minimise any of these risks.

Response:

Risk

Strategy

1. There may be risk of infection in Intravenous therapy as Staphylococcus epidermis can enter into circulatory system by access device insertion site and result in infection.

By following proper hand and body sanitization, nurses can reduce the extent of infection. Using sterilised syringes and other apparatus is also required (Brooks, 2017).

2. Phelbitis is another risk associated with IV Therapy and this is described as inflammation in tunica intima layer of veins.

Nurse must use in-line IV filters to remove any type of contamination from IV solutions.

3. Another risk is infiltration and extravasation which results in leaking of fluid from vein into surrounding tissue.

To reduce infiltration, veins in hands, wrist area and antecubital fossa should be ignored because they are region of maximum complications from catheter movement.

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Assessment Criteria

Question 2.3

Mrs Fong states that she is experiencing pain post-operatively. She is charted for three (3) different PRN pain medications including Fentanyl (IM) Endone (PO) or Panadol (PO). Describe in 50 words or less some strategies the nurse can use to assess Mrs Fong’s level of pain (NOTE: at least two (2) pain assessment tools must be provided)

Response: Nurse can either use uni-dimensional assessment tools to measure pain or they can opt for multi-dimensional tools. Uni-dimensional tools will include visual analogue scales and graphic rating scales. For multi-dimensional tools, McGill pain questionnaire and brief pain inventory.  These tools are the globally used methods for rating and assessing management of acute pain (Kishner, 2018).

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Assessment Criteria

Question 2.4

In addition to pharmaceutical approaches to pain management, what could be some non-pharmaceutical approaches the nurse could take for pain management? List three (3) strategies

Response: By using hypnosis therapy, the nurse can guide the patient in a different state of consciousness and they help in focusing or narrowing the focus of patient to reduce the level of discomfort. Another strategy is using comfort therapy which involves companionship, motivation, exercising, and meditation or positioning of patient. Last strategy used will be psychosocial therapy or counselling which can involve group or individual counselling (Kishner, 2018).

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Assessment Criteria

Question 2.5

Mrs Fong has been administered PRN Endone by the Registered Nurse (RN) to help manage her pain. How would you know if this medication has been effective or not and where would you record this information?

Response: Mrs Fong will be asked about her pain level and the relief she had been experiencing after giving PRN Endone. The efficacy of medication will be assessed on basis of post-operative pain now felt by patient. The information of level of pain in a patient is recorded in PQRST assessment questions (NHS Wirral, 2022)

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Assessment Criteria

Question 2.6

In addition to PRN Endone for pain, Mrs Fong is also charted for regular medication including Metformin, Atenolol, Furosemide, Slow-K and Paracetamol. She is also charted for a prophylactic course of IV Ampicillin upon return to ward after surgery.

Name two (2) resources that you could use to find out about correct administration such as correct dose, compatibility with other medications and correct administration.

Reference required for each resource.

Response: First resource used by nurse is Six Rights and Three Checks to know about correct administration. Second resource they can use is to check the frequency level of medication and by evaluating the medical administration record of patien (Drugs.com, 2022)t.

Mrs Fong’s FBC results have come back and indicate that she has a low haemoglobin (Hb) level requiring a blood transfusion. The doctor has charted two (2) units of packed cells.

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Assessment Criteria

Question 3.1

Describe in 50 words or less the nursing actions that should be taken by the Enrolled Nurse prior to commencement of blood transfusion including details of any observations that should be taken and how you would know the patient has consented to the procedure.

Response: It is a nurse’s responsibility of prepping patient and thus ensuring appropriate history, laboratory work, documentation and that the supplies are available for blood transfusion. Nurses are held responsible and accountable for verifying and witnessing that the patient has signed consent document (The Royal Children's Hospital Melbourne , 2022).

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Assessment Criteria

Question 3.2

Describe in 50 words or less the process for checking patient details prior to commencement of blood transfusion

Response: The nurses can check if patient is ready for blood transfusion or not by checking their IV access, completion of their consent, pre-medication administration, previous discussion of patient about benefits and risks involved in blood transfusion. Nurses must give an opportunity to patient about getting any of their questions answered (The Royal Children's Hospital Melbourne , 2022).

Assessment Criteria

Question 3.3

Approximately 30 minutes after commencing the blood transfusion, the patient is complaining of "feeling hot" and a "bit unwell". Observations reveal that her temperature has risen from 36.7o C to 38o C since the transfusion was commenced. Describe three (3) actions that you, as the Enrolled Nurse, will take.

Response: First action that a nurse must take is to immediately stop the transfusion in case of temperature rise. Second action can be keeping the IV line open with normal saline solution and must intervene for any possible signs or symptoms appropriately. Third step will be to inform the physician or doctor and the blood bank (Vera, 2016).

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Assessment Criteria

Question 4.1

MATCH the following drug schedules with the identifying description.

Medication Schedule

Schedule 2

Schedule 3

Schedule 4

Schedule 8

Schedule 2

Non-prescription, can be purchased off the shelf from a pharmacy with professional advice

Schedule 8

Controlled drugs, requiring legal prescription possession without prescription an offence

Schedule 8

Require legal prescription from dentist, medical practitioner and some optometrists

Schedule 3

Imparts a layer of governance upon the pharmacist to provide education on safe administration of certain drugs to the recipient / purchaser / client

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Assessment Criteria

Question 4.2

MATCH the following medications to their pathophysiological effect on the body.

Medication

Antibiotic

Antidepressant

Antineoplastic

Antiparkinsonian

Anticoagulants

Anticonvulsant

Vitamin

Medication

Pathophysiological effect

Antiparkinsonian

Some work by increasing the amount of levodopa, which consequently increases the amount of dopamine.

Antineoplastic

Kill cells by interfering with varying phases of cell cycle.

Antibiotic

Kills or retards growth of susceptible micro-organisms by inhibiting reproduction and synthesis functions.

Anticoagulants

Some interfere with Vitamin K. Some agents directly inhibit thrombin or factors such as Xa.

Vitamins

Necessary for normal formation and function of cells. Organic substances required for metabolic processes

Anticonvulsant

Some retard abnormal, paroxysmal excessive discharge from CNS neurones. Some stabilise hyperexcited nerve membranes.

Antidepressant

Various modes of action including serotonin and noradrenaline reuptake inhibition, Reversible inhibitors of monoamine oxidase inhibitors.

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Assessment Criteria

Question 4.3

MATCH the medication group to its pathophysiological effect on the body.

Group

Antiarrhythmic

Corticosteroids

Anaesthetics

Anticholinergic

Bronchodilators

Antacids

Antianxiety

Antidiarrheal

Antianginals

Medication Group

Pathophysiological effect

Antidiarrheal

Delay or inhibit intestinal motility

Bronchodilators

Some cause bronchodilation

Reduces the production of bronchial and nasal secretions

Antacids

Some medications buffer gastric acidity and reduce pepsin activity Some medications bind to pepsin and promote its excretion

Anticholinergic

Through various actions cause the vasodilation of peripheral arteries and veins Relaxes smooth vascular muscles

Corticosterioids

Effects the limbic system, spinal cord and thalamus

Antianxiety

Suppresses inflammatory response High levels suppress the hypothalamic-pituitary-adrenal axis

Antiarrhythemic

Class 1-Inhibit the sodium channels that slow membrane repolarisation

Class 1A-Depress myocardial excitability

Antianginals

Symptom relieving are short acting beta-2 adrenoreceptor agonists Some inhibit histamine and leukotriene release

Anaesthetics

Some depress the CNS and produce a loss of consciousness Some block or diminish nerve conduction and are reversible

References

Brooks, N. (2017, January). Remember the risks of intravenous therapy and know how to reduce them. Retrieved April 2022, from IVI Course: https://www.ivicourse.com/wp-content/uploads/2017/01/IVI-risks.pdf

Drugs.com. (2022, March 25). Medications for Blood Transfusion. Retrieved April 2022, from Drugs.com:

https://www.drugs.com/condition/blood-transfusion.html

Fredrico, F. (2022, April). The Five Rights of Medication Administration. Retrieved April 2022, from INstitute for Hrealthcare Improvement: https://www.ihi.org/resources/Pages/ImprovementStories/FiveRightsofMedicationAdministration.aspx

IVWatch. (2020, June 4). 5 Reasons You Might Need an IV. Retrieved April 2022, from IVWatch:

https://www.ivwatch.com/2020/06/04/5-reasons-you-might-need-an-iv/

Kishner, S. (2018, September 27). Pain Assessment. Retrieved April 2022, from Medscape:

https://emedicine.medscape.com/article/1948069-overview

NHS Wirral. (2022). Pain Management. Retrieved April 2022, from NHS Wirral:

https://mm.wirral.nhs.uk/document_uploads/guidelines/Pain_Management_clinical_guidelinesv2.pdf

Rubin, J., & Prager, K. (2018). Documenting refusal of treatment. Retrieved April 2022, from When a Patient Refuses Treatment, What Should Doctors Do?:

https://www.cuimc.columbia.edu/news/when-patient-refuses-treatment-what-should-doctors-do

The Royal Children's Hospital Melbourne . (2022, April). Blood administration. Retrieved April 2022, from The Royal Children's Hospital Melbourne :

https://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/

Vera, M. (2016, April 20). Blood Transfusion Therapy. Retrieved April 2022, from Nurselabs: https://nurseslabs.com/blood-transfusion-therapy-nursing-management/

Squires, A. (2018, April). Strategies for overcoming language barriers in healthcare. Nursing Management, 49(4), 20-27. doi:10.1097/01.NUMA.0000531166.24481.15

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