Procedures Basic to Nursing Care
A.
B.
C.
D.
Asepsis and Infection Control
Safety, Security and Emergency Preparedness
Complementary and Alternative Therapies
Medications
Asepsis and Infection Control
Terminologies:
 Acquired immunity/Passive Immunity
o the host receives natural (e.g., from a nursing mother) or artificial (e.g., from an injection of immune
serum) antibodies produced by another source.
 Active immunity
o the host produces antibodies in response to natural antigens (e.g., infectious microorganisms) or
artificial antigens (e.g., vaccines).
 Acute infections
o generally appear suddenly or last a short time
 Airborne precautions
o used for clients known to have or suspected of having serious illnesses transmitted by airborne
drop-let nuclei smaller than 5 microns. Examples of such illnesses include measles (rubeola),
varicella (including disseminated zoster), and tuberculosis.
 Antibodies/Immunoglobulins
o is a large, Y-shaped protein produced mainly by plasma cells that is used by the immune system to
neutralize pathogens such as pathogenic bacteria and viruses
 Antigen
o a substance that induces a state of sensitivity or immune responsiveness (immunity)
 Antiseptics
o agents that inhibit the growth of some microorganisms
 Asepsis
o the freedom from disease-causing microorganisms
 Autoantigen
o the proteins (antigens) originate in a person’s own body
 Bacteremia
o a culture of the person’s blood reveals microorganisms
 Bacteria
o are by far the most common infection-causing microorganisms, several hundred species can cause
disease in humans and can live and be transported through air, water, food, soil, body
tissues and fluids, and inanimate objects
 Bloodborne Pathogens
o are infectious microorganisms in human blood that can cause disease in humans
 Carrier
o a person or animal reservoir of a specific infectious agent that usually does not manifest any
clinical signs of disease.
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 Cell-Mediated Defences/Cellular Immunity
o occurring through the T-cell system, large numbers of activated T cells are released into the lymph
system by the lymphoid tissue on exposure to an antigen
 Chronic Infections
o infections that may occur slowly, over a very long period, and may last months or years.
 Clean
o the absence of almost all microorganisms,
 Colonization
o the process by which strains of microorganisms become resident flora.
 Communicable Disease
 caused by infectious agents that can be transmitted to an individual by direct or indirect contact or
as an airborne infection
 Compromised Host
o a person at increased risk, an individual who for one or more reasons is more likely than others to
acquire an infection
 Contact Precautions
o used for clients known to have or suspected of having serious illnesses easily transmitted by direct
client contact or by contact with items in the client’s environment
 Cultures
o laboratory cultivations of microorganisms in a special growth medium
 Dirty (Soiled, Contaminated)
o which means likely to have microorganisms, some of which may be capable of causing infection.
 Disease
o a detectable alteration in nor-mal tissue function,
 Disinfectants
o agents that destroy pathogens other than spores and by sterilization
 Droplet Nuclei
 the residue of evaporated droplets emitted by an infected host such as someone with tuberculosis
 Droplet Precautions
o used for clients known to have or suspected of having serious illnesses transmitted by particle
drop-lets larger than 5 microns. Examples of such illnesses are diphtheria (pharyngeal);
mycoplasma pneumonia;
pertussis; mumps; rubella; streptococcal pharyngitis, pneumonia,
or scarlet fever in infants and young
children; and pneumonic plague.
 Endogenous (source)
o microorganisms causing nosocomial infections that can originate from the clients them-selves
 Exogenous (source)
 microorganisms causing nosocomial infections that can originate from the hospital environment
and hospital personnel
 Exudate
o consists of fluid that escaped from the blood vessels, dead phagocytic cells, and dead tissue cells
and products that they release
 Fungi
o include yeasts and molds, Candida albicans is a yeast considered to be normal flora in the human
vagina
 Granulation Tissue
o damaged tissues which are replaced with the connective tissue elements of collagen, blood
capillaries, lymphatics, and other tissue-bound substances
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 Health Care–Associated Infection (HAI)
o those that originate in any health care setting
 Humoral Immunity (Circulating Immunity)
o defences that reside ultimately in the B lymphocytes and are mediated by antibodies produced by
B cells
 Iatrogenic Infections
o nosocomial infections which are direct results of diagnostic or thera-peutic procedures.
 Immunity
o the capability of multicellular organisms to resist harmful microorganisms from entering it
 Infection
o growth of microorganisms in body tissue where they are not usually found.
 Inflammation
o a local and nonspecific defensive response of the tissues to an injurious or infectious agent.
 Isolation
o refer to measures designed to prevent the spread of infections or potentially infectious
microorganisms to health personnel, clients, and visitors
 Leukocytes
o white blood cells
 Leucocytosis
o in response to the exit of leukocytes from the blood, the bone marrow produces large numbers of
leukocytes and releases them into the bloodstream.
 Local Infection
o limited to the specific part of the body where the microorganisms remain
 Medical Asepsis
o includes all practices intended to confine a specific microorganism to a specific area, limiting the
number, growth, and transmission of microorganisms.
 Nonspecific Defences
o protect the person against all microorganisms, regardless of prior exposure
 Nosocomial Infections
o classified as infections that originate in the hospital
 Occupational Exposure
o defined as skin, eye, mucous membrane, or parenteral contact with blood or other potentially
infectious materials that may result from the performance of an employee’s duties
 Opportunistic Pathogen
o causes disease only in a susceptible individual
 Parasites
o an organism that lives on or in a host organism and gets its food from or at the expense of its host
 Pathogenicity
o the ability to produce disease; thus, a pathogen is a microorganism that causes disease
 Personal Protective Equipment (PPE)
o includes gloves, gowns, eyewear, and masks;
 Regeneration
o the replacement of destroyed tissue cells by cells that are identical or similar in structure and
function
 Reservoirs
o sources of microorganisms.
 Resident Flora
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o the collective vegetation in a given area
 Respiratory Hygiene/Cough Etiquette
o covering the mouth and nose when sneezing or coughing, proper disposal of tissues, and
separating potentially infected individuals from others by at least 1 m (3 ft) or having them wear a
surgical mask
 Sepsis
o the condition in which acute organ dysfunction occurs secondary to infection
 Septicaemia
o bacteremia resulting in systemic infection
 Specific Defences/Immune Defenses
o are directed against identifiable bacteria, viruses, fungi, or other infectious agents
 Standard precautions (SP)
o are a set of infection control practices used to prevent transmission of diseases that can be
acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous
membranes
 Sterile field
o a process that destroys all microorganisms, including spores and viruses. Four commonly used
methods of sterilization are moist heat, gas, boiling water, and radiation
 Sterile Technique/Surgical Asepsis
o refer to those prac-tices that keep an area or object free of all microorganisms; it includes
practices that destroy all microorganisms and spores (microscopic dormant structures formed by
some pathogens that are very hardy and often survive common cleaning techniques).
 Sterilization
o a process that destroys all microorganisms, including spores and viruses. Four commonly used
methods of sterilization are moist heat, gas, boiling water, and radiation
 Systemic infection
o the microorganisms spread and damage different parts of the body,
 Universal precautions (UP)
o refers o the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the
wearing of nonporous articles such as medical gloves, goggles, and face shields
 Vector-borne transmission
o vector is an animal or fly-ing or crawling insect that serves as an intermediate means of
transporting the infectious agent.
 Vehicle-borne transmission
o vehicle is any substance that serves as an intermediate means to transport and introduce an
infectious agent into a susceptible host through a suitable portal of entry
 Virulence
o ability microorganisms to produce disease
 Viruses
o consist primarily of nucleic acid and therefore must enter living cells in order to reproduce.
Common virus families include the rhinovirus (causes the common cold), hepatitis, herpes, and
human immunodeficiency virus.
ASEPSIS AND INFECTION CONTROL
Microorganisms exist everywhere: in water, in soil, and on body surfaces such as the skin, intestinal tract,
and other areas open to the outside (e.g., mouth, upper respiratory tract, vagina, and lower urinary tract).
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Most microorganisms are harmless, and some are even beneficial in that they perform essential functions
in the body.
Some microorganisms found in the intestines (e.g., enterobacteria) produce substances called
bacteriocins, which are lethal to related strains of bacteria.
Some microorganisms are normal resident flora in one part of the body, yet produce infection in another.
 Escherichia coli, commonly referred to as E. coli, is a normal inhabitant of the large intestine but a
common cause of infection of the urinary tract.
INFECTION
 Caused by infectious agents/pathogens
 Pathogenecity/Opportunistic Pathogens
 Asymptomatic or Subclinical Infection
 No clinical evidence of disease
 Disease
 Detectable alteration in normal function
 Major cause of death worldwide
 World Health Organization (WHO) is the major regulatory agency internationally
 Department of Health (DOH) for state and county level
 Two Basic types of Asepsis
 Medical Asepsis
 Clean
 Dirty
 Surgical Asepsis/ Sterile Technique
Types of Microorganisms That Cause Infection
1. Bacteria
2. Viruses
 Common virus families include the rhinovirus (causes the common cold), hepatitis, herpes, and human
immunodeficiency virus.
3. Fungi
 Candida albicans is a yeast considered to be normal flora in the human vagina.
4. Parasites
 include protozoa such as the one that causes malaria, helminths (worms), and arthro-pods (mites,
fleas, ticks).
Types of Infection
Classification According to Infectious Agent
1. Bacterial
2. Viral
3. Fungal
4. Parasitic
Classification According to Duration
1. Acute
2. Chronic
Classification According to Severity/Extent
1. Local
2. Systemic
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

Bacteremia
Septicemia
Classification According to Origin
1. Nosocomial Infections
 Endogenous
 Exogenous
 Iatrogenic Infections
2. Community Acquired Infections
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Chain of Infection
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Links:
1. Etiologic Agent
2. Reservoir
 Carrier
3. Portal of Exit from Reservoir
4. Mode of Transmission
 Direct Transmission
 Indirect Transmission
 Vehicle-borne
 Vector-borne
 Airborne Transmission
 Droplet nuclei
5. Portal of Entry to Susceptible Host
6. Susceptible Host
 Compromised Host
Immune System/Body Defenses Against Infection
1. Nonspecific Defense
a. First Line of Defense
i. Intact skin and mucous membranes
b. Second Line of Defense
i. Inflammatory Response
2. Specific Defense
a. Third Line of Defense
i. Immune System
 Antibody-Mediated Defenses (Humoral/Circulating Immunity)
 Active Immunity
 Passive Imunity
 Cell-Mediated Defenses/Cellular Immunity
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Factors Increasing Susceptibility to Infection
1. Host Susceptibility
 Age
 Heredity
 Level of Stress
 Current Medical Therapy
 Preexisting Disease Process
2. Resistance to Infection
3. Medical Therapies
Preventing the Spread of Infection
 Preventing Nosocomial Infections
 Hand Hygiene
 Supporting Defenses of a Susceptible Host
1. Hygiene
2. Nutrition
3. Fluid
4. Sleep
5. Stress
6. Immunization
 Disinfecting and Sterilizing
1. Disinfecting
2. Sterilizing
a. Moist Heat
b. Gas
c. Boiling Water
d. Radiation
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Infection Prevention and Control
Isolation Guidelines
1. Standard Precaution
(a) hand hygiene;
(b) use of personal protective equipment (PPE), which includes gloves, gowns, eyewear, and masks;
(c) safe injection practices; (d) safe handling of potentially contaminated equipment or surfaces in the
client environment; and
(d) respiratory hygiene/cough etiquette
Transmission-Based Precautions
a. Airborne Precautions
b. Droplet Precutions
c. Contact Precautions
2. Universal Precaution
Isolation Practices
1. PPE
a. Gloves
b. Gowns
c. Face Masks
d. Eyewear
2. Disposal of Soiled Equipment and Supplies
a. Bagging
b. Linens
c. Laboratory specimens
d. Dishes
e. Blood pressure equipment
f. Thermometers
g. Disposable Needles, syringes and sharps
Sterile Technique
1. Sterile Field
2. Sterile Gloves
3. Sterile Gowns
Infection Prevention for Health Care Workers
 Occupational exposure
 Modes of transmission of infectious materials in the clinical setting:
 Puncture wounds from contaminated needles or other sharp
 Skin contact, which allows infectious fluids to enter through wounds and broken or damaged skin
 Mucous membrane contact, which allows infectious fluids to enter through mucous membranes of the
eyes, mouth, or nose

Role of the Infection Prevention Nurse
Infection Prevention Nurse—specially trained to be knowledgeable about the latest research and practices in
preventing, detecting, and treating infections
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
LIFESPAN CONSIDERATIONS
CHILDREN:
Infections are an expected part of childhood, with most children experiencing some kind of infection
from time to time. The majority of these infections are caused by viruses, and for the most part are transient,
relatively benign, and able to be overcome by the body’s natural defenses and supportive care. In some cases,
severe, even life-threatening infections occur. Considerations related to children include the following:
•Newborns may not be able to respond to infections due to an underdeveloped immune system. As a result, in
the first few months of life, infections may not be associated with typical signs and symptoms (e.g., an infant
with an infection may not have a fever).
•Newborns are born with some naturally acquired immunity transferred from the mother across the placenta.
•Breast-fed infants experience higher levels of immunity against infections than formula-fed infants.
•Fevers less than 39°C (102.2°F) in children should not be treated, except for comfort of the child.
•Children between 6 months and 5 years are at higher risk for fever-induced (febrile) seizures. Febrile seizures
are not associated with neurologic seizure disorders (e.g., epilepsy).
•Children who are immune compromised (e.g., leukemia, HIV) or have a chronic health condition (e.g., cystic
fibrosis, sickle cell disease, congenital heart disease) need extra precautions to prevent exposure to infectious
agents.
•Hand hygiene, comprehensive immunizations, good nutrition, adequate hydration, and appropriate rest are
essential to preventing and/or treating infections in children.
•Hand washing and good hygiene in day care facilities and schools are important to prevent the spread of
infections.
•Adolescents are at high risk for sexually transmitted infections and should be well educated about how to
prevent them.
OLDER ADULTS
Normal aging may predispose older adults to increased risk of infection and delayed healing. Anatomic
and physiological agents that are protective when a person is younger often change in structure and function with
increasing age and then provide a decrease in their protective ability. Changes take place in the skin, respiratory
tract, GI system, kidneys, and immune system. If unchallenged, these systems work well to maintain homeostasis
for the individual, but if compromised by stress, illness, infections, treatments, or surgeries, they find it difficult to
keep up and therefore are not able to pro-vide adequate protection. Considerations for older adults include the
following:
•Nutrition is often poor in older adults. Certain components, especially adequate protein, are necessary to build
up and maintain the immune system.
•Diabetes mellitus, which occurs more frequently in older adults, increases the risk of infection and delayed
healing by causing an alteration in nutrition and impaired peripheral circulation, which decrease oxygen
transport to the tissues.
•The immune system reacts slowly to the introduction of antigens, allowing the antigen to reproduce itself
several times before it is recognized by the immune system. T-cell effective-ness is often decreased due to
immaturity
•The normal inflammatory response is delayed. This often causes atypical responses to infections. Instead of
displaying the redness, swelling, and fever usually associated with infections, atypical symptoms such as
confusion and disorientation, agitation, incontinence, falls, lethargy, and general fatigue are often seen first.
Recognizing these changes in older adults is important in early detection and treatment of related
potential for infections and delayed healing. Nursing interventions to promote prevention include the following:
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•Provide and teach ways to improve nutritional status.
•Use strict aseptic technique to decrease chance of infections (especially nosocomial infections in health care
facilities).
•Encourage older adults to have regular immunizations for flu and pneumonia.
•Be alert to subtle atypical signs of infection and act quickly to diagnose and treat.
Chapter Highlights
•Microorganisms are everywhere. Most are harmless and some are beneficial; however, many can cause infection
in susceptible
individuals.
•Effective prevention and control of infectious disease is an international, national, community, and individual
responsibility.
•Asepsis is the freedom from disease-causing microorganisms.
•Medical aseptic practices limit the number, growth, and transmission of microorganisms.
•Surgical aseptic practices keep an area or objects free of all microorganisms.
•The incidence of health care–associated infections is significant. Major sites for these infections are the respiratory
and urinary tracts, the bloodstream, and wounds.
•Factors that contribute to nosocomial and health care–associated infection risks are invasive procedures, medical
therapies, the existence of a large number of susceptible individuals, inappropriate use of antibiotics, and
insufficient hand hygiene after client contact and after contact with body substances.
•An infection can develop if the links in the chain of infection—etiologic agent, reservoir, portal of exit, mode of
transmission, portal of entry, and susceptible host—are not interrupted.
•Intact skin and mucous membranes are the body’s first line of defense against microorganisms.
•Some body secretions (e.g., saliva and tears) contain enzymes that act as antibacterial agents.
•The inflammatory response limits physical, chemical, and microbial injury and promotes repair of injured tissue.
•Immunity is the specific resistance of the body to infectious agents.
•Immunity is active or passive and in either case may be naturally or artificially induced.
•Individuals especially at risk of acquiring an infection are the very young or old; those with a deficiency of serum
immunoglobulins, multiple stressors, poor nutritional status, or insufficient immunizations; those receiving certain
medical therapies; and those who have an existing disease process.
• Should a health care worker be exposed to substances with a high risk of transmitting bloodborne pathogens,
postexposure practices and consideration of prophylactic treatment must be followed immediately.
• Preventing infections in healthy or ill persons and preventing the transmission of microorganisms from infected
clients to others are major nursing functions.
• All health care providers must apply clean or sterile gloves, gowns, masks, and protective eyewear according to
the risk of exposure to potentially infective materials.
SAFETY
 A fundamental concern of nurses, which extends from the bedside to the home to the community, is preventing
injuries and assisting the injured.
Terminologies:
 Asphyxiation
o lack of oxygen due to interrupted breathing.
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 Bioterrorism
o the ―deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals,
or plants (para. 1).‖ Bioterrorism agents are separated into three categories, depending on how easily they can be
spread and the severity of illness or death they cause.Category A agents have the highest risk because they:• Can be
easily spread or transmitted from person to person.• Result in high death rates and have the potential for major public
health impact.• Might cause public panic and social disruption.• Require special action for public health
preparedness.Category B agents are the second highest priority because they:• Are moderately easy to spread.•
Result in moderate illness rates and low death rates.• Require specific enhancements of CDC’s laboratory capacity
and enhanced disease monitoring.Category C agents include emerging pathogens that could be engi-neered for mass
spread in the future because they:• Are easily available.• Are easily produced and spread.• Have the potential for high
morbidity and mortality rates and ma-jor health impact.
 Burn
o results from excessive exposure to thermal, chemical, electric, or radioactive agents
 Carbon Monoxide
o an odorless, colorless, tasteless gas that is very toxic
 Chemical Restraints
o involve using a medication to control behavior or to restrict the client’s freedom of movement and is not a standard
treatment for the client’s medical or psychological condition
 Electric Shock
o occurs when a current travels through the body to the ground rather than through electric wiring, or from static
electricity that builds up on the body.
 Heimlich Maneuver
o emergency response or abdominal thrust, which can dislodge the foreign object and reestablish an airway.
 Physical Restraints
o include ―any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the
ability of a patient to move his or her arms, legs, body, or head freely‖
 Restraints
o are devices used to limit the physical activity of a client or a part of the body
 Safety Monitoring Devices
o available to detect when clients are attempting to move or get out of bed. For example, a bed or chair safety monitor
has a position-sensitive switch that triggers an audio alarm when the client attempts to get out of the bed or chair.
 Scald
o a burn from a hot liquid or vapor, such as steam.
 Seclusion
o the involuntary confinement of a client alone in a room or area from which the client is physically prevented from
leaving
 Seizure
o a single temporary event that consists of uncontrolled electrical neuronal discharge of the brain that interrupts normal
brain function
 Seizure precautions
o safety measures taken by the nurse to protect clients from injury should they have a seizure.
Factors Affecting Safety
1.
2.
3.
4.
Age and Development
Lifestyle
Mobility and Health Status
Sensory-Perceptual Alterations
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5.
6.
7.
8.
9.
Cognitive Awareness
Emotional State
Ability to Communicate
Safety Awareness
Environmental Factors
a. Healthcare Setting
b. Workplace
c. Home
d. Coomunity
e. Bioterrorism
f. Disaster Planning
Nursing Management
Assessing
1. Nursing History and Physical Exam
a. Risk Assessment Tool
b. Home hazard Appraisal
2. National Patient Safety Goals
3. Bioterrorism Attacks
Diagnosing
1. Risk for Injury: Vulnerable to physical damage due to environ-mental conditions interacting with the individual’s
adaptive and defensive resources, which may compromise health (Herdman & Kamitsuru, 2014)
2. Risk for Falls
3. Latex Allergy Response; Risk for Latex Allergy Response;
4. Risk for: Infection, Suffocation, Poisoning, Trauma, Vascular Trauma, Aspiration, Adverse Reaction to Iodinated
Contrast Media, Impaired S kin Integrity, and Risk for Self-Directed Violence
Other diagnoses the nurse may choose to use are
5. Deficient Knowledge (Accident Prevention): Absence or deficiency of cognitive information related to a specific topic
(e.g., safety of self and others)
6. Readiness for Enhanced Knowledge (Accident Prevention): A pat-tern of cognitive information related to a specific
topic, or its acquisition, which can be strengthened (e.g., expresses a desire to enhance learning about accident
prevention).
Planning
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Implementing
Promoting Safety Across Lifespan
Measures to ensure the safety of people of all ages focus on:
(a) observation or prediction of potentially harmful situations
(b) client education
1. Newborns and Infants
 Use a federally approved car seat at all times (including coming home from hospital). It should be in the back
seat, facing backward.
 Never leave the infant unattended on a raised surface.• Check the temperature of the infant’s bath water and
formula prior to using.
 Hold the infant upright during feeding. Do not prop the bottle. Cut food in small pieces, and do not feed the infant
peanuts or popcorn. Slice hot dogs lengthwise in two pieces then into small pieces.
 Investigate the infant’s crib for compliance with federal safety regulations: slats no more than 6 cm (2.4 in.)
apart, lead-free paint, height of crib sides, tight fit of mattress to crib.
 Use a playpen with sides made of small-size netting. Never leave playpen sides down.
 Provide large soft toys with no small detachable or sharp-edged parts.
 Use guard gates on stairs and screens on windows. Supervise the infant in swings and highchairs.
 Cover electric outlets. Coil cords out of reach.
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2.
3.
4.
5.
 Place plants, household cleaners, and wastebaskets out of reach. Lock away potential poisons, such as
medicines, paint, and gasoline.
Toddlers
 Continue to use federally approved car seats at all times. Place children in back seat when traveling in a car.
 Teach children not to put objects in the mouth, including pills (unless given by parent).
 Keep objects with sharp edges (such as furniture and knives) out of children’s reach. Keep plastic bags out of
reach.
 Place hot pots on back burners with handles turned inward.• Keep cleaning solutions, insecticides, and
medicines in locked cupboards.
 Keep windows and balconies screened.
 Supervise toddlers in the tub.
 Fence in pools, and supervise toddlers at all times when in or near pools. Do not overfill bathtub. Do not let
toddlers play near ditches or wells.
 Teach children not to run or ride a tricycle into the street.
 Obtain a low bed when the child begins to climb.
 Cover outlets with safety covers or plugs.
Preschoolers
 Do not allow children to run with candy or other objects in the mouth.
 Teach children not to put small objects in the mouth, nose, and ears.
 Remove doors from unused equipment such as refrigerators.• Always supervise preschoolers crossing streets
and begin safety teaching about obeying traffic signals and looking both ways.
 Check Halloween treats before allowing children to eat them. Discard loose or open candy.
 Teach children to play in ―safe‖ areas, not on streets and railroad tracks.
 Teach preschoolers the dangers of playing with matches and playing near charcoal, fire, and heating appliances.
 Teach children to avoid strangers and keep parents informed of their whereabouts.
 Teach preschoolers not to walk in front of swings and not to push others off playground equipment.
Scool-Age Children
 Teach children safety rules for recreational and sports activities: Never swim alone, always wear a life jacket
when in a boat, and wear a protective helmet and knee and elbow pads when needed.
 Supervise contact sports and activities in which children aim at a target.
 Teach children to obey all traffic and safety rules for bicycling, skateboarding, and roller skating.
 Teach children to use light or reflective clothing when walking or cycling at night.
 Teach children safe ways to use the stove, garden tools, and other equipment.
 Supervise children when they use saws, electric appliances, tools, and other potentially dangerous equipment.
 Teach children not to play with fireworks, gunpowder, or firearms. Keep firearms unloaded, locked up, and out of
reach.
 Teach children to avoid excavations, quarries, vacant buildings, and playing around heavy machinery.
 Teach children the health hazards of smoking. If you smoke, stop.
 Teach children the effects of drugs and alcohol on judgment and coordination.
Adolescents
 Have adolescents complete a driver’s education course, and take practice drives with them in various types of
weather.
 Set firm limits on automobile use, namely, never to drive after drinking or using drugs, and never to ride with a
driver who has done so. Encourage adolescents to call home for a ride if they have been drinking, assuring them
they can do so without a reprimand.
 Restrict number of passengers in car during the first year of driving.
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 Teach adolescents to wear a safety helmet when riding motorcycles, scooters, and other sports vehicles. Teach
safety rules for water sports.
 Encourage adolescents to use proper equipment when participating in sports. Schedule a physical examination
before participation, and be certain there is medical supervision for all athletic activities.
 Encourage adolescents to swim, jog, and go boating in groups so they can obtain help in case of an accident.
 Teach safety measures for use of power tools.
 Teach rules for hunting and the proper care and use of firearms.
 Inform the adolescent of the dangers of drugs, alcohol, and unprotected sex. Include teaching about date rape
prevention and defense.
 Teach dangers of sunbathing and tanning beds, as well as the proper use of sun block and protective clothing
when doing outdoor activities.
 Be alert to changes in the adolescent’s mood and behavior. Listen to and maintain open communication with the
adoles-cent. Open communication is a powerful preventive measure.
 Set a good example of behavior that the adolescent can follow.
6. Young Adults
 Reinforce motor vehicle safety: Drive defensively, use ―desig-nated drivers‖ if alcohol is consumed, routinely
check brakes and tires, and use seat and shoulder belts or car seats for all passengers.
 Remind the young adult to repair potential fire hazards, such as electric wiring.
 Reinforce water safety: Know the depth of a pool or lake before diving; supervise backyard pools and other
water activities.
 Discuss evaluating the potential for workplace injuries or death when making decisions about a career or
occupation. Encourage the young adult to participate actively in programs that reduce occupational hazards.
 Discuss avoiding excessive sun radiation by limiting exposure, using sun-blocking agents, and wearing
protective clothing. Ex-plain the skin changes that may indicate a cancerous condition.
 Encourage young adults who are unable to cope with the pressures, responsibilities, and expectations of
adulthood to seek counseling.
 Discuss the dangers associated with the Internet and social networking
7. Middle-Aged Adults
 Reinforce motor vehicle safety: Use seat belts and drive within the speed limit, especially at night. Test visual
acuity periodically.
 Make certain stairways are well lighted and uncluttered.
 Equip bathrooms with hand grasps and nonskid bath mats.
 Test carbon monoxide detectors, smoke detectors, and fire alarms regularly.
 Keep all machines and tools in good working condition at work and at home. Follow safety precautions when
using machinery.
 Reinforce safety measures taught earlier in life, such as the hazards of excessive sun exposure.
8. Old Adults
 Encourage the client to have regular vision and hearing tests.
 Assist the client to have a home hazard appraisal.
 Encourage the client to keep as active as possible.
 Ensure eyeglasses are functional.
 Ensure appropriate lighting.
 Mark doorways and edges of steps as needed.
 Keep the environment tidy and uncluttered.
 Set safe limits to activities.
 Remove unsafe objects.
 Wear shoes or well-fitted slippers with nonskid soles.
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Use ambulatory devices as necessary (cane, crutches, walker, braces, wheelchair).
Provide assistance with ambulation as needed.
Monitor gait and balance.
Adapt living arrangements to one floor if necessary
Encourage exercise and activity as tolerated to maintain muscle strength, joint flexibility, and balance.
Ensure uncluttered environment with securely fastened rugs.
Encourage the client to request assistance.
Keep the bed in the low position.
Install grab bars in the bathroom.
Provide a raised toilet seat.
Instruct the client to rise slowly from a lying to sitting to stand-ing position, and to stand in place for several
seconds before walking.
Provide a bedside commode as needed.
Assist with voiding on a frequent and scheduled basis.
Encourage the client to summon help.
Monitor activity tolerance.
Attach side rails to the bed.
Keep rails in place when the bed is in the lowest position.
Monitor orientation and alertness status.
Encourage annual or more frequent review of all prescribed medications.
Key Risk factors for Suicide in Older Adults
 Gender. The suicide rate for men 75 years and older is almost twice the rate for men of all ages.
 Rural communities. Suicide rates are three times higher in rural areas than in urban ones.
 Depression. Common symptoms of depression, such as fatigue, sleep problems, and weight loss or gain,
may incorrectly be attributed to the older person’s existing chronic illness(es). Chronic pain can also worsen
depression.
 Social isolation. The risk of suicide increases when social isolation is due to bereavement or loss of social
support.
Safety Problems Across the Life Span
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Domestic Violence
 child abuse
 intimate partner abuse
 older adult abuse
Promoting Safety in Health Care Setting
1. Preventing Specific Hazards
a. Falls
b. Seizures
c. Scalds and Burns
d. Fires
e. Carbon Monoxide Poisoning
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f. Poisoning
g. Suffocation or Choking
h. Excessive Noise
i. Electric Hazards
j. Firearms
k. Radiation
l. Bioterrorism attacks
2. Procedure- and Equipment- Related Accidents
a. Restraints
Evaluating
Examples of desired outcomes include the client be-ing able to do the following:
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Describe methods to prevent specific hazards (e.g., falls, suffoca-tion, choking, fires, drowning, electric
shock).
Report use of home safety measures (e.g., fire safety measures, smoke detector maintenance, fall
prevention strategies, burn prevention measures, poison prevention measures, safe storage of hazardous
materials, firearm safety precautions, electrocution prevention, water safety precautions, bicycle safety,
motor vehicle safety).
Alter home physical environment to reduce the risk of injury.
Describe emergency procedures for poisoning and fire.
Describe age-specific risks, work safety risks, or community safety risks.
Demonstrate correct use of child safety seats.
Demonstrate correct administration of cardiopulmonary resuscitation.
Chapter Highlights
Injuries are a major cause of death among individuals of all ages in the United States.
•Nurses need awareness of what constitutes a safe environment for specific individuals and for groups of people in
the home, com-munity, and workplace.
•Hazards to safety occur at all ages and vary according to the age and development of the individual.
•Nursing assessment of safety includes assessing factors that can affect safety, for example, age and
developmental level, lifestyle, mobility and health status, sensory-perceptual alterations, cogni-tive awareness,
ability to communicate, safety awareness, and en-vironmental factors.
•Nurses assess clients at risk for injury through methods such as nursing history and physical examination, risk
assessment tools, and home hazard appraisal.
•The landmark report To Err Is Human increased the awareness in the health care industry of the need to improve
client safety. As a result, National Patient Safety Goals (NPSG) were initiated and are required to be implemented
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by The Joint Commission. The QSEN project developed guidelines to help future nurses develop the knowledge,
skills, and attitudes required to improve client safety. The foundation for a culture of safety is a blame-free
environment, transparency, and a process designed to prevent error.
•Nurses need to sustain a heightened awareness and alertness of circumstances or patterns that may indicate
potential bioterrorism. Early detection and management are needed to help stop a bioter-rorism attack.
•Major nursing diagnoses for clients at risk for injury can be cat-egorized as Risk for Injury, with more specific
diagnoses such as: Risk for Falls, Latex Allergy Response; Risk for Latex Allergy Response; Risk for Infection, Risk
for Suffocation; Risk for Poison-ing; Risk for Trauma; Risk for Vascular Trauma, Aspiration; Risk for Adverse
Reaction to Iodinated Contrast Media; Risk for Impaired Skin Integrity and Risk for Self-Directed Violence. Other
diagnoses includeDeficient Knowledge (Accident Prevention) and Readiness for Enhanced Knowledge (Accident
Prevention).
•Measures to ensure the safety of people of all ages focus on (a) ob-servation or prediction of situations that are
potentially harmful and (b) client education that empowers clients to safeguard themselves and their families from
injury.
•Falls are a common cause of injury among older adults.
•Side rails do not protect hospitalized clients from falls. It is more likely the client will fall trying to get out around
raised rails.
•Prevention of falls in health care agencies is an ongoing concern.
•Seizure precautions are safety measures taken by the nurse to protect clients from injury should they have a
seizure.
• Firearms pose a risk to individuals of all ages. Adults must take full responsibility for following safety procedures
when keeping fire-arms in the home, including storage of ammunition in a separate location.
• In hospitals, radioactive substances are used for both diagnostic and treatment purposes; agency policy must be
followed to safe-guard clients and staff from unsafe exposure.
• Various alternatives to restraints must be considered before a re-straint is applied.
• Because restraints restrict a client’s basic freedom to move, careful assessment and accurate, complete
documentation are important when restraints are used.
• Nurses must be familiar with the fire procedures in the health care agencies where they practice. In the event of a
fire, the nurse can use two mnemonics to remember the steps to follow: RACE and PASS.
• Major reasons for poisoning in children are inadequate supervision and improper storage of household toxic
substances.
• Suffocation can occur when foreign objects become lodged in the throat, cutting off an individual’s oxygen supply.
• Prolonged exposure to excessive noise can cause hearing loss.
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• Improper grounding and faulty electric equipment pose health hazards in the hospital and the home. Injuries can
be prevented by using grounded outlets and plugs, putting protective covers over outlets, keeping appliances in
good repair, and making sure that electric wiring and circuits meet safety standards
Complementary and Alternative Therapies
Terminologies:
 Acupressure/Acupuncture
o are techniques in which pressure or stimulation is applied to specific points on the body, known as
acupuncture points, to relieve pain, cure certain illnesses, and promote wellness. Acupuncture uses
needles, whereas acupressure uses finger pressure.
 Allopathic medicine
o Use of pharmacologically active agents or physical interventions to treat or suppress symptoms or
pathophysiologic processes of diseases or conditions, by proponents of alternative medicine
 Alternative medicine
o refers to use of CAM in place of conventional medicine.
 Animal-assisted therapy
o the use of specifically selected animals as a treatment modality in health and human service
settings
 Aromatherapy
o the therapeutic use of essential oils of plants in which the odor or fragrance plays an important part
 Ayurveda
o ―science of life‖ or ―sciences of life span‖
 Balance
o consists of finding a desirable point between two opposite forces rather than being purely in one
state or another.
 Bioelectromagnetics
o the emerging science that studies how liv-ing organisms interact with electromagnetic fields. It
works on the principle that every animal, plant, and mineral has an electromag-netic field that
enables organic beings and inorganic objects, such as crystals, to communicate and interact as
part of a single, unified en-ergy system
 Biofeedback
o a method by which a person can learn to control certain physiological responses of the body
 Biomedicine
 Chiropractic
o focuses on the relationship between the body’s structure—mainly the spine—and its functioning
 Complementary Medicine
o refers to the use of CAM (complementary and alternative medicine) together with conventional
medicine.
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 Conventional Medicine
 Curanderismo
o (pronounced koo-rahn-dare-ees-mo) is a cultural healing tradition found in Latin America and
among many Latinos in the United States. Although it is a traditional healing system, it may utilize
Western biomedical beliefs, treatment, and practices. Healers are called curanderos (men) and
curanderas (women). They may specialize as herbalists, midwives, counselors, spine and joint
workers, and massage therapists.
 Detoxification
o physical impurities and toxins are cleared from the body to achieve better health
 Eastern medicine
o places greater emphasis on prevention and natural healing
 Energy
o viewed as the force that integrates the body, mind, and spirit; it is that which connects everything
 Faith
o refers to our beliefs and expectations about life, ourselves, and others
 Guided Imagery
o a state of focused attention, much like hypnosis, that encourages changes in attitudes, behavior,
and physiological reactions.
 Hand-Mediated Biofield Therapies
o using the hands to alter the biofield, or energy field, are therapeutic touch (TT), healing touch, and
Reiki.
 Herbal Medicine
 Holism
o Combined mental, emotional, spiritual, relationship, and environmental components
 Homeopathy
o a self-healing system, assisted by small doses of remedies or medicines, which is useful in a
variety of acute and chronic disorders.
 Horticultural Therapy
o also called gardening or a healing garden, is an adjunct therapy to occupational and physical
therapy.
 Humanist
o includes propositions such as the following: The mind and body are indivisible, people have the
power to solve their own problems, people are responsible for the patterns of their lives, and wellbeing is a combination of personal satisfaction and contributions to the larger community.
 Hypnotherapy
o the application of hypnosis in a wide variety of medical and psychological disorders.
 Imagery
o refers to a two-way communication between the con-scious and unconscious mind and involves
the whole body and all of its senses
 Integrative Medicine
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o combines treatments from conventional medicine and CAM for which there is some high-quality
evidence of safety and effectiveness.
Massage Therapy
o the scientific manipulation of the soft tissues of the body, is a healing art, an act of physical caring,
and a way of communicating without words.
Meditation
o a general term for a wide range of practices that in-volve relaxing the body and easing the mind.
Music Therapy
o often used in healing, from the ancient sounds of the drum, rattle, bone flute, and other primi-tive
instruments to the use of current music as a prescription for health
Naturopathic Medicine
o is not only a system of medicine but also a way of life with emphasis on client responsibility,
education, health maintenance, and disease prevention.
Pilates
o (pronounced pih-lah-tes) is a method of physical move-ment and exercise designed to stretch,
strengthen, and balance the body, in particular the core or center including the abdominal re-gion
Prayer
o most often defined simply as a form of communica-tion and fellowship with the Deity or Creator.
Qi
o life energy, flows through the body along pathways known as meridians
Qi Gong
o (pronounced chee-goong) is a Chinese discipline consisting of breathing and mental exercises
combined with body movements.
Reflexology
o a form of acupressure most commonly performed on the feet but the hands or ears may also be
manipulated.
Spirituality
o includes the drive to become all that one can be, and is bound to intuition, creativity, and motivation
T’ai Chi
o T’ai chi (pronounced teye chee) arose out of qi gong and is a discipline that combines physical fitness, meditation, and self-defense.
Traditional Chinese Medicine (TCM)
o based on the premise that the body’s vital energy or qi circulates through pathways or meridians
and can be accessed and manipulated through specific anatomic points along the surface of the
body
Western Medicine
o an approach to health that focuses on the use of science in the diagnosis and treatment of health
problems
Yoga
o a way of life that includes ethical models for behavior and mental and physical exercises aimed at
producing spiritual enlightenment.
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INTRODUCTION:
Western Medical Practice
1. Conventional Medicine
2. Allopathic Medicine
3. Biomedicine
Eastern Medical System
1. Complementary and Alternative Medicine
a. Complementary Medicine
b. Alternative Medicine
c. Integrative Medicine
BASIC CONCEPTS
Concepts Common to Alternative Therapies
1.
2.
3.
4.
5.
6.
Holism
Humanism
Balance
Spirituality
Energy
Healing Environments
HEALING MODALITIES
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Systematized Health Care Practices
1. Ayurveda
2. Traditional Chinese Medicine
3. Native American Healing
4. Curanderismo
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Botanical Healing
1. Herbal Medicine
2. Aromatherapy
3. Homeopathy
4. Naturopathy
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Nutritional Therapy
consists of the consumption of specific types of diets or supplements, including vitamins, min-erals,
amino acids, herbs and other botanicals, and miscellaneous substances such as enzymes and fish oils for
the purpose of preventing or treating illness
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Manual Healing Methods
1. Chiropractic
2. Massage
3. Acupuncture, Acupressure, and Reflexology
4. Hand-Mediated Biofield Therapies
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Mind-Body Therapies
1. Yoga
2. Meditation
3. Hypnotherapy
4. Guided Imagery
5. Biofeedback
6. Qi Gong and T’ai Chi
7. Pilates
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Spiritual Theraphy
1. Faith and Prayer
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Miscellaneous Therapies
1. Music Therapy
2. Humor and Laughter
3. Bioeletromagnetics
4. Detoxifying Therapies
5. Animal-Assisted Therapy
6. Horticultural Therapy
Chapter Highlights:
• The concepts common to most alternative practices include holism, humanism, balance, spirituality, energy, and
healing environments.
• We create healing environments when we provide holistic nursing care, take time to be with clients in deeply
caring ways, and balance technology and compassion.
• If we do not create healing environments for ourselves, we are in danger of nursing ―burnout.‖
• Ancient health care practices typically include an entire set of values, attitudes, and beliefs that generate a
philosophy of life, not simply a group of remedies.
• Many prescription drugs sold in the United States are derived from plants.
• Although many botanical and nutritional supplements can be helpful in certain conditions, their effectiveness and
safety are not all well studied.
• Manual healing methods include chiropractic, massage, acupuncture, acupressure, reflexology, and handmediated biofield therapies.
• Mind–body therapies such as yoga, meditation, hypnotherapy, guided imagery, biofeedback, qi gong, t’ai chi, and
Pilates all focus on realigning or creating balance in mental and physical processes to bring about healing.
• Other CAM approaches include faith and prayer, music therapy, humor and laughter, bioelectromagnetics,
detoxifying therapies, animal-assisted therapy, and horticultural therapy.
Medication
Medication –a substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of
disease
Drug – any substance (other than food that provide nutritional support) that, when inhaled, injected, smoked,
consumed, absorbed via a patch on the skin, o dissolved under the tongue causes temporary physiological (and
often psychological) change in the body.
Prescription— a written direction for the preparation and administration of a drug
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Four Kinds of Drug Names:
1. Generic Name – assigned by the United States Adopted Names (USAN) Council and is used throughout
the drug’s lifetime.
2. Trade Name – Brand Name; is the name given by the drug manufacturer and identifies it as property of that
company
3. Official Name – the name under which a drug is listed in one of the official publications
4. Chemical Name – the name by which a chemist knows it; this name describes the constituents of the drug
precisely
Pharmacology—is the study of the effect of drugs on living organisms.
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Pharmacy—is the art of preparing, compounding, and dispensing drugs. The word also refers to the place
where drugs are prepared and dispensed. The licensed pharmacist prepares, makes, and dispenses
drugs as ordered by a physician, dentist, nurse practitioner, or physician assistant.
Clinical pharmacist—is a specialist who often guides the primary care provider in prescribing drugs.
Pharmacy technician – is a member of the health team who in some states administers drugs to clients
Drug Standards
 Drugs may be natural (plant, mineral, animal) or synthesized in the laboratory
 Pharmacopoeia (pharmacopeia)—a book containing a list of products used in medicine, with descriptions of
the product, chemical tests for determining identity and purity, and formulas and prescriptions.
Legal Aspect of Drug Administration
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Nurses need to
a. know how nursing practice acts in their areas define and limit their functions and
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b. be able to recognize the limits of their own knowledge and skill.
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Controlled substances are kept in a locked drawer, cupboard, medication cart, or computer-controlled
dispensing system.
Counts of controlled substances are taken at the end of each shift
Effects of Drugs
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Therapeutic Effect – Desired Effect; is the primary effect intended, that is, the reason the drug is
prescribed
Side Effect – secondary effect, of a drug is one that is un-intended. Side effects are usually predictable
and may be either harmless or potentially harmful.
Adverse Effects – more severe side effects
Drug toxicity – harmful effects of a drug on an organism or tissue; results from overdosage, ingestion of a
drug intended for external use, or buildup of the drug in the blood because of impaired metabolism or
excretion (cumulative effect).
Drug Allergy – an immunologic reaction to a drug. When a client is first exposed to a foreign substance
(antigen), the body may react by producing antibodies. A client can react to a drug in the same manner as
an antigen and thus develop symptoms of an allergic reaction.
Anaphylactic Reaction – a severe allergic reaction usually occurs immediately after the administration of
the drug
Drug tolerance – exists in a person who exhibits an unusually low physiological response to a drug and
who requires increases in the dosage to maintain a given therapeutic effect.
Cumulative Effect –is the increasing response to repeated doses of a drug that occurs when the rate of
administration exceeds the rate of metabolism or excretion.
Idiosyncratic Effect – is one that is unexpected and may be individual to a client. Underresponse and
overresponse to a drug may be idiosyncratic.
drug interaction occurs when the administration of one drug before, at the same time as, or after another
drug alters the effect of one or both drugs. Drug interactions may be beneficial or harmful.
The effect of one or both drugs may be either increased (potentiating effect) or decreased (inhibiting effect).
Potentiating effects may be additive or synergistic. When two of the same types of drug increase the action
of each other, the effect is known as additive.
A synergistic effect occurs when two different drugs increase the action of one or another drug.
Iatrogenic disease (disease caused unintentionally by medi-cal therapy) can be a result of drug therapy.
Hepatic toxicity resulting in biliary obstruction, renal damage, and malformations of the fetus as a result of
specific drugs taken during pregnancy are examples.
Drug Misuse
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Drug misuse is the improper use of common medications in ways that lead to acute and chronic toxicity
Illicit drugs, also called street drugs, are those sold illegally. Illicit drugs are of two types:
a.
drugs unavailable for purchase under any circumstances, such as heroin (in the United
States), and
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b.
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drugs normally available with a prescription that are being obtained through illegal channels.
Drug abuse is the inappropriate intake of a substance, either continually or periodically.
a.
Drug dependence is a person’s reliance on or need to take a drug or substance.
 Physiological dependence is due to biochemical changes in body tissues, especially the
nervous system.
 Psychological dependence is emotional reliance on a drug to maintain a sense of well-being,
ac-companied by feelings of need or cravings for that drug.
b.
Drug habituation denotes a mild form of psychological dependence
Actions of Drugs on the Body
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Half-life – the time interval required for the body’s elimination processes to reduce the concentration of the
drug in the body by one-half.
 For example, if a drug’s half-life is 8 hours, then the amount of drug in the body is as follows:
Initially: 100%
After 8 hours: 50%
After 16 hours: 25%
After 24 hours: 12.5%
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After 32 hours: 6.25%
Peak Plasma Level – when an orally administered drug is absorbed from the gastrointestinal (GI) tract into
the blood plasma, its concentration in the plasma increases until the elimination rate equals the rate of
absorption.
Key terms related to drug actions are as follows:
a. Onset of action: the time after administration when the body initially responds to the drug
b. Peak plasma level: the highest plasma level achieved by a single dose when the elimination rate of the
drug equals the absorption rate
c. Drug half-life (elimination half-life): the time required for the elimination process to reduce the
concentration of the drug to one-half what it was at initial administration
d. Plateau: a maintained concentration of a drug in the plasma during a series of scheduled doses.
Pharmacodynamics –is the mechanism of drug action and the relationships between drug concentration
and responses in the body
receptor is the drug’s specific tar-get, usually a protein located on the surface of a cell membrane or within
the cell
When a drug binds to its receptor, the pharmacologic effects are either agonism or antagonism. When a
drug produces the same type of response as the physiological or endogenous substance, it is referred to as
an agonist.
a drug that inhibits cell function by occupying receptor sites is called an antagonist
Pharmacokinetics is the study of the absorption, distribution, bio-transformation, and excretion of drugs.
 Absorption is the process by which a drug passes into the blood-stream.
 Distribution is the transportation of a drug from its site of absorption to its site of action.
 Biotransformation, also called detoxification or metabolism, is a process by which a drug is
converted to a less active form.
 Metabolites – product of biotransformation
1. active metabolite has a pharmacologic action itself
2. inactive metabolite does not
 Excretion is the process by which metabolites and drugs are eliminated from the body.
Factors Affecting Medication Action
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Developmental Factors
Gender
Cultural, Ethnic, and Genetic Factors
 Pharmacogenetics – A client’s response to a drug is influenced by genetic variations such as
gender, size, and body composition.
 Ethnopharmacology –is the study of the effect of racial and ethnic differences/responses to
prescribed medication.
Environment
Diet
Psychological Factors
Illness and Disease
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Time of Administration
Routes of Administration
1.
2.
3.
4.
Oral
Sublingual
Buccal
Topical
a. Dermatologic preparations—applied to the skin
b. Instillations and irrigations—applied into body cavities or orifices, such as the urinary bladder, eyes,
ears, nose, rectum, or vagina
c. Inhalations—administered into the respiratory tract by a nebulizer or positive pressure breathing
apparatus. Air, oxygen, and vapor are generally used to carry the drug into the lungs.
5. Parenteral
a. Subcutaneous (hypodermic)—into the subcutaneous tissue, just below the skin
b. Intramuscular (IM)—into a muscle
c. Intradermal (ID)—under the epidermis (into the dermis)
d. Intravenous (IV)—into a vein.
e. intra-arterial (into an artery)
f. intracardiac (into the heart muscle)
g. intraosseous (into a bone)
h. intrathecal or intraspinal (into the spinal canal)
i. intrapleural (into the pleural space)
j. epidural (into the epidural space)
k. intra-articular (into a joint).
Medication Orders
Types of Medication Orders
1. A stat order indicates that the medication is to be given immediately and only once (e.g., morphine sulfate
10 milligrams IV stat).
2. The single order or one-time order is for medication to be given once at a specified time (e.g., Seconal
100 milligrams at bedtime before surgery).
3. The standing order may or may not have a termination date. A standing order may be carried out
indefinitely (e.g., multiple vitamins daily) until an order is written to cancel it, or it may be carried out for a
specified number of days (e.g., KCl twice daily × 2 days). In some agencies, standing orders are
automatically canceled after a specified number of days and must be reordered.
4. A prn order, or as-needed order, permits the nurse to give a medication when, in the nurse’s judgment,
the client requires it (e.g., Amphojel 15 mL prn). The nurse must use good judgment about when the
medication is needed and when it can be safely administered.
Essential Parts of a Medication Order
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When the nurse judges a primary care provider–ordered medication inappropriate, the following actions are
required:
 Contact the primary care provider and discuss the rationale for believing the medication or dosage to be
inappropriate.
 Document in notes the following: when the primary care provider was notified, what was conveyed to the
primary care provider, and how the primary care provider responded.
 If the primary care provider cannot be reached, document all at-tempts to contact the primary care provider
and the reason for withholding the medication.
 If someone else gives the medication, document data about the client’s condition before and after the
medication.
 If an incident report is indicated, clearly document factual information.
Systems of Measurements
1. Metric System
2. Apothecaries’ System
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3. Household System
Methods of Calculating Dosages
1. Basic Formula
D = desired dose (i.e., dose ordered by primary care provider)
H = dose on hand (i.e., dose on label of bottle, vial, ampule)
V =vehicle (i.e., form in which the drug comes, such as tablet or liquid)
2. Ratio and Proportion method
H:V::D:x
3. Fractional Equation Method
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4. Dimensional Analysis
Six steps are suggested when using dimensional analysis:
1. Identify the dose on hand.
2. Identify the desired dose.
3. Write down the conversion factor, if needed.
4. Set up the equation.
5. Cancel units that appear in the numerator and denominator.
6. Multiply the numerator. Multiply the denominator. Divide the products.
Calculation for Individualized Drug Dosages
1. Body Weight
Steps involved in calculating an individualized dose are as follows:
a. Convert pounds to kilograms.
b. Determine the drug dose per body weight by multiplying drug dose × body weight × frequency.
c. Choose a method of drug calculation to determine the amount of medication to administer.
2. Body Surface Area
Administering Medications Safely
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Medication Administration Errors
Four main types of medication errors that occur with hospitalized clients:
1. prescription errors (e.g., wrong drug or dose);
2. transcription/interpretation error (e.g., misinterpretation of abbreviations);
3. preparation errors (e.g., calculation error); and
4. administration errors (e.g., wrong dose, wrong time, omission, or additional dose).
Medication Reconciliation
 medication reconciliation –the process of creating the most accurate list possible of all medications a patient is
taking—including drug name, dosage, frequency, and route—and comparing that list against the physician’s
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admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all
transition points within the hospital.
Medication Dispensing Systems
1.
2.
3.
4.
Medication Cart
Medication Cabinet
Medication Room
Automated Dispensing Cabinet
Process of Administering Medications
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