Module 4

• Meds ketp in the med room or in mobile carts or in store drugs and supplies or in a locked cabinet in patient's room
• Stock supply: bulk quantity, labeled, and in a central location. You have to masure everytime you prepare it increasing posibility for med erros but cost-effective
• ¨Unit-dose system: is the prescribed amount of drug the patient receives. Kept in a mobile chart and it refiled by pharmachy staff every 24 hours. Each unit dose is a single tablet individualy packed checked by pharmacist and then by a nurse before administration.
• Automated Dispensing System: computereized system similar to a unit-dose system. The locked cart contains all the meds frequenlty used and computer database contains records and counts of the meds, as well as med prescritpions for each patient on the unit. Once nurse enered her code into the system to access the machine and enters the data bout the needed drug, after which the machine dispenses the med. Imidiate administration.
• Self-Administration: these drugs a prescribed and patient can take it whenever and needs to tell the nurse when he took it. Stored at bedside.Promotes patient independs plus you can assess patien'ts ability to self admnister meds.

• Components of the order:
• Patients' full name (address)
• Name of the prescriber, credentials and legal registration number such as NPI
• Address of the prescriber
• Date and time prescription was written
• Name of medication
• Dosage (size, frequency, number of doses)
• Route of administration
• Signature of prescriber
• Types of Medication orders:
• standard written prescriptions: can be with a stop date or without a renewal, prescriber writes a prescirpiton to alter or stop it.
• Automatic stop dates: are protocols that hospital use for discontinuing eds after a certain lenght of time.
• STAT: immediately and only once.
• Single: med is to be given only once at a specified time.
• Standing orders: officially accepted sest of prescriptions to ve applied routinely by nurses of rhe care of patients under certain conditions. They establish guidelines for treating a particular disease or set of symptoms.
• PRN meds: care provider prescribes. as needed by a patient.

• As a nurse, you are legally responsible for medications you administer
• Steps when you belived an order is inocrect:
• Ask nother nurse or physician to check the prescription.
• Look up medication in a reliable resource to verify spelling, usage,dosages and routes
• Contact the presriber for clafirications, concersn, or question.
• Do not assume you are correctly interpreting the prescription if you have any question at all.

• Before administration:
• Vital signs
• Whether the patient's general condition is appropriate for the medication
• Your knowledge of the medication
• Biological factors that affect drug metabolism
• During:
• Mentalstatus
• Coordination
• Ability to self-administer the drug
• Swallowing (for oral medications)
• After administration:
• Effectveness of the drug
• For side effects
• For signs of toxicity or adverse reactions

Wilkinson Vol 2 pg. 445 and a powerpoint slide 46.

• Topical medicaitons are: Lotions, creams, oitnments and transdermal (patches). pg. 525 in Wilk, vol 1
• Cleanse the skin with sopa and water and pad dry before applying, always wear gloves.
• For patches - also remove with gloves.

• Liquid medications: pour into a measuring device.
• Buccal(in the cheek) and sublingual(under the tongue) - absorpted in the mucous membrane of the mouse.
• Enteral (nasogastric and gastrostomy) - given to patients who cannot swollow or have feeding tubes.

Accommodation allows the healthy eye to focus images sharply on the retina whether the image is close to the eye or distant. The process of maintaining a clear visual image when the gaze is shifted from a distant to a near object is known as accommodation. The eye can adjust its focus by changing the curve of the lens. Convergence is the ability to turn both eyes inward toward the nose to ensure only a single image of close objects is seen.

• The cornea is the clear layer that forms the external coat on the front of the eye
• The cornea is best observed by directing a light at it from the side using several angles. The cornea should be transparent, smooth, shiny, and bright. Any cloudy areas or specks may be the result of accidents or injuries.

• Hyphema: hemorrhage in the anterior chamber, break of blood vessel
• Contusion: contusion of the eyeball and surrounding tissue is caused by traumatic contact with a blunt object.
• Foreign Bodies: eyelashes, dust, fingernails, dir, airboren particles come in contact with conjunctiva or cornea and irriate.
• Lacerations: wounds cause by shapr objects and projectiles.
• Penetrating injuries: have poorest chance of retaining vision in the injured eye.

A cataract is an opacity of the lens that distorts the image projected onto the retina. With aging, the lens gradually loses water and increases in density.This increased density occurs as older lens fibers are compressed and new fibers are produced in the outer layers. Lens proteins dry out and form crystals. As the density of the lens increases, it becomes opaque with a painless loss of transparency.

• ex.
• Myopia 20/100 means that to see text a person with normla vision can read at 100 feet, the clietn has to stand just 20 feet rom the snellen chart.

The conjunctivae are the mucous membranes of the eye. The palpebral conjunctiva is a thick membrane with many blood vessels that lines the undersurface of each eyelid. Located over the sclera is the thin, transparent bulbar conjunctiva.

seperation of the retina from the epithelium.

• Glaucoma is a group of ocular diseases resulting in increased IOP. Intraocular pressure (IOP) is the fluid pressure within the eye
• reduces blood flow to the eye

diminished near vision, client must hold the paper more than 14 in. away.With age ability to accomodate to near objects loses.

naturaly with ageing lost of near vision in people older than 45 years of age. lens loses its elasticity

is the colored portion of the external eye, its center opening is the pupil

its where the tears are produces. Located in the upper outer part of each orbit

(nearsightedness) occurs when the eye overrefracts or overbends the light. As a result, images are focused in front of the retina. Near vision is normal, but distance vision is poor. Myopia is corrected with a biconcave lens in eyeglasses or contact lenses.

an involuntary and rapid twitching of the eyeball, is a normal finding for the far lateral gaze. It may also be caused by abnormal nerve function or prolonged reduced vision.

• is the deterioration of the macula (the area of central vision) and can be atrophic (age-related) or exudative. Age-related macular degeneration (AMD) has two types. The most common type is dry AMD, caused by gradual blockage of retinal capillaries, allowing retinal cells in the macula to become ischemic and necrotic. Rod and cone photoreceptors die. Central vision declines, and patients describe mild blurring and distortion at first. Eventually, the person loses all central vision. Another cause of AMD is the growth of new blood vessels in the macula, which have thin walls and leak blood and fluid
• wet AMD).
• Exudative macular degeneration is also wet but can occur at any age. The condition can occur only in one eye or in both eyes. In addition, the person with AMD can also develop exudative macular degeneration. Patients with exudative (wet) degeneration have a sudden decrease in vision after a serous detachment of pigment epithelium in the macula. Newly formed blood vessels invade this injured area and cause fluid and blood to collect under the macula (like a blister), resulting in scar formation and visual distortion.

drooping of the lid may be seen in clients who have experienced a stroke or Bell's palsy(paralisys of the facial nerve)

• External ear: Pina - outer cartilage of the year. Mastoid process - bony ridge located over the temporal bone behind the pinna. The external ear extends from the pinna throught the external ear canal to the tympanic membrane ( eardrum). Cerum lines the ear canal.
• Middle ear: Begin at the inner side of the eardrum. Epitympanum is the middle ear compartment. Then there are top opening of the eustachina tube and the three small bones known as bony ossicles ( malleus, incus, stapes). Moving for vibration to creat sound swaves to hit the eardrum.
• Inner ear: The inner ear is on the other side of the oval window and contains the semicircular canals, cochlea, vestibule, and the distal end of the eighth cranial nerve. The semicircular canals are tubes made of cartilage and contain fluid and hair cells. These canals are connected to the sensory nerve fibers of the vestibular portion of the eighth cranial nerve. The fluid and hair cells within the canals help maintain the sense of balance.
• The cochlea, the spiral organ of hearing, is divided into the scala tympani and the scala vestibuli. The scala media is filled with endolymph, and the scala tympani and scala vestibuli are filled with perilymph. These fluids protect the cochlea and the semicircular canals by allowing these structures to “float” in the fluids and be cushioned against abrupt head movements.
• The organ of Corti is the receptor of hearing located on the basilar membrane of the cochlea. The cochlea contains hair cells that detect vibration from sound and stimulate the eighth cranial nerve.
• The vestibule is a small, oval-shaped, bony chamber between the semicircular canals and the cochlea. It contains the utricle and the sacculus, organs that are important for the sense of balance.

is the part of the external ear that is composed of cartilage covered by skin and attached to the head at about a 10-degree angle

Epitympanum is the middle ear compartment. Then there are top opening of the eustachina tube and the three small bones known as bony ossicles ( malleus, incus, stapes). It begins at the floor of the middle ear and extends to the throat. It allowes pressure on both sides of the eardrum to equalize. Secreations from the middle ear drain to the throat.

wax producing glands, sebaceous glands, and hair follicles inside the ear canal

spinnig sensation

• can be acute and chronic affect the middle ear
• An infecting agent intorduced into the middle ear cause inflammationof the mucosa, leading to swelling and irritation of the small bones withi the middle ear. Exudate follows
• If left untreated can loose hearing permanantly

• Conductive hearing loss occurs when sound waves are blocked from contact with inner-ear nerve fibers because of external-ear or middle-ear disorders. If the inner-ear sensory nerve fibers that lead to the cerebral cortex are damaged, the hearing loss is termed sensorineural. Combined hearing loss is known as mixed conductive-sensorineural.
• The differences in conductive and sensorineural hearing loss are listed in Table 51-2. Disorders that cause conductive hearing loss are often corrected with no or minimal permanent damage. Sensorineural hearing loss is often permanent, and measures must be taken to prevent further damage or to amplify sounds as a means to improve hearing.

• Pinna becomes elongated because of loss of subcutaneous tissues and decreased elasticity
• Hair in the canal becomes coarser and longer, especially in men
• Cerumen is dryer and impacts more easily, reducing hearing function.
• Tympanic membrane loses elasticity and may appear dull and retracted.
• Hearing acuity decreases (in some people).
• The ability to hear high-frequency sounds is lost first. Older adults may have particular problems hearing the f, s, sh, and pa sounds.
• Dull and retracted tympanic membrane is normal in older adoluts and is not an indicator of otitis media.

reddened canal

hearing loss for high-pitched sounds

cavities, cuased primarily by a failure to remove plaque, an invisible, destructive bacterial film that builds up on the teeth.

bad breath, liver deases, unctonrtolled diabetes, infections, caries, systemic diseases.

Thick, elevated white patches, that do not scape off may be precancerous lesions

sign of periodonal disease, red, swallen, spongy, bleeding gums and residing gum line.

difficulty swalowing

nose bleed

ear discharge

irregular bone growth around ossicles

bol' v oblasti ushnoi rakovini, i naruzhnogo sluxovoga proxoda