Patient self-administration

Intravenous injection

In many respects the administration of medicines via the IV route is an admission that the use of other routes will not allow for an intended therapeutic outcome or goal of the treatment to be met. Not only is the route inconvenient for the patient and practitioner, but it carries the greatest risk of any route of drug administration. By administering directly into the systemic circulation either by direct injection or infusion, the drug is instantaneously distributed to its sites of action.

Such administration is frequently complex and confusing. It may require dose calculations, dilutions, information to be gathered on administration rates and compatibilities with other solutions, and the use of programmable infusion devices.

Moreover the preparation of medicines requires the use of an aseptic technique, often in a ward environment that is unsuited for such work. It is imperative that to minimise the risk of errors occurring in the administration of medicines that practitioners can demonstrate their competence to practice safely in this area, and have access to appropriate sources of expert information and advice.

Considerations when preparing an intravenous injection or infusion

Is the drug suitable for preparation at ward level or should it be prepared in pharmacy?

Does the drug require initial dilution?

If so what diluent is required and in what volume?

Does the drug require further dilution?

If so to what volume and with what diluent?

Is the drug suitable for direct injection or must it be infused over time?

What length of time can it be administered over?

Is an infusion device required?

Is the drug compatible with other drugs or fluids to be administered at the same time?

Does the drug cause any local reaction when given?

Is any monitoring required during or after administration?

For many years the standard method of medicines administration in the healthcare settings such as hospitals and nursing homes has been based on nurses interpreting a prescription and giving the relevant medicine in the required dose via the required route. The patient’s role in the process has been passive.

Self-administration as an alternative means of administering medicines is based on the patient being encouraged to play a central and active part in their drug treatment, just as they would be expected to do if at home.

The safety and success of a self-administration scheme is based on an ongoing nursing assessment that measures individual patients’ ability to interpret and participate in their prescribed treatment regimen.

This assessment must initially evaluate whether or not patients administer any prescribed treatment at home, whether or not they are able to read medicine labels, can understand dose instructions and open medicine containers or packaging (Box 1). The assessment must also reflect events that take place during the hospital stay.

For example a patient judged to be capable of self-administration before surgery is unlikely to be able to do so in the immediate postoperative period. Such changes in patient capability must be reflected in the patient’s care plan, and any indications that the ability to self-administer is compromised should trigger a return to nurse-administered treatment.

The system requires that safe and secure arrangements are in place for patients’ medicines and that local policies and procedures are in place to guide practice (NMC, 2006).

A number of factors have stimulated hospital practitioners to look at the benefits of self-administration for patients and carers. There is now widespread acknowledgement that traditional methods of medicines administration in hospitals do little to encourage patient compliance and often leave patients being discharged with a bewildering bag of medicines that they may never have seen before and may not be sure how to take.

Encouraging those patients who are able to administer their own medicines, as they would do at home, raises the possibility of identifying their education needs and improving concordance. For those assessed as unable to self-administer, consideration needs to be given prior to discharge to the problems this may present.

Criteria for patient assessment for self-administration:

Is the patient receiving medicines and willing to participate?

Does the patient appear confused or forgetful?

Does the patient have a history of drug / alcohol abuse / self harm?

Does the patient self-administer at home?

Can the patient read medicines labels?

Can the patient open medicines containers?

Can the patient open his or her medicines locker?

Do the patient know what his or her medicines are for (and dosage, instructions, side-effects)?

The successful operation of an extensive self-administration scheme throughout an acute hospital offers insights into the complexities and contradictions of modern medicines management which may have been hidden by the drug trolley approach.

It requires an acknowledgement that the traditional manner of working does not meet the needs of most patients, and for ward-based practitioners to be committed to adopting this approach in their practice. It also requires a truly integrated multi-professional approach that focuses on ensuring patients gain the maximum benefit from their medicines.

Allergy reactions:

Nettle-rash, acute catarrh, conjunctivitis, Kvinke oedema, anaphylaxis shock.

Call doctor!

First aid in anaphylaxis shock:

- stop injection;

- nip tourniquet higher the injection place;

- horizontal position. Fixed toungue;

- prick around injection place with 0,5 ml 0,1% adrenaline solution (diluted in isotonic solution of NaCl 1:10);

- call ambulance;

- control arterial pressure and pulse;

- if its not enough – 60-90 mg prednisolone intravenous or intramuscular;

- symptom therapy;

- in case of shock on penicillin – 1 000 000 ED pennicillinaze in the 2 ml of isotonic solution;

- if not help – 2,5% pipolfen solution 2-4 ml or 2% solution of suprastine 2-4 ml intramuscular, in case of systolic arterial oressure is nit less that 100 mm.mercury;

- if its needed provide cardiopulmonary reanimation;

The Most Common Types of Drugs Currently Available:

Analgesics: Drugs that relieve pain. There are two main types: non-narcotic analgesics for mild pain, and narcotic analgesics for severe pain.

Analgesics generally recommended are: Tylenol, Tylenol with codeine, Vicodin, Darvon and Ultram. These medications, except Tylenol are prescribed for pain at the physician's discretion and are generally prescribed for those requiring a greater analgesic effect than acetaminophen alone can deliver, and/or those who are allergic to, or cannot take aspirin.

Antacids: Drugs that relieve indigestion and heartburn by neutralizing stomach acid.

Antianxiety Drugs: Drugs that suppress anxiety and relax muscles (sometimes called axiolytics, sedatives, or minor tranquilizers).

Antiarrhythmics: Drugs used to control irregularities of heartbeat.

Antibacterials: Drugs used to treat infections.

Antibiotics: Drugs made from naturally occurring and synthetic substances that combat bacterial infection. Some antibiotics are effective only against limited types of bacteria. Others, known as broad spectrum antibiotics, are effective against a wide range of bacteria.

Anticoagulants and Thrombolytics: Anticoagulants prevent blood from clotting. Thrombolytics help dissolve and disperse blood clots and may be prescribed for patients with recent arterial or venous thrombosis.

Anticonvulsants: Drugs that prevent epileptic seizures.

Antidepressants: There are three main groups of mood-lifting antidepressants: those belonging to the tricyclics, SSRI (selective serotonin reuptake inhibitors) class, and monoamine oxidase inhibitors.

Tricyclic Antidepressants

Elavil (Amitriptyline) dose is typically 2.5 to 50 mg per night. Elavil is known forpain relieving effects and ability to help sleep. This medication should be takenearly in the evening, or half-dose in the evening and the other half at bedtime to avoid morning hangover.

Flexeril (Cyclobenzaprine) dose is usually 10 to 30 mg per night. A tricyclic drug similar to Elavil with muscle relaxant qualities. May be taken along with Elavil to provide muscle relaxant relief. This medication usually reaches its maximum effect after one to two weeks of continuous use.

Sinequan (Doxepin) a typical dose is 2.5 to 75 mg. Also a tricyclic that functionsin the body as an antihistamine. Available in tablet form as well as liquid.

Pamelor (Nortriptyline) the usual dose is 10 to 50 mg per night. Similar effects as Elavil but may be less sedating.

Desyrel (Trazodone) the usual dose is 25 mg to 50 mg per night. Desyrel is as effective as the other anti-depressants, however, is chemically different and may be less likely to cause side effects. Desyrel is a mild stimulant and may make a sleep problem worse if combined with a tricyclic anti-depressant at night. It has also been reported to cause nightmares.

Many of the tricyclic antidepressants have side effects that may be intolerable for some people. These include constipation, drowsiness, dry mouth and eyes, headache, heart rate abnormalities, increased sensitivity to sunlight, morning "hangover," and weight gain. These side effects may improve after patients have been using the medication for a few weeks. If not the doctor should be consulted regarding another medication.

Benzodiazepines (antidepressant and anti-anxiety properties)

Xanax (Alprazolam) a typical dose is 0.25 to 1.5 mg at night. Xanax has been found to be more effective if taken with 2400 mg (per day) of ibuprofen. However, Xanax may cause depression in some people, and has been known to be addictive. Xanax may be effective for some fibromyalgia patients if taken in low does.

Klonopin (Clonazepam) 0.5 to 1 mg at night is helpful in sleep myoclonus (arm and/or leg spasms). Klonopin may help patients who grind their teeth. It stays active in the body longer, and has the same possibility of being addictive as Xanax, and may cause depression in some people.

The antidepressant and anti-anxiety properties of these medications can cause the following effects: Depression, drowsiness, impaired coordination, impaired memory, muscular weakness and/or concentration problems, and they are known to be addictive.

Serotoning Boosting Medications

Prozac (Fluoxetine) is available in liquid as well as tablet form. Typical dose is 1 to 20 mg in the morning. Prozac may cause insomnia, but it can be taken in combination with one of the sedating tricyclics such as Elavil or Sinequan.

Paxil (Paroxetine hydrochloride) the usual dose is 5 to 20 mg in the morning. This medication is the most potent of this type. A sedating medication may be needed at night in conjunction with Paxil. It can cause nervousness, insomnia, nausea, sexual difficulties and sweating, although many patients report having fewer side effects with Paxil as compared to Prozac.

Zoloft (Sertraline) 50 to 200 mg is the usual dosage. Anecdotally proven helpful for some patients. Sedating medication may also be needed to combat insomnia.

Serzone (Nefazodone) is the newest of these agents. As well as increasing serotonin, it also increases norespinephrine. Serzone's efficacy and side effects are similar to Effexor.

Effexor (venlafaxine hydrochloride) the usual dose is 27.5 mg two times per day. This dosage can be adjusted, depending on the effects. Effexor is not related to the tricyclics or the Prozac-like drugs, however, it does boost serotonin and has tricyclic properties. The typical side effects are nervousness, anxiety, insomnia and increased blood pressure.

The following are some of the side effects of serotonin boosting medications: anxiety/nervousness, headache, insomnia, mood swings, sexual difficulties, nausea and stomach distress.

Antidiarrheals: Drugs used for the relief of diarrhea. Two main types of antidiarrheal preparations are simple adsorbent substances and drugs that slow down the contractions of the bowel muscles so that the contents are propelled more slowly.

Antiemetics: Drugs used to treat nausea and vomiting.

Antifungals: Drugs used to treat fungal infections, the most common of which affect the hair, skin, nails, or mucous membranes.

Antihistamines: Drugs used primarily to counteract the effects of histamine, one of the chemicals involved in allergic reactions.

Antihypertensives: Drugs that lower blood pressure. The types of antihypertensives currently marketed include diuretics, beta-blockers, calcium channel blocker, ACE (angiotensin- converting enzyme) inhibitors, centrally acting antihypertensives and sympatholytics.

Anti-Inflammatories: Drugs used to reduce inflammation - the redness, heat, swelling, and increased blood flow found in infections and in many chronic noninfective diseases such as rheumatoid arthritis and gout.

Antineoplastics: Drugs used to treat cancer.

Antipsychotics: Drugs used to treat symptoms of severe psychiatric disorders. These drugs are sometimes called major tranquilizers.

Antipyretics: Drugs that reduce fever.

Antivirals: Drugs used to treat viral infections or to provide temporary protection against infections such as influenza.

Barbiturates: Als called sleeping drugs.

Beta-Blockers: Beta-adrenergic blocking agents, or beta-blockers for short, reduce the oxygen needs of the heart by reducing heartbeat rate.

Bronchodilators: Drugs that open up the bronchial tubes within the lungs when the tubes have become narrowed by muscle spasm. Bronchodilators ease breathing in diseases such as asthma.

Cold Remedies: Although there is no drug that can cure a cold, the aches, pains, and fever that accompany it can be relieved by aspirin or acetaminophen often accompanied by a decongestant, antihistamine, and sometimes caffeine.

Corticosteroids: These hormonal preparations are used primarily as anti-inflammatories in arthritis or asthma or as immunosuppressives, but they are also useful for treating some malignancies or compensating for a deficiency of natural hormones in disorders such as Addison's disease.

Cough Suppressants: Simple cough medicines, which contain substances such as honey, glycerine, or menthol, soothe throat irritation but do not actually suppress coughing. They are most soothing when taken as lozenges and dissolved in the mouth.

As liquids, they are probably swallowed too quickly to be effective. A few drugs are actually cough suppressants. There are two groups of cough suppressants: those that alter the consistency or production of phlegm such as mucolytics and expectorants; and those that suppress the coughing reflex such as codeine (narcotic cough suppressants), antihistamines, dextromethorphan and isoproterenol (non-narcotic cough suppressants).

Cytotoxics: Drugs that kill or damage cells. Cytotoxics are used as antineoplastics (drugs used to treat cancer) and as immunosuppressives.

Decongestants: Drugs that reduce swelling of the mucous membranes that line the nose by constricting blood vessels, thus relieving nasal stuffiness.

Diuretics: Drugs that increase the quantity of urine produced by the kidneys and passed out of the body, thus ridding the body of excess fluid. Diuretics reduce water logging of the tissues caused by fluid retention in disorders of the heart, kidneys, and liver. They are useful in treating mild cases of high blood pressure.

Expectorants: Drugs that stimulate the flow of saliva and promotes coughing to eliminate phlegm from the respiratory tract.

Hormones: Chemicals produced naturally by the endocrine glands (thyroid, adrenal, ovary, testis, pancreas, and parathyroid). In some disorders, for example, diabetes mellitus, in which too little of a particular hormone is produced, synthetic equivalents or natural hormone extracts are prescribed to restore the deficiency. Such treatment is known as hormone replacement therapy.

Hypoglycemics (Oral): Drugs that lower the level of glucose in the blood. Oral hypoglycemic drugs are used in diabetes mellitus if it cannot be controlled by diet alone, but does require treatment with injections of insulin.

Immunosuppressives: Drugs that prevent or reduce the body's normal reaction to invasion by disease or by foreign tissues. Immunosuppressives are used to treat autoimmune diseases (in which the body's defenses work abnormally and attack its own tissues) and to help prevent rejection of organ transplants.

Laxatives: Drugs that increase the frequency and ease of bowel movements, either by stimulating the bowel wall (stimulant laxative), by increasing the bulk of bowel contents (bulk laxative), or by lubricating them (stool-softeners, or bowel movement-softeners). Laxatives may be taken by mouth or directly into the lower bowel as suppositories or enemas. If laxatives are taken regularly, the bowels may ultimately become unable to work properly without them.

Muscle Relaxants: Drugs that relieve muscle spasm in disorders such as backache. Antianxiety drugs (minor tranquilizers) that also have a muscle-relaxant action are used most commonly.

Tricyclic Antidepressants

Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help loosen the tightness of FMS muscles. Flexeril may be taken in combination with Elavil to provide maximum relief.

Norflex (Orphenadreine Citrate) is one doctors often try if the patient does not respond to Elavil or Flexeril. The recommended dose is 50 to 100 mg twice a day. Norflex is a central acting analgesic muscle relaxant that has been found to decrease pain in some FMS patients.

Patients should be cautioned that muscle relaxants can cause drowsiness and they should not operate a motor vehicle when taking this type of medication. There are other muscle relaxants to try if these do not work.

Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help loosen the tightness of FMS muscles. Flexeril may be taken in combination with Elavil to provide maximum relief.

Norflex (Orphenadreine Citrate) is one doctors often try if the patient does not respond to Elavil or Flexeril. The recommended dose is 50 to 100 mg twice a day. Norflex is a central acting analgesic muscle relaxant that has been found to decrease pain in some FMS patients.

Sedatives: Same as antianxiety drugs.

Sex Hormones (Female): There are two groups of these hormones (estrogens and progesterone), which are responsible for development of female secondary sexual characteristics. Small quantities are also produced in males. As drugs, female sex hormones are used to treat menstrual and menopausal disorders and are used as oral contraceptives. Estrogens may be used to treat cancer of the breast or prostate, progestins (synthetic progesterone to treat endometriosis).

Sex Hormones (Male): Androgenic hormones, of which the most powerful is testosterone, are responsible for development of male secondary sexual characteristics. Small quantities are also produced in females. As drugs, male sex hormones are given to compensate for hormonal deficiency in hypopituitarism or disorders of the testes. They may be used to treat breast cancer in women, but synthetic derivatives called anabolic steroids, which have less marked side- effects, or specific anti-estrogens are often preferred. Anabolic steroids also have a "body building" effect that has led to their (usually nonsanctioned) use in competitive sports, for both men and women.

Sleeping Drugs: The two main groups of drugs that are used to induce sleep in patients with insomnia are benzodiazepines and barbiturates. All such drugs have a sedative effect in low doses and are effective sleeping medications in higher doses. Benzodiazepines drugs are used more widely than barbiturates because they are safer, the side-effects are less marked, and there is less risk of eventual physical dependence.

Sleep Medications may be used occasionally during flares or when the patient is having severe sleeping problems. They can be habit forming, however, Ambien is thought to be less habit forming, is well tolerated, with few side effects, and there are no known drug interactions. This sleep medication should not be used more than two or three times a week.

Tranquilizers: This is a term commonly used to describe any drug that has a calming or sedative effect. However, the drugs that are sometimes called minor tranquilizers should be called antianxiety drugs, and the drugs that are sometimes called major tranquilizers should be called antipsychotics.

Vitamins: Chemicals essential in small quantities for good health. Some vitamins are not manufactured by the body, but adequate quantities are present in a normal diet. People whose diets are inadequate or who have digestive tract or liver disorders may need to take supplementary vitamins.

NSAIDS (anti-inflammatories) Advil, Clinoril, Motrin, Naproxen, Relafen and Voltaren. Used alone, these anti-inflammatories have not proven effective in reducing FMS pain. However, Elavil and Xanax's effectiveness is increased when used in combination with ibuprofen (2400 mg per day). If the patient has arthritis, osteoarthritis or tendinitis these medications would be helpful in alleviating the pain.

Advil, Motrin, Naproxen, Relafen, etc., are non-steroidal anti-inflammatories. These medications can cause stomach upset and some patients have developed bleeding ulcers.

Дата добавления: 2014-12-23