...significant improvement in other areas. 100% compliance in all areas will have positive benefits for the patient as well as for the hospital. The goal is to improve compliance in order to ensure patient safety and decrease mortality rates for surgical patients. Assessment Appropriate hair removal and normathermia are two areas that show consistent compliance. Maintaining current processes and procedures is recommended. While antibiotic selection was meeting the desired goal as set forth in the Surgical Care Improvement Project (SCIP) Inf-2, after May a significant decrease in compliance is noted. Use of prophylactic antibiotics prior to incision (SCIP Inf-1), stopping the antibiotic within 24 hrs. of surgery end time (SCIP Inf-3), beta blockers given during perioperative period (SCIP Card-2), recommended VTE prophylaxis ordered (SCIP VTE-1) and given within 24 hrs. prior through 24 hrs. after surgery (SCIP VTE-2) Corrective Action Plan The goal of the prophylactic antibiotic before and after surgery is to promote serum levels and gain bactericidal tissue. There is no known benefit for the patient to continue these antibiotics greater than 24 hrs. post-surgery (qualitymeasures.ahrq.gov, 2013). Physicians have been educated regarding the selection of antibiotics and the importance of administering the first dose within one hour of surgery (jointcommission.org, 2014). Concurrent audits to capture data in real time of these cases will help to ensure compliance by physicians...
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...marketed as Coreg CR. References Press Release, FDA Approves First Generic Versions of Coreg, U.S. Food and Drug Administration, Sep. 5, 2007 Stafylas PC, Sarafidis PA (2008). "Carvedilol in hypertension treatment". Vasc Health Risk Manag 4 (1): 23–30. doi:10.2147/vhrm.2008.04.01.23. PMC 2464772. PMID 18629377. Othman AA, Tenero DM, Boyle DA, Eddington ND, Fossler MJ (2007). "Population pharmacokinetics of S(-)-carvedilol in healthy volunteers after administration of the immediate-release (IR) and the new controlled-release (CR) dosage forms of the racemate". AAPS J 9 (2): E208–18. doi:10.1208/aapsj0902023. PMC 2751410. PMID 17614362. Vanderhoff BT, Ruppel HM, Amsterdam PB (November 1998). "Carvedilol: the new role of beta blockers in congestive heart failure". Am Fam Physician 58 (7): 1627–34, 1641–2. PMID 9824960. Kornhuber J, Muehlbacher M, Trapp S, Pechmann S, Friedl A, Reichel M, Mühle C, Terfloth L, Groemer T, Spitzer G, Liedl K, Gulbins...
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...3. An increase in glucose (or sugar) release - this additional sugar gives our muscles something to 'feed on,' which helps them work better and faster. 4. An increase in breathing rate - when we breathe faster, we are delivering more oxygen to the body and brain. This helps our entire body work better. 5. A shutting down of metabolic processes - shutting down processes, like digestion and growth, allows blood and energy that would normally go to these functions to be shunted to our muscles and brain. Receptors Like many biologically active substances, norepinephrine exerts its effects by binding to and activating receptors located on the surface of cells. Two norepinephrine receptors have been identified, known as alpha and beta...
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...TOP 200 DRUGS FOR 2009 WITH CLASSIFICATION, ROUTE, AND USE GENERIC | BRAND | CLASS | MAJOR USE | SCHEDULE | ROUTES | atorvastatin | Lipitor | HMA-CoA reductase inhibitor | hypercholesterolemia | not controlled | PO | amoxicillin | Amoxil, Trimox | Penicillin antibiotic | infection | not controlled | PO | hydrochlorothiazide | Microzide | Thiazide Diuretic | Hypertension/edema | not controlled | PO | azithromycin | Zithromax | macrolide antibiotic | infection | not controlled | PO, IV | metformin | Glucophage, Glucophage XR | antidiabetic | Type 2 Diabetes | not controlled | PO | atenolol | Tenormin | beta blocker (B1) | hypertension/angina/acute M.I. | not controlled | PO, IV | Simvastatin | Zocor | HMG-CoA Redctase inhibitor | hypercholesterolemia | not controlled | PO | alprazolam | Xanax, Xanax XR | benzodiazepeine | anxietty/panic disorder | schedule 4 | PO | furosemide | Lasix | loop diuretic | edema/hypertension | not controlled | PO, IV | zolpidem | Ambien, Ambien CR | anxiolytic/hypnotic | insomnia | schedule 4 | PO | potassium chloride | K-Dur, Klor-Con, Micro-K | posassium supplement/electrolyte | hypokalemia | not controlled | PO, IV | sertraline | Zoloft | selective serotonin reuptake (SSRI) | major depression/ocd/panic disorder | not controlled | PO | montelukast | Singulair | leukotriene inhibitor | asthma maintenence | not controlled | PO | escitalopram | Lexapro | selective serotonin reuptake inhibitor (SSRI) | major depression/anxiety...
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...Antiarrhythmics Antiarrhythmia drugs are used to treat abnormal heart rhythms resulting from irregular electrical activity of the heart. There are many different types of antiarrhythmic drugs. Examples include: * Tambocor (flecainide) * Procanbid (procainamide) * Cordarone (amiodarone) * Betapace (sotalol) In addition, there are other types of heart drugs that can be used to treat arrhythmias, including: Read the Do You Know Which Symptoms Signal a Heart Attack in Women? article > > * Beta-blockers such as metoprolol or Toprol XL, which reduce the heart's workload and heart rate. * Calcium channel blockers such as Calan, which also reduces the heart rate. There are also a variety of drugs used by the doctor in an emergency situation to control or convert an abnormal heart rhythm. Why Do I Need to Take an Antiarrhythmia Drug? Your doctor has determined that you have an abnormal heart rhythm that would be best treated with drugs alone or in addition to a procedure, such as putting in an implantable cardioverter defibrillator (ICD). Because these drugs only control abnormal heart rhythms, not cure them, you may have to take them for life. Can I Take Other Drugs While Taking Antiarrhythmics? If you are taking an antiarrhythmic, talk to your doctor before taking any other drugs (prescription or over-the-counter), herbal remedies, or supplements. Are There Side Effects Associated With Antiarrhythmics? Yes, antiarrhythmics do have side effects...
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...University of Pennsylvania School of Nursing Medication Tracking Sheet Tracking Medications Across the Curriculum Major Drug Classification (s): beta blocker Generic drug name: Metoprolol Trade (Brand) name: Lopressor Normal dosage range:______25-50mg Safe dosage range: Route(s) of administration: PO once a day Drug action (s): Blocks simulation of beta1 adrenergic receptors. * Uses: * Hypertension. * Angina pectoris. * Prevention of MI and decreased mortality in patients with recent MI. * Management of stable, symptomatic (class II or III) heart failure due to ischemic, hypertensive or cardiomyopathc origin (may be used with ACE inhibitors, diuretics and/or digoxin; Toprol XL only). * * * Significant side effects: fatigue, weakness * Significant adverse reactions: CV- bradycardia, tachycardia, pulmonary edema, hypotension Significant drug/drug interactions: Drug-Drug * General anesthesia, IVphenytoin, and verapamil may cause ↑ myocardial depression. * ↑ risk of bradycardia when used with digoxin, verapamil, diltiazem, or clonidine . * ↑ hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates . * Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension...
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...using drugs called Benzodiazepines (BZs). These are the most common type of drug to relieve stress and anxiety issues. They work by slowing down the Central Nervous System activity. GABA, the hormone responsible for anxiety relief naturally in the human body is enhanced by the BZs. The BZs will also help to reduce the serotonin activity in the brain, which is the neurotransmitter which causes stimulation, and reduces anxiety as a result. Benzodiazepines have a number of effects that all lead to the reduction of stress in people without much effort. The other type of drug that could be used to treat stress and anxiety issues are Beta Blockers (BBs). When the body detects stress, the SNS is activated which leads to raised heart rate, which leads to higher blood pressure which can lead to Chronic Heart Disease, heart attack, stroke etc. The Beta Blocker is taken then and it acts by reducing activity of adrenaline and noradrenaline and also binds to the receptors of the heart and other areas of the body stimulated by arousal. As a result of blocking these receptors, it is therefore harder to stimulate them and so the heart beat is slowed, and therefore lower blood pressure. An advantage of drugs is that they work very quickly and are effective in reducing stress almost immediately. Their use can be therefore be justified, provided that the stressor is a short-term one rather than a long-term one. Another advantage is that drugs are also relatively inexpensive compared to psychological...
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...This assignment will take the form of a case study on a current patient with heart failure being nursed in a community setting. Due to confidentiality and patient privacy, the patient discussed will be referred to as John¹. John is an 82 year old gentleman who lives alone in sheltered accommodation. John’s son and daughter live close and take it in turns to visit daily. John is an ex-smoker who gave up 20 years ago, has long standing hypertension and is overweight having a BMI of 30 kg/m. John was diagnosed with heart failure a year ago after being hospitalised three times in the space of four months. Stewart (2004) feels that a diagnoses of heart failure is problematic in older patients as their symptoms can often mimic other diseases. According to the National Institute for Clinical Excellence Guidelines (NICE) 2003, hospitalisation accounts² for 70% of the £716 million pounds spent on heart failure annually. In this assignment the physiology of the heart will be discussed and how heart failure affects its performance. John’s symptoms, medication and how his condition was diagnosed will be discussed³. John’s future care and how it will be managed along with who will be involved in his care4. NICE (2003) defines heart failure as a “complex syndrome” that results from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a “physiological circulation”. Tendera5 (2005) states that heart failure...
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...Creative Change in Healthcare Mary Ofili HSC 587 May 19, 2014 Lanny A. Kope Creative Change in Healthcare Change in any organization, especially healthcare is a given constant, frequent and always almost inevitable. Several factors may lead to these changes and sometimes, these factors are internal and other times they are external. In the United States, the economy determines the interactions between the cost of healthcare and the way hospitals deliver care to the patients. The current persistent economic downturn continues to force Medicare to look closely at how hospitals are reimbursed and to cut reimbursement rates. With the overhaul of the healthcare system, hospitals have to evaluate how to deliver care to the patients with limited financial resources. Therefore, Medicare expects hospitals to bear the cost of any adverse outcome caused by any changes within the hospital environment. For examples, hospitals are no longer reimbursed for the cost of diabetic ulcer treatment acquired while the patient is in the hospital. The quality of the expected result is much higher while the reimbursement is much lower. Hospitals have to look closely at how the nursing staff delivers care to the patients. The traditional bedside nursing is staffed by three levels of nurses. Certified Nurse’s Assistant (CNA), Licensed Vocation Nurse (LVN), and the Registered Nurse (RN). Other levels of nurses such as Nurse Practitioners and other advanced practice nurses are not included in the...
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...VERY IMPORTANT,because you may get a drug you've never heard of it, but will be able to recognize it's category, and the most common side-effects. Once you've done that you should definitely know at the very least these, their side-effects, dangerous drug interactions, safe dosage ranges, etc. Digitalis, Lasix, Nitro, Clozaril, Lithium, Theophylline, Aspirin, Nardil (know all the MAOI's since there are only a couple), Cogentin, know never to mix a MAOI with an SSRI or other antidepressants, Tylenol, Dilantin, Mag Sulfate, and the major cardiac drugs. helps for better memorization coumadin is highly protein bound. so an increase in protein intake will decrease the effectiveness KCL must be diluted and administered no faster than 20 mEq/hr long-term use of rocephin can cause over-growth of organisms such as Candida albicans Periorbital edema is indicative of post-strept glomerulonephritis After birth, the infant of a diabetic mother is often hypoglycemic epigastric pain can be indicative of an impending seizure variable decelerations indicate a problem with cord compression Clients stered on Disulfiram (Antabuse) must avoid any form of alcohol Tetany is the major sign of hypoparathyroidism nervousness and insomnia suggest an overdose of thyroid hormone replacement therapy remember ELAIN for drugs that can be admin via endotracheal tube (epinephrine, lidocaine, atropine, isuprel, and narcan) ASA can cause hemorrhage during a sickle cell crisis Normal...
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...GENERIC NAME:LABETALOL - ORAL (luh-BET-uh-lol) BRAND NAMES: Normodyne, Trandate DRUG CLASS AND MECHANISM: Labetalol is a drug that is used for treating high blood pressure. Nerves from the adrenergic nervous system travel from the spinal cord to arteries where they release norepinephrine. Norepinephrine attaches to adrenergic receptors on arteries and causes the arteries to contract, narrowing the arteries, and increasing blood pressure. Labetalol blocks receptors of the adrenergic nervous system. When labetalol attaches to and blocks the receptors, arteries expand, resulting in a fall in blood pressure. GENERIC AVAILABLE: Yes PRESCRIPTION: Yes PREPARATION: Tablets: of 100, 200 and 300 mg; Injection: 5 mg/ml STORAGE: Tablets should be stored between 2-30 C (36-86 F). PRESCRIBED FOR: Labetalol is used alone or in combination with other drugs to reduce blood pressure. DOSING: The recommended starting oral dose of labetalol is 100 mg twice daily and the dose can be increased by 100 mg twice daily every 2-3 days based on the response of the blood pressure. Usual maintenance doses are 200-400 mg twice daily. Patients with severely high blood pressure may require 1.2 to 2.4 g daily. Stopping or changing the dose of the drug should be directed by a physician because serious side effects may occur. The initial intravenous dose of labetalol is 20 mg injected over 2 minutes. Additional injections of 40 or 80 mg may be administered every 10 minutes as needed up to a total dose...
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...Mastering the art Memorizing does not have to be as hard as most people make it. The problem is that most people only know how to memorize by reading the same thing over and over again. * Memorization - The property of permanent terms to be stored in permanent memory and be amenable to retrieval. * How to memorize * Practice Recalling not Repeating * Reading is the way a person gets information from written letters and words. * Speaking from notes- There is a right way and wrong way to use speaking notes when delivering a presentation. The wrong way is to read directly from your notes. The right way is to glance at them throughout your presentation to keep it on track. If you want to use speaking notes, here are a few tips you can use to ensure that you do not end up reading them word for word: * Use speaking notes to capture the outline of your presentation. If you write out everything you want to say, you will likely end up reading it to your audience. * Use speaking notes to capture additional points or points of interest you want to mention. * Put your speaking notes on index cards, instead of full sheets of paper. Index cards are easier to hold (and have less space for notes!). * * Impromptu speaking * without preparation * Made or done without previous preparation: an impromptu address to the unexpected crowds. * Overcome Anxiety and stage fright * The first step in mastering stage fright, and all kinds of...
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...In: Other Topics Mock Code Cardiopulmonary Arrest PNCI - Learner Robert Johnson Age: 60 Weight: 70 kg Base: Stan D. Ardman Patient History Past Medical History: Hypertension well-controlled by medication, hypercholesterolemia and obesity; minor car accident three weeks ago in which he sustained whiplash Allergies: No known drug allergies Medications: Lopressor (metoprolol), Zocor (simvastatin) Code Status: Full Code Social/Family History: Married with two adult children who live locally; Does not smoke, drink or use illicit drugs Handoff Report Situation: The patient is a 60-year-old male in room 425 on the Orthopedic Unit who is recovering from an anterior-posterior interbody fusion of L4 – L5 performed two days ago. His has had an uneventful recovery. He is in his room eating breakfast. Background: Hypertension, hypercholesterolemia and obesity. The hypertension has been well controlled by his medication. He is wearing a soft neck collar for support following a minor car accident three weeks ago in which he sustained whiplash. The patient has no known drug allergies and is awake and alert. Assessment: Vital signs: HR 87, BP 128/62, RR 18, SpO2 has been 98% on room air, Temp 37.1oC Cardiovascular: No telemetry; HR regular Respiratory: Clear in both lung fields GI: Advanced to full liquid diet and tolerating it well GU: Voiding clear, yellow urine Extremities: Pink, warm and with adequate turgor; Movement is strong in all...
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...Beta Blockers After Myocardial Infarction Clinical Scenario The acute care nurse practitioner on the cardiology service treats a 67 year-old-male admitted after recovering from an acute ST-Elevation Myocardial Infarction (STEMI). His risk factors include obesity, Type II diabetes mellitus, and family history. Upon exam the patient asks why he has not been started on a beta blocker yet. He explains further that when his brother had a “heart attack” in 2005, he was immediately placed on a beta blocker because the cardiologist reported how beta blockers reduce mortality after myocardial infarction (MI). The patient wants to know if a beta blocker would reduce his chance of mortality? Using the Patient-Intervention-Comparator-Outcome (PICO) format we formulated the following question. In a 67-year-old male with multiple co-morbidities with MI (P), does treatment with a beta blocker (I), compared with no beta blocker or placebo (O), reduce mortality rate (O)? Risk Factors, Incidence and Prevalence of Disease * US incidence rates of cardiovascular disease, including MI, are seen in men more than women (Alexander et al., 2007). This trend is also true in Utah ("Impact of heart," 2007). * The incidence rates of cardiovascular disease increase with age (Alexander et al., 2007). * Risk factors for cardiovascular disease include not eating enough fruits and vegetables, lack of physical exercise, smoking cigarettes and the co-morbidities of diabetes, hypertension, hyperlipidemia...
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...Lisa Dauenhauer Pharmacology II- NSGD 326 Heather Paulson, MN, RN May 21st, 2013 There is no other organ in the body as magnificent as the heart. It seems interesting that it is also placed at the center of our bodies. Without this amazing muscle made of involuntary striated muscle cells, we would not be able to live. It is a mean machine! It only takes about 20 seconds to circulate the blood through the entire body. An adult heart pumps approximately 2,000 gallons of blood throughout the body. However, there are plenty of other organs in our bodies that we can do without and they do not necessarily sustain our wellbeing. For example, we can live just fine with only one kidney. Also, our spleen, tonsils, appendix and gallbladder can be removed, but that is not the case for our heart. We need its’ life sustaining abilities in order to live. The heart is not only associated with our physical well- being, but it also is strongly linked to our emotional well being as well. “The Greeks believed the heart was the seat of the spirit, the Chinese associated it with the center for happiness and the Egyptians thought the emotions and intellect rose from the heart.” (Condron, 2011). The heart is so much more than just an organ that pumps blood throughout the body. It is a key factor to life. When the heart has issues...
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