Outpatients

Placement of vascular access ports is similar to that of a long-term indwelling arterial catheter. A small incision is made over the selected vein and a second incision is made lower in the anterior chest to create a pocket to house the port. The catheter is tuimeled subcutaneously from its entry point into the vein with the tip inside the right atrium. The final position of the catheter is verified by fluoroscopy, secured with sutures, and the subcutaneous pocket is closed. The port septum is easily palpable transcutaneously, and the system may be used immediately. A surgeon typically inserts the vascular access port in an outpatient setting. 

In addition to administering the drug, the nurse monitors the therapeutic response (desired response) and reports adverse reactions. In the home setting, the nurse is responsible for teaching the patient and family members the necessary information to administer drugp safely in an outpatient setting. 

Assessments are both initial and ongoing. An initial assessment is made based on objective and subjective data collected when the patient is first seen in a hospital, outpatient clinic, health care provider s office, or other type of health care facility. The initial assessment usually is more thorough and provides a database (sometimes called baseline) from which later data can be compared and decisions made The initial assessment provides information that is analyzed to identify... 

Mr. Garcia is receiving sulfisoxazole for a recurrent bladder infection. When keeping an outpatient dinic appointment, he tells you that he developed a fever and sore throat yesterday. Analyze the steps you would take to investigate his recent problem. Give a reason for your answers. 

After administering penicillin IM in the outpatient setting, the nurse asks the client to wait in the area for at least 30 minutes Anaphylactic reactions are most likely to occur within 30 minutesafter injection. 

After administering penicillin to a patient in an outpatient setting, you request that the patient unit about 30 minutes before leaving. The patient is reluctant to stay, saying that die has a busy schedule. Discuss how you would handle this situation. 

After administering penicillin in an outpatient setting the nurse. ... 

A patient who is a recent immigrant to the United Spates is seen in the outpatient clinic for a severe upper respiratory infection. The primary health care provider prescribes a cephalosporin and asks you to give the patient instructions for taking the drug. You note that the patient appears to underhand very little English. Discuss how you would solve this problem. Determine what information you would include in a teaching plan... 

When taking the drug history of Mr. Woods, a patient in the outpatient clinic, you note that he has been taking... 

Ms. Carson is seen in the outpatient clinic for a severe respiratory infection and is prescribed ciprofloxacin. Discuss what you would include in the teaching plan for this patient. 

To decrease the chance of noncompliance, the nurse emphasizes the following points when any of these drugs are prescribed on an outpatient basis ... 

Depending on the severity of the disease patients may be treated initially in the hospital and then discharged to their home for supervised follow-up care, or they may have all treatment instituted on an outpatient basis. 

These drugp are often given on an outpatient basis. Each time the patient is seen in the clinic or primary health care provider s office, the nurse performs a general physical examination, with particular attention given to the affected areas. 

M ICON AZOLE This drug is self-administered on an outpatient basis. See Fhtient and Family Education for information to give to the patient concerning this drug. 

Patients with massive helminth infections may or may not be acutely ill. The acutely ill patient requires hospitalization, but many individuals with helminth infections can be treated on an outpatient basis. 

Educating the Patient and Family When an anthelmintic is prescribed on an outpatient basis, the nurse gives the patient or a family member complete instructions about taking the drug, as well as household precautions that should be followed until the helminth is eliminated from the intestine The nurse develops a patient education plan to include the following... 

The expected outcomes for the patient may include an optimal response to therapy, management of common adverse reactions, an absence of diarrhea, maintenance of an adequate intake of fluids, maintenance of adequate nutrition, an understanding of the therapeutic regimen (hospitalized patients), and an understanding of and compliance with the prescribed therapeutic regimen (outpatients). 

Educating the Patient and Family The nurse stresses the importance of completing the full course of treatment. The nurse should provide the following information to patients receiving an amebicide on an outpatient basis ... 

On a visit to an outpatient clinic, Ms. Cain tells you that die takes aspirin daily for the minor aches and pains die experiences. Determine what you might want to discuss with Ms. Cam to explore her use of this drug. Discuss what you might incorporate into the teaching plan to increase her knowledge of the drug and to prevent any complications. 

Maintenance therapy is designed to reduce the patient s desire to return to the drug that caused addiction, as well as to prevent withdrawal symptoms. The dosses used vary with the patient, die length of time die individual has been addicted, and the averse amount of drug used each day. Fhtients enrolled in an outpatient methadone program for detoxification or maintenance therapy on methadone must continue to receive methadone when hospitalized. 

Each time the patient visits the outpatient clinic, the nurse evaluates the patient s response to therapy and looks for any signs that drug dependency might again be a problem. 

Ms. Martin has been prescribed propranolol (Inderal) for hypertension. She arrives at the outpatient dinic and tellsyou that she is having episodes of dizziness and at times feels as if she is going to faint. Discuss how you would investigate this problem and what information you could give Ms. Martin that might help her. 

Mr. Johnson, age 78 years, has glaucoma and is prescribed the pilocarpine ocular system. On a visit to the outpatient clinic, Mr. Johnson tells you that he is having problems retaining the ocular system. You notice that his right eye is very red and inflamed. Determine how you can investigate this problem further with Mr. Johnson. Provide suggestions that will help Mr. Johnson to retain the system. 

When a cholinergic blocking drug is prescribed for outpatient use, die nurse informs die patient about die more common adverse reactions associated with tiiese drugp, such as dry mouth, drowsiness, dizziness, and... 

ANOREXIANTS When an anorexiant or amphetamine is used as part of the treatment of obesity, the drug is usually prescribed for outpatient use The nurse obtains and records the blood pressure, pulse, respiratory rate, and weight before therapy is started. 

W EIGHT LOSS. When an amphetamine or anorexiant is prescribed for obesity, the nurse obtains the patient s weight and vital signs at the time of each outpatient visit. 

Seizures that occur in the outpatient setting are almost always seen first by family members or friends, rather than by a member of the medical profession. The occurrence of abnormal behavior patterns or convulsive movements usually prompts the patient to visit the primary health care provider s office or a neurologic clinic. A thorough patient history is necessary to identify the type of seizure disorder. Information the nurse should obtain from those who have observed the seizure is listed in Display 28-1. 

A patient receiving an antianxiety drug may be treated in the hospital or in an outpatient setting. Before starting therapy for the hospitalized patient, the nurse obtains a complete medical history, including mental status and anxiety level. In the case of mild anxiety, patients may (but sometimes may not) give a reliable history of their illness. 

In addition, if possible, die nurse obtains a history of any past drug or alcohol abuse. Individuals with a history of previous abuse are more likely to abuse odier drug s, such as the antianxiety drug s. Some patients, such as diose with mild anxiety or depression, do not necessarily require inpatient care. These patients are usually seen at periodic intervals in die primary health care provider s office or in a psychiatric outpatient setting. The preadministration assessments of the outpatient are the same as diose for the hospitalized patient. 

When the patient is an outpatient, the nurse observes the patient for a response to therapy at the time of each clinic visit. In some instances, the nurse may question the patient or a family member about die response to therapy. The type of questions asked depends on the patient and die diagnosis and may include questions such as How are you feeling, Do you seem to be less nervous, or Would you like to tell me how everything is going Many times the nurse may need to rephrase questions or direct the conversation toward other subjects until these patients feel comfortable and are able to discuss their dierapy. 

A patient is prescribed buspirone 5 mg PO TID to be taken on an outpatient basis. What assessments would be important for the nurse to make when the patient comes to the clinic for a visit ... 

The preadministration assessments of the outpatient are basically die same as diose for the hospitalized patient. The nurse obtains a complete medical history and a history of die symptoms of the depression from die patient, a family member, or die patient s hospital records. During die initial interview, die nurse observes die patient for symptoms of depression and die potential for suicide The initial physical assessment also should include the patient s vital signs and weight. 

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