Primary care

It is important to question any order that is unclear. This includes unclear directions for the administration of the drug, illegible handwriting on the primary care provider s order sheet, or a drug dose that is higher or lower than the dosages given in approved references. 

Comments stating tiiat the drug looks different from die one previously received, tiiat the drug was just given by another nurse, or tiiat the patient thought tiie primary care provider discontinued die drug therapy. 

Parenteral drug administration means the giving of a drug by the subcutaneous (SC), intramuscular (IM), intravenous (IV), or intradermal route (Fig. 2-5). Other routes of parenteral administration that may be used by the primary care provider are intralesional (into a lesion), intra-arterial (into an artery), intracardiac (into the heart), and intra-articular (into a joint), hi some instances, intra-arterial dragp are administered by a nurse. However, administration is not by direct arterial injection but by means of a catheter that has been placed in an artery. 

The primary care provider may administer a drug by the intracardial, intralesional, intra-arterial, or intra-articular routes. The nurse may be responsible for preparing the drug for administration. The nurse should ask the primary care provider what special materials will be required for administration. 

The primary care provider may write special instrucfions for Hie applicafion of a topical drug. For example, to apply Hie drug in aHiin, even layer or to cover Hie area after applicafion of Hie drug to Hie skin. 

Observing the adverse reactions. The frequency of these observations will depend on die drug administered. The nurse must record all suspected adverse reactions and report them to die primary care provider. The nurse must immediately report serious adverse reactions to the primary care provider. 

Ms. Watson has diabetes and is taking tolbutamide (Orinase). Her primary care provider prescribes the combination drug sulfamethoxazole and trimethoprim (Septra) for a bladder infection. Discuss any instructions information you would give to Ms. Watson in the patient education session... 

The primary care provider orders 500 mg of Augmentin oral suspension. Read the label below to answer die following questions ... 

HYPERTHERMIA. The nurse monitors the temperature at frequent intervals, usually every 4 hours unless the patient has an elevated temperature. When the patient has an elevated temperature the nurse checks the temperature, pulse, and respirations every hour until the temperature returns to normal and administers an antipyretic if prescribed by the primary care provider. 

The primary care provider has prescribed fluconazole 200 mg PO initially, followed by 100 mg PO daily. On hand are fluconazole 100-mg tablets. What would tiie nurse administer as tiie initial dose ... 

The nurse reports to the primary care provider any adverse reactions, such as unusual or prolonged bleeding or dark stools. 

The nurse checks the color of the stools. Black or dark stools or bright red blood in the stool may indicate gastrointestinal bleeding. The nurse reports to the primary care provider any change in the color of the stool. 

MTX is potentially toxic. Therefore, the nurse observes closely for development of adverse reactions, such as thrombocytopenia (see Nursing Alert in Gold Compounds section) and leukopenia (see discussion of adverse reactions associated with hydroxychloroquine). Hematology, liver, and renal function studies are monitored every 1 to 3 months with MTX therapy. The primary care provider is notified of abnormal hematology, liver function, or kidney function finding. The nurse immediately brings all adverse reactions or suspected adverse reactions to the attention of the primary health care provider. 

Do not stop taking the drug abruptly, except on the advice of the primary care provider. Most of these drugp require that the dosage be gradually decreased to prevent precipitation or worsening of adverse effects. 

Do not use any nonprescription drug (eg, cold or flu preparations or nasal decongestants) unless use of a specific drug has been approved by the primary care provider. 

Inform dentists and other primary care providers of therapy with this drug. 

Keep all primary care provider appointments because close monitoring of therapy is essential. 

In addition, when an adrenergic blocking drug is prescribed for hypertension, the primary care provider may want the patient to monitor his or her own blood pressure between office visits. This may enable the number of visits to the primary care provider office to be reduced and will help the patient learn to manage his or her own health (see Fhtient and Family Teaching Checklist Monitoring Blood Pressure). 

The primary care provider allows the patient to keep pilocarpine eye drops at the bedside and to self-administer the eye drops 4 times daily. The nurse... 

The dosage of neostigmine is 0.022 mg/kg. Wliat dosage would the nurse expect the primary care provider to prescribe for a patient who weighs 150 pounds ... 

The primary care provider prescribes 2.5 mg of betiianechol subcutaneously. The drug is available in a solution of 5 mg/mL. The nurse administers... 

A. consider this to be unusual and contact the primary care provider... 

Notify the primary care provider if the following reactions occur visual disturbances, excessive drowsiness or dizziness, sore throat, fever, skin rash, pregnancy, malaise, easy bruising, epistaxis, or bleeding tendencies. 

Fhtients with diabetes Levodopa may interfere witii urine tests for glucose or ketones. Report any abnormal result to the primary care provider before adjusting the dosage of die antidiabetic medication. 

Tolcapone Keep all appointments with the primary care provider. Laver function tests are performed... 

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