Primary health care

Occupational health advice as part of primary health care nursing The fracture behaviour of polyethylene - A literature review First aid retention of knowledge survey... 

Prescriptions for controlled substances must be written in ink and include the name and address of the patient and the Drug Enforcement Agency number of the primary health care provider. Prescriptions for these drugs cannot be filled more than 6 months after the prescription... 

Fhtients with liver or kidney disease are usually given dragp with caution because a cumulative effect may occur. When the patient is unable to excrete the drug at a normal rate the drug accumulates in the body, causing atoxic reaction. Sometimes, the primary health care provider lowers the dose of the drug to prevent a toxic drug reaction. 

Nurses must carefully monitor the patient s blood levels of drugs to ensure that they remain within the therapeutic range Any deviation should be reported to the primary health care provider. Because some dragp can cause toxic reactions even in recommended doses, the nurse should be aware of the signs and symptoms of toxicity of commonly prescribed drugs. 

Certain factors may influence drug response and are considered when the primary health care provider prescribes and the nurse administers a drug. These factors include age, weight, gender, disease, and route of administration. 

In liver disease, for example, the ability to metabolize or detoxify a specific type of drug may be impaired. If the average or normal dose of the drug is given, the liver may be unable to metabolize the drug at a normal rate Consequently, the drug may be excreted from the body at a much slower rate than normal. The primary health care provider may then decide to prescribe a lower dose and lengthen the time between doses because liver function is abnormal. 

Drug reactions are potentially serious. The nurse should observe all patients for adverse drug reactions, drug idiosyncrasy, and evidence of drug tolerance (when applicable). It is important to report all drug reactions or any unusual drug effect to the primary health care provider. 

The nurse must use judgment about when adverse drug reactions are reported to the primary health care provider. Accurate observation and evaluation of the circumstances are essential the nurse should record all observations in the patient s record. If there is any question regarding the events that are occurring, the nurse can withhold the drug but must contact the primary health care provider. 

Inform your primary health care provider of any natural produds that you take (eg, herbs, vitamins, minerals, teas, etc.). Gertain herbs can interad with the medications that you take, causing serious adverse readions or toxic effeds. 

Jnny Davis, age 25, is pregnant. Jenny s primary health care provider tells her that she may not take any medication without first checking with the health care provider during the pregnancy. Jnny is puzzled and questions you about this. Discuss how you would address Jnny s concerns. 

Before a medication can be administered in a hospital or other agency the nurse must have a physician s order. Medications are ordered by the primary health care provider such as a physician, dentist, or in some cases a nurse practitioner. 

Always check die health care provider s written orders and verify any questions witii die primary health care provider. 

To evaluate die patient s response to tiierapy, and depending on die drug administered, die nurse may check die patient s blood pressure every hour, inquire whether pain has been relieved, or monitor die pulse every 15 minutes. After evaluation, certain otiier decisions may need to be made and plans of action implemented. For example, die nurse may need to notify die primary health care provider of a marked change in a patient s pulse and respiratory rate after a drug was administered, or die nurse may need to change die bed linen because sweating occurred after a drug used to lower die patient s elevated temperature was administered. 

Mr. Hatfield, age 69 years, confides to you that he is not taking the drug prescribed by his primary health care provider. He dates he took the drug for a while and then quit. Explain some possible reasons Mr. Hatfield could have for not taking his drug. Discuss questions you could ask to assess the reason for Mr. Hatfield s noncompliance. 

Adverse reactions to report to the nurse or primary health care provider... 

Capsules or tablets should be taken with water unless the primary health care provider or pharmacist directs otherwise (eg, take with food, milk, or an antacid). Some liquids, such as coffee, tea, fruit juice, and carbonated beverages, may interfere with the action of certain drags. 

The dose of a drug or the time interval between doses is never increased or decreased unless directed by the primary health care provider. 

A prescription drug or nonprescription drug recommended by a primary health care provider is not stopped or omitted except on the advice of the primary health care provider. 

If the symptoms for which a drug was prescribed do not improve, or become worse, the primary health care provider must be contacted as soon as possible because a change in dosage or a different drug may be necessary. 

Check prescriptions carefully when obtaining refills from die pharmacy and report any changes in die prescription (eg, changes in color, size, shape) to the pharmacist or primary health care provider before taking die drug because an error may have occurred. 

Adverse effects are always reported to the primary health care provider as soon as possible ... 

In some instances, especially when an ointment or liquid drug is prescribed, some drug may remain after it is used or taken for the prescribed time. Some drag have a short life (a few weeks to a few months) and may deteriorate or change chemically after a time. A prescription must never be saved for later use unless the primary health care provider so advises. 

When administering a sulfonamide for a bum, the nurse inspects Hie burned areas every 1 to 2 hours because some treatment regimens require keeping the affected areas covered witii Hie mafenide or silver sulfadiazine ointment at all times. Any adverse reactions should be reported immediately to Hie primary health care provider. 

StevensJohnson syndrome isa serious and sometimes fatal hypetsenslivity reaction. The nurse must be alert for lesions on the skin and mucous membranes , a diagnostically important symptom of this syndrome. The lesons appear as red wheats or blisters , often starting on the face, in the mouth, or on the lips neck, and extremities This syndrome, which also may occur with the administration of other types of drugs can be fatal. The nurse must notify the primary health care provider and withhold the next dose of the drug. In addition, the nurse must exercise care to prevent injury to the involved areas... 

Maintaining Adequate Fluid Intake and Output Because one adverse reaction of the sulfonamide dragp is altered elimination patterns, it is important that the nurse helps the patient maintain adequate fluid intake and output. The nurse can encourage patients to increase fluid intake to 2000 mL or more a day to prevent crystal-luria and stone formation in the genitourinary tract, as well as to aid in the removal of microorganisms from the urinary tract. It is important to measure and record the intake and output every 8 hours and notify the primary health care provider if the urinary output decreases or the patient fails to increase his or her oral intake... 

Take the drug with a full glass of water. Do not increase or decrease the time between doses unless directed to do so by the primary health care provider. 

Notify the primary health care provider immediately if the following should occur fever, skin rash or other skin problems, nausea, vomiting, unusual bleeding or bruising, sore throat, or extreme fatigue. 

The primary health care provider prescribed sulfasalazine oral suspension 500 mg every 8 hours. The nurse has sulfasalazine oral suspension 250 mg 5 mL on hand. What dosage would the nurse give ... 

After a culture and sensitivity report is received, the strain of microorganisms causing the infection is known, and the antibiotic to which these microorganisms are sensitive and resistant is identified. The primary health care provider then selects the antibiotic to which the microorganism is sensitive because that is the antibiotic that will be effective in the treatment of the infection. 

The nurse should observe the patient closely for a hypersensitivity reaction, which may occur any time during therapy with the penicillins If it should occur, it is important to contact the primary health care provider immediately and withhold the drug until the patient is seen by the primary health care provider. 

The nurse evaluates the patient daily for a response to therapy, such as a decrease in temperature, the relief of symptoms caused by the infection (such as pain or discomfort), an increase in appetite, and a change in the appearance or amount of drainage (when originally present). Once an infection is controlled, patients often look better and even state that they feel better. It is important to record these evaluations on the patient s chart. The nurse notifies the primary health care provider if signs and symptoms of the infection appear to worsen. 

Promoting Optimal Response to Therapy The results of a culture and sensitivity test take several days because time must be allowed for the bacteria to grow on the culture media However, infections are treated as soon as possible In a few instances, the primary health care provider may determine that a penicillin is the treatment of choice until the results of the culture and sensitivity tests are known. In many instances, the primary health care provider selects a broad-spectrum antibiotic (ie, an antibiotic that is effective against many types or strains of bacteria) for initial treatment because of the many penicillin-resistant strains of microorganisms. 

When administering penicillin IM, the nurse warns the patient that there may be a stinging or burning sensation at tiie time the drug is injected into the muscle. Discomfort at the time of injection occurs because the drug is irritating to the tissues. The nurse inspects previous areas used for injection for continued redness, soreness, or other problems. It is important to inform the primary health care provider if previously used areas for injection appear red or the patient reports pain in the area... 

---