Given the increase in various drug-resistant organisms and in patients who are allergic to penicillin, perioperative nurses are likely to encounter patients who are receiving IV vancomycin, a tricyclic glycopeptide antibiotic. In general, vancomycin is not considered a first-line agent because of its possible adverse effects (e.g., hypotension, phlebitis, nephrotoxicity, ototoxicity); therefore, it is reserved for treating serious or severe infections caused by organisms that are unresponsive to other antimicrobial agents. Vancomycin is administered intravenously over a minimum of 60 minutes to avoid infusion-related reactions. Some considerations for nurses administering vancomycin include ensuring a patent IV line, planning for administration of the preoperative dose as much as two hours before the initial incision is made, and including information about the dose and timing of preoperative vancomycin administration in the surgical time out.
Background and purpose
The purpose of this study was to characterize the meaning nurse practitioners (NPs) ascribed to personal experiences providing care to older adults who take multiple medications to manage complex conditions. The study illuminated the NP experience in caring for the older adult while addressing the complexities of medication management through narrative stories in practice.
Methods
NPs self‐identifying as caring for older adults were interviewed (N=15). Narrative inquiry and the three‐dimensional narrative inquiry space were used to guide the researcher during data collection and analysis.
Conclusions
Three common themes emerged from the narratives. These themes illuminated the complexities NPs face in managing patients with multiple comorbidities, taking multiple medications, and seeing multiple providers. Identified themes were “mastering the art of the puzzle,” “it takes a village,” and “power in knowledge.” Tools to assist NPs identify and manage polypharmacy were identified including the 2015 updated Beers Criteria, ARMOR (Assess, Review, Minimize, Optimize, and Reassess), STOPP (screening tool of older people's potentially inappropriate prescriptions), and START (screening tool to alert providers to the right treatment) tools.
Purpose: To provide nurse practitioners (NPs) with an overview of prehypertension identification and management. Additionally, the article serves to highlight the prevalence and impact of prehypertension in the United States.
Results of current research into perioperative medication errors have revealed that more than half of medication errors occur during the administration phase of the medication-use process. The administration phase is the point at which the medication and the patient intersect and the medication imposes its pharmacological effect. During this phase, the only safety net between the patient and the medication is the health care provider's attention and care when administering the medication. To help mitigate these errors, perioperative nurses must understand pharmacotherapeutics: the use of medications to prevent, treat, cure, or alleviate symptoms of disease. Pharmacotherapeutics incorporates pharmacokinetics (ie, what the body does to a medication after it enters the system) and pharmacodynamics (ie, how a medication acts on the body to achieve a desired therapeutic effect).
Patient-controlled analgesia (PCA) is an effective treatment option for reducing pain, but PCA errors can be quite serious. Opioid analgesics are among the most effective pain relievers available, but all have contraindications and can have adverse effects, including respiratory depression and other effects on the central nervous system. Practitioners must weigh the potential benefits of PCA use against the risks. Errors associated with the PCA process have been documented in each phase of the medication-use process; therefore, practice improvements in prescribing, transcribing, dispensing, administering, and monitoring PCA may reduce the likelihood of errors. Perioperative nurses can make important contributions to safe PCA use by establishing standardized processes to help ensure positive patient outcomes in pain management.
The first convenient care clinics opened in the United States in 2000. Twenty years later, with more than 2,700 locations in 44 states, convenient care has logged more than 40 million patient visits, most of them by family nurse practitioners (FNPs). 1 Few would argue that health care in the United States is in need of innovation, and innovation always brings controversy, opposition, and doubt before it achieves broad acceptance. The numbers alone argue that convenient care is meeting a need that had been unmet previously. The question of drawing a line between urgent/acute care and chronic disease management and suggesting that the latter should take place elsewhere, to my mind, is the wrong question. These are NPs we are talking about. How many NPs would ignore a chronic condition in a patient they happened to be seeing for another problem? When an innovation that is working is criticized, it begs a few questions: How many of those 40 million visits could have been absorbed by already overburdened "traditional" health care resources? How many of those patients would instead have gone without care? How many went to a convenient clinic because they prefer seeing an NP? But are convenient care centers set up to dealing with chronic problems?
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