The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [516]
a If the patient has a recent history of falls.
b If the patient has a history of dizziness or syncope on changing position.
c If the patient has a history of hypertension.
d If the patient has a history of hypotension.
5 What do the adverse effects of hypotension include?
a Decreased conscious level, reduced blood flow to vital organs and renal failure.
b The patient could become confused and not know who they are.
c Decreased conscious level, oliguria and reduced coronary blood flow.
d The patient feeling very cold.
6 What are the contraindications for the use of the blood glucose meter for blood glucose monitoring?
a The patient has a needle phobia and prefers to have a urinalysis.
b If the patient is in a critical care setting, staff will send venous samples to the laboratory for verification of blood glucose level.
c If the machine hasn’t been calibrated.
d If peripheral circulation is impaired, collection of capillary blood is not advised as the results might not be a true reflection of the physiological blood glucose level.
7You are caring for a patient who has had a recent head injury and you have been asked to carry out neurological observations every 15 minutes. You assess and find that his pupils are unequal and one is not reactive to light. You are no longer able to rouse him. What are your actions?
a Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS) and document clearly.
b This is a medical emergency. Basic airway, breathing and circulation should be attended to urgently and senior help should be sought.
c Refer to the neurology team.
ad Break down the patient’s Glasgow Coma Scale as follows: best verbal response V = XX, best motor response M = XX and eye opening E = XX. Use this when you hand over.
8What is the most accurate method of calculating a respiratory rate?
a Counting the number of respiratory cycles in 15 seconds and multiplying by 4.
b Counting the number of respiratory cycles in 1 minute. One cycle is equal to the complete rise and fall of the patient’s chest.
c Not telling the patient as this may make them conscious of their breathing pattern and influence the accuracy of the rate.
d Placing your hand on the patient’s chest and counting the number of respiratory cycles in 30 seconds and multiplying by 2.
9You are caring for a 17yearold woman who has been admitted with acute exacerbation of asthma. Her peak flow readings are deteriorating and she is becoming wheezy. What would you do?
a Sit her upright, listen to her chest and refer to the chest physiotherapist.
b Suggest that the patient takes her Ventolin inhaler and continue to monitor the patient.
c Undertake a full set of observations to include oxygen saturations and respiratory rate. Administer humidified oxygen, bronchodilators, corticosteroids and antimicrobial therapy as prescribed.
d Reassure the patient: you know from reading her notes that stress and anxiety often trigger her asthma.
Answers to the multiple choice questions can be found in Appendix 3.
These multiple choice questions are also available for you to complete online.
Visit www.royalmarsdenmanual.com and select the Student Edition tab.
Part four
Supporting the patient through treatment
13 Medicines management
14 Perioperative care
15 Wound management
Chapter 13
Medicines management
Overview
This chapter will provide an overview of medicine management and the main routes of administration such as oral and injections. Other routes such as inhalation, topical and vaginal will also be discussed.
Medicines management
Definitions
Medicines management can be defined as the way medicines are selected, procured, delivered, prescribed, administered and reviewed to optimize the contributions that medicines make to producing informed and desired outcomes of patient care (Audit Commission 2001). The Medicines and Healthcare Products Regulatory Agency (MHRA 2004) defines it as the clinical, cost-effective and safe use of medicines