One day in my placement in saad hospital in surgical male unit my preceptor that day wants to prepare the patient’s medication. So I went with her to learn and help. She told me that ,the preparation of medication is very important process must done accurately ,and you must always follow The five Rights when you prepare any drugs ,which it is 1-the right medication,2- the right dosage 3- the right patient ,4-the right rout ,5- the right time, and important thing to check the expiry date of the medication .
Then we check the doctor’s order ,we collect the medication in its tray, then we start one by one check its name ,the dosage, the patient name the route and the time from the MAR( medication administration record) . Also she told me one of SSH polices is that: tow nurses should sharing in papering of one patient’s medication, to make sure there is nothing missing and prevent the mistakes . I like that way in medication preparation and SSH polices, and keep it in my mind.
So when we finch we went to the patient’s room to assist him before token his medication and see if he had his breakfast or not, also I bring the dianamap machine to took his vital signs. MR. R was a76 year’s old man with history of al zheiymers, hypertension, chronic renal failure and diabetes, with right hand dressing because it was infected. He was not in private room so his room was too small also many things were not in its places. When we came he was just waking up and his breakfast was beside the chair. So Because al zheiymers Mr.
H wasn’t like any normal person, he was not talk too much just a little words and when he should to eat, his son was assist him, and most of the time he was do strange sound, but I felt he is can understand what we talk about and what we wont to do for him. After that we make the room tidy and organized ,then told him to start his breakfast to give him his medication. At 9:30 am his son came and we told him what we had told his father, in addition my preceptor told me to inform them that Mr. R has appointment in the dialysis today at 11 o’clock.
So all the time I was translate to him what she say because they were just speak Arabic . then we left the son with his father to feed him .
after about half an hour we came again with the tray of the medication and the MAR, then again we remember him about the appointment of the dialysis and my preceptor explain to them she will start give the medication ,but the sun was not look agree and ask why now not after the dialysis ,in that time my preceptor stop and keep listen to what he said, the son continue saying my father had 5 years go to the dialysis and never he was took his medication before the dialysis just after, so direct I translate all what he said to my preceptor, then she stopped to thinking for seconds ,then she collect the medication and does not give any things to the patient ,and told us that, she will ask the doctor first when she should give the medication , I told the son we will not give his father anything until we asking the doctor.
Then we left the room, return the medication to its place, then my preceptor took the phone to call the doctor, and asking him that the patient will go to the dialysis after one hour when it is better to give him his medication now or after dialysis? The doctor replace by no after the dialysis. So she thanks the doctor and ends the call. after that I go back to the patient room and told them what the doctor said . So this situation let me thinking why it is better to administrate the medication after the dialysis in chronic renal failure patient why not before ??
What the different will be? I was thinking in many reasons , first one came in my mind is that, may if the drug given, then the patient blood washed , so the drug will removed ,then it will not be effective due to, the drug not reach its onset time(time when drug start show affect ),because the less time contact of the drug , or because the less bioavailability as I studied in the pharmacology…I was not sure and I need to evidence so I asked my preceptor ,but she also was not sure from the reasons .
After that when I went home I do some recherche in books to answering my question and that what I found : – Just as many medication are excreted wholly or in part by the kidney many medication are removed from the blood during hemo- dialysis; therefore, the physician may need to adjust the dosage. – Metabolites of drugs that are bound to protein are not removed during dialysis.
– The patient should know when not to take to the medication for example, if an antihypertensive agent is take on the dialysis day ,a hypotensive affect may occur during dialysis, causing dangerously low blood pressure. – Many medication that are taken once daily can be held until after the dialysis treatment. So the doctor did the right decision, and my preceptor also she did the right when she ask the doctor before give the medication which can harm the patient if it is given or affects at his attitude toward dialysis.
So on reflection in this situation I learnt many things about medication administration and how I should be careful when dealing with any medications and always follow the 5rights, and never do something I’m not sure if it’s right or not, I can ask and also save patient’s health and life. Refrences: Smeltzer. s,Bare. B,Hinkle. J,Cheerer. K (2010) Brunner and sudderth’s text book of medical- surgical nursing (12th edition). new York: lippcott Rains. D (2007) the quick study for nursing (1st Edition) thailand: BarCharts, inc.