Nursing: Question and Answer

Answer

Nursing: Question and Answer

1. Phases of Clinical Trials

There are four phases of clinical trials. Phase I clinical trials are conducted to assess a new biomedical intervention on a small sample of individuals for the first time. The purpose is evaluation of safety. Phase II clinical trials are conducted to examine an intervention in a relatively large sample of individuals to establish efficacy and for supplementary evaluation of its safety. Moreover, Phase III clinical trials are conducted for the purpose of studying the efficacy of a proposed intervention in large sample groups of trial participants through comparison between the intervention and other experimental or standard interventions. These trials track adverse implications and gather data that enables the safe implementation of the intervention. Lastly, Phase IV clinical trials are conducted following the marketing of an intervention. They monitor the intervention’s effectiveness in the overall population and gather data concerning any severe implications related to the extensive use of extended time periods (Australian Government, 2015).

2. Therapeutic Good Administration (TGA)

The main responsibility of the TGA is to ensure that the customers have access to good quality therapeutic goods. Essentially, TGA ensures that therapeutic goods have been adequately manufactured and formulated to specific standards.

There are variable methods that the TGA uses to regulate medications for use in Australia. One such method is “post-market monitoring and enforcement of standards”. Essentially, the TGA has established certain standards to which all medications in Australia must adhere to. It therefore monitors the medications that have already been dispatched into the market to assess their effectiveness or adverse effects on the population and whether they meet the predetermined standards. In relation to this, another method of regulation that TGA uses is: “licensing of Australian manufacturers and verifying overseas manufacturers’ compliance with the same standards as their Australian counterparts” (Australian Government (TGA), 2017). Similarly, TGA ensures that manufacturers consider certain standards while manufacturing medications.

3. Pharmacokinetics and Pharmacodynamics

The current definition of pharmacokinetics is a study of the time course of absorbing, distributing, metabolizing, and excreting drugs. Clinical pharmacokinetics denotes the application of the principles of pharmacokinetics to the effective and safe therapeutic management of drugs on a patient. Notably, the main aim of clinical pharmacokinetics is to enhance efficiency and to decrease toxicity of a patient’s drug therapy. The establishment of solid connections between drug concentrations and the resultant pharmacological responses enables clinicians to implement pharmacokinetic principles in practical patient contexts (Gong et al., 2012).

Pharmacodynamics denotes the correlation between drug concentration at the action site and the resultant implication, inclusive of the intensity and time course of adverse and therapeutic implications. The implication of a drug at the action site is established by binding the drug with a receptor. Notably, receptors may exist in the central nervous systems, on neurons for the purpose of depressing pain sensations or on cardiac muscle to influence the intensity of contraction.

4. Hepatic First Pass Effect

The hepatic first pass effect denotes an occurrence of drug metabolism in which the drug concentration is largely minimized before it arrives at the systematic circulation. It may also be termed as presytemic metabolism or first-pass metabolism. In this context, the hepatic first pass effect refers to the portion of drug that is lost in the absorption process that is usually connected with the gut wall and liver. In essence, when an individual ingests a drug orally, the drug is absorbed into the system of digestion and proceeds to the hepatic portal system. The drug is then transported via the portal vein and into the liver. Notably, this occurs prior to the drug even reaching the rest of an individual’s body. The liver is commonly known to metabolize numerous drugs, such that in numerous circumstances only a small portion of the active drug leavers the liver and reaches the rest of the body. The hepatic first pass effect via the liver considerably minimizes the drug’s bioavailability. The main systems that impact on the hepatic first effects of a drug are: the hepatic enzymes, the bacterial enzymes, the gut wall enzymes, and the enzymes found in the gastrointestinal lumen (Renwick, 2013).

5. Glyceryl Trinitrate 600 Microgram Tablets

The ingredient called gyleceryl trinitrate is commonly known to undergo high first pass metabolism or hepatic first pass effect. Hence, a lot of it is lost during the absorption process. Therefore, when the drug is consumed orally through swallowing, it would not act quickly enough to relieve a patient’s pain when a heart attack is impending. The act of dissolving the tablet under the tongue (sublingual administration) enables the medicine to undergo instantaneous absorption into the bloodstream and relieve a patient’s pain within five minutes (Australian Government & Therapeutic Goods Administration, 2016).

A patient should be advised thoroughly on the medication Glyceryl Trinitrate for effective usage. Firstly, one should be enlightened on the appropriate time for consumption. Usually, the medication is consumed at the first indication of an angima attack (chest pain). Importantly also, the patient should also be education on the proper administration of the medication (Australian Government & Therapeutic Goods Administration, 2016). While man would assume that oral administration via swallowing would suffice, this would be ineffective. 

6. Roles and Responsibilities of the Registered Nurse, Doctor and Pharmacist
7. Registered nurses

Registered nurses have various roles and responsibilities concerning the use of medicines in Australia. They assess the patients’ medical charts to ensure that the medicine being administered aligns with a patient’s condition. They also help patients who are unable to perform self-administration of medicines. Registered nurses supervise the subordinate nurses in the administration of medicines. Notably, nurses undergoing training may be assigned to administer medicines to patients under the supervision of registered nurses. Additionally, they provide they ensure that they administer the right medication to patients as prescribed by the doctors. Lastly, registered nurses administer medication in the proper manner (The Victorian Department of Health, 2014).

Concerning the use of medicines, doctors have a role to prescribe the right medicines for patients’ usage. In addition, they also provide patients with the necessary guidelines concerning the use of the medicines that they have prescribed. This may include information on the time and method of administration. Doctors also coordinate with registered nurses to ensure that the admitted patients who are unable to conduct self-administration receive the right medication on time. Furthermore, doctors develop a medication plan for their patients to avoid disrupting patients’ lives too much. Lastly, doctors inform both patients and nurses concerning the benefits and risks associated with various medications (Morgan et al., 2012).

One role of pharmacists is to supervise or prepare the dispensing of medicines to the right individuals. They also advise patients concerning how to use their medicines in the most effective and safest means. Pharmacists advise health care professionals and the mass public on medicines inclusive of therapeutic implications, prospective side effects, dosage and drug interactions, and appropriate selection. In addition, pharmacists establish legally recognizable standards and advise on government regulations and controls about the supply and production of medicines. Lastly, there are pharmacists who partake in the research and development of medications (Pharmaceutical Society of Australia, 2017).

7. Medication Errors

There are variable types of medication errors. Prescribing errors involve the incorrect selection of a drug on the bases of a patient’s allergies among other indications. This may also involve the wrong rate of admission, concentration, route, quantity, form or dose. The environment is a contributory factor; for example, when a nurse or doctor is overworked (Roughead, Semple, & Rosenfeld, 2013).

Administrations errors are also common and involve the improper administration of medication. For instance, one may administer medication intravenously as opposed to orally. This error may be caused by distraction. For instance, an administering nurse may be distracted and read the prescription wrongly.

There are omission errors which denote a failure to provide a medication dosage before scheduling the next one (Roughead, Semple, & Rosenfeld, 2013). This may be caused by incomplete patient information.

There are wrong time errors whereby a medication is administered outside the established interval from its scheduled time. This may be caused by lack of knowledge of understanding on the part of the healthcare professional.

There are wrong drug preparation errors whereby a medication is incorrectly prepared. This may involve too little or too much dilution in the reconstitution of medication. Systemic problems may be causative agents; e.g. when medications or ingredients are improperly labeled.

9. Person-centered approach and system-centered approach

A person-centered approach to healthcare adopts the position that errors result from human weaknesses in which case certain individuals are more prone to error than others. Therefore, errors can be reduced by determining the difference between humans and subsequently focusing on those who are prone to making errors. Notably, the person-centered approach is a blame-oriented approach (Garfield, 2016).

The system-centered approach attributes errors to systems, in which case humans are a single component. For instance, the humans that cause the most errors may be the ones who have been assigned the most difficult or risky tasks or working in highly unconducive environments. The solution to errors according to the system-centered approach is to address the environmental and task factors as opposed to taking disciplinary actions against the individuals involved.

1. Swiss Cheese Model

The Swiss Cheese Model was developed by James T. Reason and Dante Orlandella in 1990 (Jeffs et al., 2012). Three of its major components are defenses, barriers, and safeguards. From a general perspective, high technology systems comprise several defensive layers such as automatic shutdowns, physical barriers, and alarms. Alternatively, others rely on individuals like control room operators, pilots, anesthetists, and pilots whereas there are those that rely on administrative and procedural controls. The defenses, barriers, and safeguards can prevent the occurrence of a medication error by installing certain measures that control various aspects of the health care system such as tasks and environment to ensure that the humans are better-placed to work efficiently and without making errors. For example, one measure is to provide a conducive working environment whereby doctors and nurses are not overworked to avoid errors resulting from exhaustion. Additionally, the nurses can be given tasks that they are equipped to handle. By avoiding giving nurses advanced tasks, which they are yet to gain knowledge and understanding on, one can avoid the medication error or administration and wrong dosages.

1. Holes in Defense

The holes in these defenses are attributed to latent conditions and active failures.

1. Latent conditions

Latent conditions denote the problems that are intrinsically connected with the system (Jeffs et al., 2012). One example of latent condition is the reduction of the number of pharmacists in a health care facility, which may result in a shortage. Another latent condition is the decision to double the number of working hours for nurses per shift, which may result in overworking and exhaustion. Additionally, a latent condition is the decision to not provide further training to nurses at the facility.

1. Active failures

Active failures are perpetrated by individuals who come into direct contact with the patients (Jeffs et al., 2012). An example of active failure is when a nurse has a memory lapse and forgets to administer a certain antibiotic to a patient. Another example is when a nurse or doctor makes a slip and enters the wrong dosage of medication on a patient’s drug chart. In addition, an active failure occurs when a nurse or pharmacist misreads the name of a drug on a prescription or drug chart and administers a drug with an almost-similar name but not quite.

9. Contributory Factors to Medication Errors

One contributory factor to medication error is distraction. Nurses who administer drugs may be distracted due to personal or professional issues. For instance, one may be unable to focus at work and misread drug titles (Manias, Williams, & Liew, 2012).

 Another contributory factor is the environment. This may be caused by overworking the health care professionals, which may result in their exhaustion and hence, medical errors. There are also environmental causes like improper lighting, cold/heat, and hygiene among others.

Insufficient knowledge or understanding is another contributory factor. This may be caused by poor training in educational institutions or at the health care facility. Nurses may lack absolute knowledge on how drugs function, their names, contraindications, and side effects.

Incomplete patient information is a contributory factor. This may be caused by ignorance on the part of the patient concerning some personal health factors such as allergies to certain medications. A patient may also be unaware of prior diagnoses and the names of current medications (Manias, Williams, & Liew, 2012).

Another contributory factor is incompetence. This may be caused by frequent memory lapses with regards to the professionals. For instance, a nurse may forget a patient’s allergies and administer the wrong medication.