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Parenteral Therapies
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Lesson 6-A: Parenteral Therapies
Lesson 6-B: Medications
From NCSBN site created by Galyna P.
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Lesson 6-A: Parenteral Therapies
Drug/Medication Safety
,Drug/Medication Safety
Medication Administration
Two major goals of medication administration are to prevent or limit adverse drug
events (ADEs) and to recognize dangerous side effects.
ADEs and side effects of a drug are not the same thing. An ADE is an unexpected
pharmacologic effect that occurs despite correct dosing and correct administration of
a medication.
A side effect is a secondary, unintended effect of drug therapy that was discovered
in the clinical trials for the drug and is disclosed within drug packaging. Unlike ADEs,
side effects can be foreseen. The nurse will educate or reinforce education for the
client about the most common side effects of the client's prescribed medication(s).
Allergic and anaphylactic reactions are severe and potentially life-threatening side
effects that the nurse must monitor the client for, especially with medications the
client is receiving for the first time. Other examples of potentially fatal drug reactions
are toxic epidermal necrolysis
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are
severe cutaneous hypersensitivity reactions. Drugs, especially sulfa drugs,
anti-epileptics and antibiotics, are the most common causes.
SJS and TEN are clinically similar except for their distribution. By one commonly
accepted definition, changes affect less than 10% of the body surface area in SJS
and more than 30% of body surface area in TEN.
, Within 1 to 3 weeks after the start of the offending drug, clients develop a prodrome
of malaise, fever, headache, cough and keratoconjunctivitis. Then macules appear
suddenly, often in a target configuration, usually on the face, neck and upper trunk.
These macules simultaneously appear elsewhere on the body, coalesce into large
flaccid bullae and slough over a period of 1 to 3 days. Nails and eyebrows may be
lost along with epithelium. The palms and soles may be involved. Skin, mucosal and
eye pain are common. In some cases, diffuse erythema is the first skin abnormality
of toxic epidermal necrolysis.
In severe cases of toxic epidermal necrolysis, large sheets of epithelium slide off the
entire body at pressure points (Nikolsky sign), exposing weepy, painful and
erythematous skin. Painful oral crusts and erosions, keratoconjunctivitis and genital
problems (e.g., urethritis, phimosis) accompany skin sloughing in up to 90% of
cases. Bronchial epithelium may also slough, causing cough and dyspnea.
(TEN) and Stevens-Johnson Syndrome
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe
cutaneous hypersensitivity reactions. Drugs, especially sulfa drugs, anti-epileptics
and antibiotics, are the most common causes.
SJS and TEN are clinically similar except for their distribution. By one commonly
accepted definition, changes affect less than 10% of the body surface area in SJS
and more than 30% of body surface area in TEN.
Within 1 to 3 weeks after the start of the offending drug, clients develop a prodrome
of malaise, fever, headache, cough and keratoconjunctivitis. Then macules appear
suddenly, often in a target configuration, usually on the face, neck and upper trunk.
These macules simultaneously appear elsewhere on the body, coalesce into large
flaccid bullae and slough over a period of 1 to 3 days. Nails and eyebrows may be
lost along with epithelium. The palms and soles may be involved. Skin, mucosal and
eye pain are common. In some cases, diffuse erythema is the first skin abnormality
of toxic epidermal necrolysis.
In severe cases of toxic epidermal necrolysis, large sheets of epithelium slide off the
entire body at pressure points (Nikolsky sign), exposing weepy, painful and
erythematous skin. Painful oral crusts and erosions, keratoconjunctivitis and genital
problems (e.g., urethritis, phimosis) accompany skin sloughing in up to 90% of
cases. Bronchial epithelium may also slough, causing cough and dyspnea.
(SJS).
The U.S.
Food and Drug Administration (FDA) is responsible for protecting the American
public by approving, regulating and monitoring all drugs, vaccines and other
biological products used to treat and/or prevent human diseases and medical
conditions.
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