New York City schools offer many health services to support student health. School physicians and nurses conduct physical exams and help manage the health of students with health issues like asthma, allergies and diabetes. Students with health issues and disabilities can receive prescribed medicine, skilled nursing treatments and Accommodations in school.

Office of School Health nurses and physicians are dedicated to improving the health of New York City students. Click below to read the services each can offer your child:. Ninety percent of all New York City public schools have school nurses. Our school nurses are actively involved in school health programs. School nurses:. Our school physicians are board-certified or board-eligible physicians. They provide care in a select number of public and private schools in New York City. School physicians:.

Help your child feel healthier and more comfortable during the school day. If your child has a health condition, they may benefit from taking prescribed medicine at school or a skilled nursing treatment. Ask if taking medicine at school or a skilled nursing treatment would help your child better manage his health condition.

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Applying for your child to take medicine at school or getting a skilled nursing treatment is easy:. We offer three different levels of supervision while your child is taking medicine. Your child will be assisted by a trained adult. For example, if your child asks, the staff member may help open bottles, pour liquid or assemble a nebulizer.

Your child will give themselves medicine without any help. For rescue medicines, like those needed for asthma, diabetes, and allergies, your child will carry the medicine with them during the school day. This option is best for students who can consistently take their medicine correctly on their own.

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Controlled substances must be kept in the school medical room. Large school buildings have additional units installed throughout the building. High school coaches are required to take portable AEDs to all games and practices. While these are accepted on a rolling basis, we recommend submitting them by May That way your child will have no break in access to their medication. If your child has asthma, your school will provide free Flovent and Albuterol.Colleague's E-mail is Invalid.

Your message has been successfully sent to your colleague. Save my selection. The author has disclosed that she has no financial relationships related to this article.

a nurse is reviewing the medication administration record of a

The process of medication delivery includes several components: prescribing, transcribing, dispensing, administering, and monitoring. One-third of all medication errors occur during the administration phase of medication delivery.

Nurses need to recognize the challenges they face when administering medications to their patients. Because nurses consistently administer medications, they're well positioned to prevent medication errors. This article defines medication errors and near-miss events, explores human and environmental factors contributing to medication administration errors, and discusses the nurse's role in minimizing errors.

Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.

Intercepting a medication error before it reaches the patient is an example of a near-miss event. Often nurses aren't aware that a medication error or near-miss event has occurred. This contributes to the inability to change key aspects of a complex medication delivery system.

Medication administration errors are the subject of much research. Medication administration errors are underestimated and underreported. Explanations for underreporting include a lack of awareness that a medication error has occurred, unfamiliarity with medication administration error reporting processes, fear of legal ramifications, and fear of being perceived as incompetent.

About half of nurses are reticent about reporting medication errors because they fear disciplinary action. A stigma is associated with making an error, and nurses perceive they'll be a target for repercussions if they admit to making a mistake. For instance, the error could have a negative impact on the nurse's performance evaluation. Decades ago, Leape recognized this paradox in healthcare: The standard of practice in medicine and nursing is perfection—even though medical professionals acknowledge that mistakes are inevitable and most want to learn from these mistakes, ideally in an understanding and supportive environment.

Reason used a Swiss cheese model to represent accident causation and illustrate how an error can slip through despite overlapping system defenses and safeguards.

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However, safety gaps exist, and when gaps line up, errors occur. Unless a pattern of errors or evidence of reckless behavior occurs, a single event shouldn't warrant disciplinary action or termination. In order for nurses to learn from their mistakes, they must be willing to disclose them; this in turn improves practice and ensures a safer patient care environment.

Furthermore, not reporting errors sets up other nurses to make errors and fails to improve the system.John Smith. Forgot your password?

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Speak now. Login Sign Up Free. Quiz Maker All Products. Discuss Medical Disease Gastrointestinal Disease. The nurse is reviewing the medication record of a female client with acute gastritis. Digoxin Lanoxin B.

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Furosemide Lasix C. Indomethacin Indocin D. Propranolol hydrochloride Inderal. Asked by RN pediaLast updated: Oct 05, Post Your Answer. John Smith Answered Apr 25, Indomethacin Indocin Indomethacin Indocin is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine.

Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide Lasix is a loop diuretic. Digoxin is a cardiac medication. Propranolol Inderal is a -adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.

Write Your Answer. More Gastrointestinal Disease Questions What are the symptoms and causes of esophageal varices? What should the nurse do when the client requires enteric precautions?

A female client with viral hepatitis A What would the nurse observe for when evaluating a male client for complications of acute pancreatitis? What is the appropriate nursing action? The nurse is performing a colostomy irrigation on a male client What instruction does the nurse, who is providing discharge instructions to a male client following Which diagnostic test would be used first to evaluate a client with upper GI bleeding?

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Which condition is most likely to have a nursing diagnosis of fluid volume deficit? Which option does best fit here? A female client with hepatitis C develops liver failure and GI hemorrhageA patient looks up the drug he is taking in a drug guide. The patient asks the nurse why the physician prescribed a medication that has a lethal dose measure.

What is the best response by the nurse? It just refers to what is done in research; it is not used by doctors prescribing drugs.

It is a value determined during research, which helps to determine the safe dose to give. All that means is that the drug could be lethal, but I will watch you for side effects. Rationale 1 : The difference between a median effective dose and a median lethal dose is a measure of a drugs safety margin, which helps determine the safest dose to give. The lethal dose measure is used by doctors prescribing drugs. Telling a patient not to worry is non-therapeutic; this is a condescending response.

Telling a patient that the drug could be lethal, but he will be observed for side effects, will frighten him and most likely result in refusal of the medication. Rationale 2 : The difference between a median effective dose and a median lethal dose is a measure of a drugs safety margin, which helps determine the safest dose to give.

Rationale 3 : The difference between a median effective dose and a median lethal dose is a measure of a drugs safety margin, which helps determine the safest dose to give. Rationale 4 : The difference between a median effective dose and a median lethal dose is a measure of a drugs safety margin, which helps determine the safest dose to give. Prior to administering medications, the student nurse reviews the therapeutic index. Which statement best describes the students understanding of therapeutic index?

The student is able to determine if the physician prescribed the best drug for the patient. The student is able to determine if the patients are receiving safe doses of the medications. The student is able to identify interactions among the drugs each patient is receiving. The student is able to identify the patients who will need to have serum blood levels monitored.

Rationale 1 : Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. The therapeutic index will give some information about safe doses, but this is not the most complete response. The therapeutic index will not help to determine if the physician prescribed the best drug for the patient.

The therapeutic index will not help to identify interactions among the drugs the patients receive. Rationale 2 : Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests.

Rationale 3 : Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. Rationale 4 : Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. The nursing instructor prepares to teach student nurses about how mean effective doses of medications are related to clinical practice.

As a result of the instruction, what is the best understanding of the student nurses? Some patients will require more or less of the drug. The mean effective dose is not related to ethnicity. The mean effective dose does not predict how many patients will experience severe side effects from the drug.

The patient receives antibiotics for a serious infection. The patient asks the nurse, Why dont you just give me more of that drug to cure this infection faster? Rationale 1 : When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect.

Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. An increase in dosage may cause interactions with other medications, but this is not the best answer. Rationale 2 : When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit.

Rationale 3 : When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Rationale 4 : When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit.The nurse literally plays the role of a lifeguard in medication administration.

She often provides the last opportunity for the health-care team to identify and correct errors in prescribing and distributing medication. Although the physician prescribes the medication and the pharmacist fills the prescription, the nurse usually administers the medication. She is the last link in medication administration and a safeguard against error. The medication administration record MAR is based on the physician's order and provides the information the nurse needs to administer medication.

Prior to administering medication, the nurse verifies the patient's identity. The "Journal of Continuing Education in Nursing" reports that "patient misidentification continues to be the root cause of many errors. She compares the patient's wristband identification with a written document such as a MAR or physician's order.

Alternately, the nurse may ask the patient to state his name and birthdate and match the information to the patient's wristband.

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In safely treating the patient, the nurse observes six patient rights, ensuring that she administers the right medication, in the right dosage, to the right patient, at the right time, via the right route, in accordance with the physician's orders. She completes the process with the right documentation. In addition, before a nurse administers medication, she references the action and expected effect of the drug.

She monitors the patient and reports any adverse reactions to the medication. Health-care providers prescribe and administer medication according to a medication distribution system. The health-care team works together to identify and prevent errors in the system. The nurse verifies medical calculations with a colleague and consults the prescribing physician or her nursing supervisor if she suspects that a prescribed dosage of medication is unsafe.

The nurse also identifies prescribed medications, over-the-counter drugs, and client allergies that can interfere with the physician's recommended drug therapy.

a nurse is reviewing the medication administration record of a

She gathers data pertaining to the patient's medical history and compares it to the MAR to identify incompatible drug combinations or possible allergic reactions to medication.

Medical facility guidelines also ensure six rights of the nurse. The nurse has the right to legible, clearly written medication orders that specify the dosage, route, and time for medication administration. The nurse also has the right to receive the correct form of the drug from the pharmacist and to access information about the drug.

She has the right to report problems in the medication system, to halt the administration process if she identifies an unsafe condition, and she has the right to work in a medical facility that provides guidelines and policies for safe administration of medication. Miriam Breeze, a freelance writer sinceis a year Marine Corps veteran and was a merchant mariner for five years.

She specializes in health care topics and has published articles on eHow. She has a Bachelor of Science in nursing from National University and a California registered nursing license. Share It. About the Author. Copyright Leaf Group Ltd.Chapter 2. However, in the law was changed to allow district nurses and health visitors employed in pilot sites throughout England to prescribe from a limited formulary.

Many of the preparations they were initially able to prescribe were for over-the-counter preparations. In it became possible for all appropriately qualified community nurses to prescribe from a limited nursing formulary.

In the law changed again, enabling nurses who had undergone the requisite training to prescribe from the full range of drugs in the British National Formulary with the exception of most controlled drugs provided this was in their sphere of competence. The controlled drugs which nurses are able to prescribe are shown in Table 2. Table 2. Independent nurse prescribers are now able to prescribe in agreement with their employers and clinical teams. Based on this, a free choice is made from the British National Formulary of the most appropriate drug or treatment.

The nurse signs the prescription form and remains professionally and legally accountable for his or her actions. Patient safety is the key issue and the thrust of the reforms is to benefit patients by permitting more rapid access to medicines. The service benefits because professional time is freed for those with more complex needs. The extension of the nursing role which has resulted from nurse prescribing is in line with health care policy in the UK and extending professional roles.

Nurse prescribing policy applies only to qualified nurses and midwives and they must first complete a recognized non-medical prescribing extended and supplementary prescribing training course with assessments including competency-based practice portfolios signed by a medical supervisor.

Breakdown of communication is possible after the patient is discharged from hospital and when drugs may be prescribed by more than one person. The new prescribing—dispensing process means greater contact between the nurse and pharmacist, especially when problems arise. The prescribing record contains details of previous and current drugs, including any additional over-the-counter products and drug allergies. When prescribing, the nurse will need to consider psychosocial as well as physical factors and the need for patient education must be recognized.

The record should monitor the response to drugs and reasons for discontinuing their use. Irrespective of whether or not they are permitted to prescribe and the setting in which they are employed, however, all nurses need to help patients understand the purpose of their treatment and to promote adherence with taking medication.Page 1. You must be logged in to post a comment. When administering heparin subcutaneously, the nurse should A Aspirate after injection B Aspirate before the injection C Vigorously massage the site D Never aspirate Ans: D Feedback: When administering heparin subcutaneously, never aspirate before administration.

When the nurse administers the morning dose of a medication during the evening, which of the rights of medication administration has she failed to follow? Childrens medication dosages are most often calculated using the childs body surface area and A Age B Diagnosis C Height D Weight Ans: D Feedback: Childrens dosages are most often calculated using the childs weight or body surface area.

A severe allergic reaction from a medication requires A Asprin B Atarax C Dopamine D Epinephrine Ans: D Feedback: A severe allergic reaction, called an anaphylactic reaction, requires immediate medical intervention because it can be fatal.

Treatment includes discontinuing the medication and administering epinephrine, IV fluids, and antihistamines. Following an allergic reaction to a medication, the nurse should A Instruct the patient to wear an identification addressing the allergy B Instruct the patient to be sure the allergy is on his medical record C Inform the patient that an allergic reaction can be transient D Inform the patient that the medication may cause an allergy only one time Ans: A Feedback: Allergic reactions result from an immunologic response to a substance to which the patient is sensitized.

a nurse is reviewing the medication administration record of a

The patient should wear identification noting the medication to which the patient is allergic. When the patient demonstrates a rash 30 minutes after she has taken a dose of penicillin, the nurse recognizes that the patient is likely demonstrating which type of drug reaction? Which of the following patients is likely to have altered metabolism of medications? Metabolism takes place in the liver. Alterations in liver function, including decreased functions that occurs with aging or disease, affect the rate at which drugs are metabolized.

What is involved in the absorption, distribution, metabolism, and excretion of medication? The physiologic and biochemical effects of a drug on the body defines A Pharmacology B Pharmacotherapeutics C Pharmacokinetics D Pharmacodynamics Ans: D Feedback: Pharmacodynamics refers to the physiologic and biochemical effects of a drug on the body.

The process by which a drug moves through the body and is eventually eliminated is A Pharmacology B Pharmacotherapeutics C Pharmacokinetics D Pharmacodynamics Ans: C Feedback: Pharmacokinetics is the process by which a drug moves through the body and is eventually eliminated. In administering medications, the five rights include patient, drug, route, and time. What is the fifth right? If the dosage is inappropriate for a patient, who is responsible? A Physician B Pharmacist C Nurse D Medical technician Ans: C Feedback: Whereas physicians and other healthcare providers prescribe and pharmacists dispense therapeutic agents, it is the nurses legal domain to administer medications in a safe and timely manner.

According to the nurse practice act, the nurse is liable for A Writing a physician order B Clarifying a physician order C Administering what is written D Determining the dosage Ans: B Feedback: The nurse is responsible to determine if the medication order is ambiguous or inappropriate. The nurse must clarify the medication order with the prescribing healthcare provider. Regarding medication administration, what must occur at the change of shifts? A The patients medications must be drawn up B The medications for the division are counted C The narcotics for the division are counted D The LPNs only on the division count medications Ans: C Feedback: Healthcare facility personnel perform a count of controlled medications at specified times each shift or when removed from an automated dispensing machine.

The primary reason for the Controlled Substances Act is A To regulate the purchase of antibiotics B To regulate the purchase of narcotics C To prevent overuse of antibiotics D To prevent drug abuse Ans: D Feedback: The primary reason for the Controlled Substances Act is to prevent drug abuse and dependence, provide treatment and rehabilitation for people who are dependent on drugs, and strengthen drug abuse laws.

In terms of categories of controlled substance, which of the following descriptions reflects schedule IV drugs? A May lead to severe psychological dependence B Has the highest potential for abuse C May lead to limited physical dependence D deemed safe for use in pregnancy Ans: C Feedback: Schedule IV drugs may lead to limited physical and psychological dependency.

Which of the following medication dosages is properly written? What electronic medical record advance helps the nurse recognize when a generic drug has been ordered?