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Range Doses Range doses are medication orders in which the dose wellbutrin 300mg amex depression and sleep, frequency or route of administration for a medication is prescribed in a range (e buy wellbutrin 300mg line depression symptoms fainting. Range doses are used in situations where a client’s need for the medication varies from day to day or within the same day. A range dose order gives the nurse the flexibility to make a decision on the appropriate dose of medication to administer, based on their assessment of the client immediately prior to medication administration. Orders for pain medication that contain a dosage range should have a fixed time interval (Gordon et al, 2004). Whenever possible, the nurse should have the client rate their pain using approved pain management tools, discuss with the client the appropriate amount of medication required, review the effectiveness of any previous medication dosages administered as a reference point, monitor and document the effectiveness of the medication administered. Problems can occur with range dose orders when clients are prescribed an exhaustive variety of pain management medication options in multiple routes and dosages without clear indications when to use which analgesic. In addition, problems can occur if the nurse considers using the unused dosage of a range dose order as a break-through pain order as this is not best practice. The nurse cannot administer another 1-2 mg of Morphine an hour later based on this same order as the order identifies the timeframe as q4h, not q1h. The nurse needs to contact the authorized prescriber for further medication orders to address the client’s pain. In the example provided above, the decision by the nurse to administer another 1-2 mg of Morphine is not permitted because of:  the accountability and legal risk for the nurse acting outside of the timeframe of the Morphine order (the above order indicates that the client needs to wait at least three hours between doses)  the lack of clarity on the time to administer the next prn dose of Morphine Clear communication among clients, nurses, physicians and pharmacists is vital for a range dose system to work effectively. Policy should address:  which medication may be ordered and administered by means of a range dose order  what type of range dose orders are appropriate (i. Prn Medications Prn medications are medications prescribed to be given only when a client requires it. A prn prescription includes the frequency with which the medication may be given, such as q4h prn. This time frame means that the client needs to wait at least four hours between doses. Nurses must not administer any prn medication for a purpose other than the one identified in the order. Allergy Testing and Desensitizing Injections Specialized knowledge, skill and judgment are required to administer allergy tests or desensitizing injections. Nurses who administer these agents should be supported by practice setting policy, as there may be a risk of sudden, severe side effects. Emergency equipment and resources should be readily available in the practice setting. Guideline 25: Nurses administering allergy testing and desensitizing injections must have specialized knowledge, skill and judgment. Investigational and Special Access Program Medication Investigational and special access program medication must be prescribed. An investigational drug is a medication that has been approved for human clinical trials by Health Canada and the practice setting. Special access program medications refer to drugs that are not on a practice setting’s formulary or approved for general use, and require special authorization through the Canada Food and Drug Act (1985). Guideline 26: Nurses administering investigational or special access program medication must have the necessary information (e. Placebos The administration of placebos to clients without their knowledge and consent is inappropriate and unethical. Cosmetic Procedures The number of clients who receive cosmetic procedures in Canada is on the rise. Some examples of the services provided are Botox injections, dermal fillers, use of laser for a number of purposes, fat and cellulite manipulation, chemical peels and hair transplants. Nurses require additional education and experience to ensure that they are competent if they engage in these interventions. Nurses are responsible for attaining, maintaining and evaluating their competence in the performance of any intervention or activity.

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If stool samples are obtained buy 300 mg wellbutrin amex anxiety upper back pain, antibiotic susceptibility testing should be performed to confirm and inform antibiotic choice discount wellbutrin 300 mg without prescription bipolar depression support alliance. Therapy should be adjusted subsequently based on the results of the diagnostic work-up. Antimicrobial resistance among enteric bacterial pathogens outside the United States is an important public health problem. For example, traveler’s diarrhea caused by fluoroquinolone-resistant Campylobacter jejuni in Southeast Asia is common. For the same patients with bacteremia, 14 days is appropriate, provided clearance of bacteremia is documented. Recurrence may present as bacteremia or as an anatomically localized infection, including intra-abdominal, endothelial, urinary tract, soft tissue, bone and joint, lung, or meningeal foci. The value of this secondary prophylaxis has not been established and must be weighed against the risks of long-term antibiotic exposure. A follow-up stool culture to demonstrate clearance of the organism is not required if clinical symptoms and diarrhea resolve. Follow-up stool culture may be required when public health considerations and state law dictate the need to ensure micro¬biologic cure, such as in health care or food service workers. Immune reconstitution inflammatory syndrome has not been described in association with treatment for bacterial enteric pathogens. Managing Treatment Failure Follow-up stool culture should be considered for patients who fail to respond clinically to appropriate antimicrobial therapy. In patients with persistent or recurrent diarrhea despite therapy, clinicians should consider other enteric infections in the context of the patient’s immune status and, in all cases, the possibility of C. Preventing Recurrence The pharmacologic approach to recurrent enteric infections is covered in the section on directed therapy for each bacterial species. Special Considerations During Pregnancy The diagnosis of bacterial enteric infection in pregnant women is the same as in women who are not pregnant. Bacterial enteric infections in pregnant women should be managed the same as in women who are not pregnant, with several considerations. Since rifaximin is not systemically absorbed, it can be used in pregnancy as in non-pregnant individuals. Limited data are available on the risks of vancomycin use during pregnancy, however minimal absorption is expected with oral therapy. If no clinical response after 3 to 4 days, consider follow-up stool culture with antibiotic susceptibility testing and other methods to detect enteric pathogens (e. For patients with persistent diarrhea (>14 days) but no other severe clinical signs (e. Antimicrobial resistance among enteric bacterial pathogens outside the United States is common. Antibiotic choices for secondary prophylaxis are the same as for primary treatment and are dependent on the sensitivity of the Salmonella isolate. Clinicians should be aware that recurrence may represent development of antimicrobial resistance during therapy. Many Shigella strains resistant to fluoroquinolones exhibit resistance to other commonly used antibiotics. Bacterial enteric infections in persons infected with human immunodeficiency virus. Infections with Campylobacter jejuni and Campylobacter-like organisms in homosexual men. Prevalence of Campylobacter-associated diarrhea among patients infected with human immunodeficiency virus. Emergence of multidrug resistance in Campylobacter jejuni isolates from three patients infected with human immunodeficiency virus. Development of quinolone- resistant Campylobacter fetus bacteremia in human immunodeficiency virus-infected patients. Zidovudine therapy protects against Salmonella bacteremia recurrence in human immunodeficiency virus-infected patients.

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If the amount of Extra Help red are you get is changing discount 300mg wellbutrin mastercard anxiety natural treatment, so that your copayment amounts change for defned next year cheap wellbutrin 300mg amex depression justification, you’ll get a notice (on orange paper) in the mail with the on pages new copayment amounts. Even if you get the notice on grey paper because you don’t automatically qualify, you may still be able to save on your Medicare drug coverage costs. Te change in Extra Help you get starts the month afer you report the change in your marital status. You can report changes in your income, resources, or family size to Social Security to review at any time. If you applied and qualifed for Extra Help through your state, your state’s rules may require you to tell them about changes in your circumstances. If you automatically qualify, you should get a purple, yellow, orange, or green notice from Medicare that you can show to your plan as proof you qualify for Extra Help (see chart on page 34). If you applied for Extra Help, you can show your plan your “Notice of Award” letter from Social Security as proof you qualify. Proof you have Medicaid and live Other proof you have Medicaid in an institution or get home- and community-based services A bill from an institution (like a A copy of your Medicaid card nursing home) or a copy of a state (if you have one) document showing Medicaid paid A copy of a state document for your stay for at least a month that shows you have Medicaid A print-out from your state’s A print-out from a state Medicaid system showing you electronic enrollment fle, or lived in the institution for at least a screen print from your state’s month Medicaid systems that shows A document from your state you have Medicaid that shows you have Medicaid Any other document from and are getting home- and your state that shows you have community-based services Medicaid Your plan must accept any of these documents as proof you qualify for Extra Help. As soon as you have given them any one of these documents, your plan must make sure you pay no more than the right amount to fll your prescriptions. Your plan must also contact Medicare so Medicare can get proof that you qualify, if it’s available. You should expect your request to take anywhere from several days to up to 2 weeks, depending on the circumstances. Your plan and Medicare will work to process your request before you run out of medication, if possible. If you paid for prescription drugs since you qualifed for Extra Help, you may be able to get back part of what you paid. If you applied for Extra Help through Social Security, they’ll give you a hearing by phone unless you choose a case review. Either way, Social Security will review those parts of the decision that you believe are wrong and will look at any new information you provide. If you want to fle an appeal, keep in mind: You have 60 days to ask for an appeal. Social Security will assume you got the letter 5 days afer the date on it, unless you show them you didn’t get it within the 5-day period. Call Social Security at 1-800-772-1213 for a list of groups that can help you with your appeal. If you apply for Extra Help with your state, your decision letter should include appeal rights and procedures. Call your State Medical Assistance (Medicaid) ofce for information on your state’s appeals process. You’ll have to pay the monthly premium, yearly deductible (some plans don’t have a deductible), and a share of the cost of your drugs. Even if you don’t qualify for Extra Help now, you can apply or reapply later if your income and resources change. Other ways to save if you don’t get Extra Help Tere are other ways you may also be able to save. Ask your doctor if there are generic, over-the-counter, or less-expensive brand-name drugs that could work just as well as the ones you’re taking now. Switching to lower-cost drugs can save you hundreds or possibly thousands of dollars a year. Exploring National- and Community-Based Programs that may have programs that can help you with your drug costs, like the National Patient Advocate Foundation or the National Organization for Rare Disorders. Get information on federal, state, and private assistance programs in your area by visiting beneftscheckup. Virgin Islands ofer some type of coverage to help people with Medicare with paying drug plan premiums and/or cost sharing. Many of the major drug manufacturers ofer assistance programs for people enrolled in a Medicare drug plan. Words in red are Medicare works with other government representatives, defned community- and faith-based groups, employers and unions, doctors, on pages pharmacies, and other people and organizations to educate people 83–86. Look for information in your local newspaper, or listen for information on the radio, about events in your community. If you have limited income and resources, you may qualify for Extra Help paying the costs of Medicare drug coverage.

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