CLASSIFICATION OF DRUGS CLASSIFICATION OF DRUGS:- 1) ANALGESICS - TO REDUCE PAIN. E.G. IMOL, ASPIRIN PILL 2) ANTIPYRETICS - TO REDUCE FEVER. E.G. PARACETAMOL 3) ANTI-INFLAMMATORY - TO REDUCE INFLAMMATION AND PAIN. E.G. COMBIFLAM 4) ANTIHELMENTIC - ANTI-WORM IS USED. E.G. ALBENDIAZOLE. 5) ANTIHISTAMINIC - IT IS GIVEN TO STOP COLD, RUNNY NOSE AND REDUCE ALLERGIES. E.G. AVIL'S PILL / CETRIZINE PILL, INJECTION FINARGAN / AVIL. 6) ANTACIDS - ANTACIDS. E.G. RANTAC, ZENTEK PILL. 7) ANTIBIOTICS - ANTIBIOTICS - TO KILL GERMS OR TO STOP THE GROWTH OF GERMS. E.G. COTRIM PILL, AMOXICILLIN CAPSULES, CIPROX PILL ETC. 8) EXPECTORANT - COUGH MEDICINE FOR COUGH. 9) LAXATIVES - ACUTE LAXATIVES TO ELIMINATE CONSTIPATION - CASTOR OIL, MILD LAXATIVES, LIQUID PARAFFIN 10) ANESTHETICS - TO ANESTHETIZE. TO ANESTHETIZE THE LOCAL AND THE BODY. 11) BLOOD CLOT PREVENTERS - ANTICOAGNLANTS - PREVENT BLOOD CLOTS FROM FORMING. E.G. HEPARIN, CLOPID TABLETS. 12) ANTISEPTIC - TO PREVENT INFECTION. 13)ANTIDIARRHOEAL - OFFERED TO REDUCE DIARRHEA. 14) ANTI TUSSIVE - CENTRAL NERVOUS SYSTEM IN COUGH - RECEPTORS FUNCTION IN THE SYSTEM 15)ANTIPURITICS - TO REDUCE ITCHING. TO RELAX 16) VASO CONSTRICTOR - CONSTRICTING BLOOD VESSELS E.G. F-CHOLINE 17) VASODILATOR - RELAXING BLOOD VESSELS. GIVE PATIENTS INCREASED BLOOD PRESSURE. 18) ANTIFUNGAL - TO REDUCE FUNGAL INFECTIONS. 19) ANTISPASMODIC - TO REDUCE MUSCLE SPASM. E.G. VELADONA. 20) ANTIEMETIC - TO PREVENT VOMITING. 21) BRONCHODIALATOR - TO WIDEN THE AIRWAYS. 22) CATHERTICS ARE GIVEN TO CLEANSE THE INTESTINES. A) LAXATIVES MILD LAXATIVES. E.G. LIQUID PARAFFIN B) PARGETIVES - ACUTE LAXATIVES. E.G. CASTOR OIL. 23) CORTICOSTEROIDS - HORMONES MADE FROM THE ADRENAL CORTEX - TO REDUCE INFLAMMATION. A) GLUCOCORTICOIDS B) MINERALOCARTICOIDS 24) DIURETICS - TO INCREASE THE AMOUNT OF URINE. E.G. LASIKUS PILL. 25) EMETICS - FOR VOMITING. STIMULANTS - STIMULANTS ARE GIVEN TO STIMULATE THE NERVOUS SYSTEM. 27) TRACVILIZERS - TO REDUCE ANXIETY. CLASSIFICATION OF DRUGS ACCORDING TO DRUGS AFFECTING DIFFERENT ORGANS OF THE BODY: 1) DRUGS AFFECTING THE DIGESTIVE SYSTEM. 2) AFFECTING THE HEART AND CIRCULATORY SYSTEM. 3) AFFECTING THE NERVOUS SYSTEM. 4) AFFECTS MUSCLES AND SKELETAL SYSTEM. 5) HORMONES E.G. INSULIN, THYROXINE, ESTROGEN, PROGESTERONE 6) AFFECTING THE URINARY SYSTEM - E.G. PYRIDINE) AFFECTS THE REPRODUCTIVE SYSTEM - METHANE 7) AFFECTS THE RESPIRATORY SYSTEM. 8) NUTRITIONAL - E.G. IRON, FOLIC ACID TABLETS. 9) MEDICINES THAT AFFECT THE SENSES - E.G. EARS, NOSE, THROAT, EYES, SKIN. 10) EXCERPTS FROM POISONING. E.G. ATROPINE 11) CANCER DRUGS.

TRACHEOSTOMY

Tracheostomy is a procedure in which an artificial opening is created in the throat to assist with patient's breathing or to create an alternate airway it is a fairly common procedure in patients with prolonged ICU stay or ventilator support.

• indications for tracheostomy -

tracheostomy may be needed when there is -

some sort of upper airway obstruction eg cancer of the larynx laryngeal edema etc - if patient is unable.
remove respiratory secretions eg coma respiratory muscles paralysis in such cases tracheostomy allows suctioning of the secretions and the cuff of the tracheostomy reduces further aspiration of secretions.
if the patient has respiratory insufficiency eg chronic lung diseases then tracheostomy might help oxygen ventilation by reducing respiratory dead space.
prophylactic measures in a patient on prolonged mechanical ventilation via endotracheal tube there is a risk for tracheal stenosis so in such patients tracheostomy is done v as part of another procedure sometimes tracheostomy is done to gain access to airway for general anaesthesia or as a precautionary measure in some patients who undergo an extensive neck surgery.



type of tracheostomy -

there are various types of tracheostomy procedures depending on the circumstances of the patient and the treatment intent similarly there are various types of tracheostomy tubes each with specific functions the common types of tracheostomy procedures are-

emergency tracheostomy 
elective tracheostomy
permanent tracheostomy
percutaneous tracheostomy
mini tracheostomy also known as cricothyroidotomy

tracheostomy can also be classified as high mid or low depending on the level at which it is inserted into the trachea different varieties of tracheostomy tube include -

cuffed 
non cuffed 
double-lumen tubes 
tubes with speaking valves
 metallic tubes

procedure -

the procedure is preferably done under general anesthesia but emergency cases may necessitate local anesthesia only.
there are variations on the technique of the procedure but generally these are the steps the patient is put in a supine position with neck extended.
skin incision which may be transverse or longitudinal is given on the neck subcutaneous fat and platysma are cut .
strap muscles of the neck are retracted or dissected away if thyroid gland is encountered then it is displaced upwards or may be cut any blood vessels.
encountered along the way alligatored incision is given on the trachea a hole is made and the tracheostomy tube is inserted preferably through the second or third tracheal ring the skin incision is closed and the tracheostomy tube is secured to the skin via stitches or simply tied around the neck.

care-

after tracheostomy is done certain precautions and care is required to ensure proper functioning of the tracheostomy tube and to prevent complications 
the tracheostomy forces the air to bypass the nasal and oral passages hence the air entering the tracheostomy is not adequately humidified this dry air leads to increased racheal irritation and secretion production because these secretions may lead to crusting and blockage of the tracheostomy tube 
the first point regarding care is adequate suctioning of the secretions through the tracheostomy tube secondly humidification of air this can be done with humidified air attached to the tube placing a humidifier or steam near the patient's bed or applying a wet porous gauze onto the tracheostomy tube
although the latter is considered a crude measure thirdly keep the patient under regular supervision and ensure that
the tube is functioning and not dislodged since the tracheostomy forces the air to bypass the vocal cords patients would not be able to speak effectively in such cases a notepad and Bell should be provided to the patient.


Thank you..

Intramuscular And Subcutaneous Injection

These procedures are commonly carried out to introduce small volumes of a drug into the system of a patient where oral medication cannot be tolerated or absorbed usually a volume of one milliliter less will be injected subcutaneously whilst larger volumes from two to five mil will be injected intramuscular also size of needle depends slightly on patient size but in general blue or green can be used for IM and blue for subcutaneous.

INTRAMUSCULAR INJECTION -

Intramuscular injection sites -

mid anterior and mid lateral areas of the quadriceps mid deltoids and upper outer quadrant of the gluteal muscles the katiyal region is used less frequently nowadays due to the risk of damaging sciatic nerve.

Equipment required for this procedure -

syringe 
drawing up needle
correctly sized needle for injection commonly blu or green
cotton wool ball 
non sterile gloves
sharps container


process -

sure to recheck whether the patient has any allergy to the drug euro back to deliver as well as ensuring that the drug you have selected matches what is written on the prescription.
you should also record the batch numbers and expiry date of the drug in a suitable location usually a ward register or the patient's notes 
identify a suitable site for injection usually from one of the three previously mentioned
once identified be sure to thoroughly wash your hands
you may then begin to prepare your injection by drawing up the drug using the syringe and drawing up needle
ensure your Reyna gloves when drawing up a drug 
once this has been done proceed to removing the drawing up needle and attaching the injection needle usually blue or green depending on the size of the patient
being careful not to expose the needle until you are ready to inject
stabilize the skin with your non-dominant hand current best practice suggests that it is not necessary to cleanse the target skin area with an alcohol wipe provided the patient is clean 
with your dominant hand hold the syringe as though you would hold a dart and insert it into the skin at 90 degrees almost to the health of the needle
draw back on the plunger slightly to ensure that you have not entered a blood vessel 
when you are confident that you are in the musculature proceed to delivering the drug for a large volume wait several seconds before withdrawing the needle 
once you have withdrawn apply pressure with the cotton wool bowl and dispose of the sharp immediately 
after a few moments of pressure check the wound to assess bleeding it is usually minimal 
check that your patient is comfortable and dispose of your equipment after washing your hands ensure you document everything in the notes correctly and on the prescription charts correctly.

• SUBCUTANEOUS INJECTION -
  

Subcutaneous injection sites -

apparatus or arm lower abdomen upper outer thigh they are generally given for smaller volumes over a slower release is preferred 

Equipment required for this procedure -

syringe 
drawing up needle
correctly sized needle for injection commonly blu or green
cotton wool ball 
non sterile gloves
sharps container

Process -

sure to recheck whether the patient has any allergy to the drug euro back to deliver as well as ensuring that the drug you have selected matches what is written on the prescription.
you should also record the batch numbers and expiry date of the drug in a suitable location usually a ward register or the patient's notes 
identify a suitable site for injection usually from one of the three previously mentioned
once identified be sure to thoroughly wash your hands
you may then begin to prepare your injection by drawing up the drug using the syringe and drawing up needle
ensure your Rayne gloves when drawing up a drug 
once this has been done proceed to removing the drawing up needle and attaching the injection needle usually blue or green depending on the size of the patient
being careful not to expose the needle until you are ready to inject
stabilize the skin with your non-dominant hand current best practice suggests that it is not necessary to cleanse the target skin area with an alcohol wipe provided the patient is clean 
with your dominant hand hold the syringe as though you would hold a dart and insert it into the skin at 45 degrees almost to the health of the needle
draw back on the plunger slightly to ensure that you have not entered a blood vessel 
when you are confident that you are in the musculature proceed to delivering the drug for a large volume wait several seconds before withdrawing the needle 
once you have withdrawn apply pressure with the cotton wool bowl and dispose of the sharp immediately 
after a few moments of pressure check the wound to assess bleeding it is usually minimal 
check that your patient is comfortable and dispose of your equipment after washing your hands ensure you document everything in the notes correctly and on the prescription charts correctly.

                                                   thank you ..

Intradermal injection

 Intradermal injection which means administering medication into the dermis
 skin testing is done through intradermal injection example ,tuberculosis screening and allergy tests.
these medications are potent so inject these into the dermis their blood supply is reduced and drug absorption occurs slowly.

sites for intradermal injection -

• inner aspect of the lower arm upper aspect of the anterior chest.
•  on the posterior -side upper aspect of the posterior chest and posterior side of the upper arm.

pre pocuder assingment -

• check accuracy and completeness of medication administration record with prescribers original medication order
• check patients name medication name and dosage route of administration and time of administration
• recopy any portion of medication administration record that is difficult to read
• review medication reference information about expected reaction when testing skin with specific allergen or medication an appropriate time to read site .
• assess patients history of allergies known type of allergens and normal allergic reaction.
• assess for contraindication to intradermal injections such as reduce local tissue perfusion.
• assess for history of severe adverse reactions or necrosis that happen after previous intradermal injection .
• assess patients knowledge of purpose and response to skin testing.
• check date of expiration for medication .

procuder-

• close room curtain to provide privacy.
• perform hand hygiene and apply clean gloves .
• keep sheet draped over body pots not requiring exposure to reduce transmission of infection
• select appropriate site note lesions or discolorations of skin if possible select site three to four finger widths below antecubital space and one hand width above wrist
• help patient too comfortable for she'll have her extend elbow and supported and forearm on flat surface
• for stabilizing injection site enabling easy accessibility
• clean site with antiseptic swab a place web at center of site and rotate outward in circular direction for about five centimeter this removes secretions containing microorganisms
• hold the gas between third and fourth fingers of non-dominant hand so it remains readily accessible when withdrawing needle .
• remove needle cap from needle by pulling it straight off preventing needle from touching sites of cap prevents contamination
• hold syringe between thumb and forefinger of dominant hand with bevel of needle pointing up
• administer injection
• with non-dominant hand stretched skin over site with four finger or thumb needle pierces tight skin more easily with needle almost against a patient's skin inserted slowly at five to 15 degree angle until resistance is felt advance needle through epidermis to approximately three millimeter below skin surface 
• you will see bulging of needle tip through skin this ensures that needle dippers and dermis you will obtain in accurate results if you do not inject needle at correct angle and depth inject medication slowly because slower injection minimizes discomfort at site then normally you feel resistance
•  if not needle is too deep remove and begin again.

clinical decision alert  -

It is not necessary to aspirate because dermis is relatively a vascular.
by injecting medication note that small bleb resembling mosquito bite appears on skin surface
blood indicates that you deposited medication in dermis
after withdrawing needle apply alcohol swab or gasps gently over site
 do not massage site applied and H if needed
help patient to comfortable position
gives patient a sense of well-being
discard uncap needle in needle disposal and drop the plunger and Barrel in leak-proof receptacle
this helps to prevent injury to patients and healthcare personnel
remove gloves and perform hand hygiene to reduce transmission of microorganisms.
stay with PATIENT for several minutes and observe for any allergic reactions. 

                                                 thank you...