By L. Pranck. Parsons School of Design. 2017.

The impli- cation is that if care does not meet a minimal standard order micardis 80 mg free shipping, remedial action is called for. Optimal standards denote the level of quality that can be reached under the best conditions, typically conditions similar to those under which efficacy is determined. Optimal standards are probably most useful as a ref- erence point for setting achievable standards—the level of performance that should be reached by everyone to whom the standards are being applied. One way to define achievable standards is in relation to the level of per- formance of the top quartile of providers of care. The reasoning is that if the top quartile can perform at that level, the other three quartiles should be able to reach it as well (Muir Gray 2001). Since there is no a priori level at which a particular standard ought to be set, a sensible and frequently adopted approach is to choose the level based on why the underlying eval- uation is being conducted in the first place. Using Measurement-Related Concepts How does understanding structure, process, and outcomes; efficacy; and criteria and standards give us insight into quality-of-care measurement issues? The two cases cited at the beginning of this section provide some illustrations. In the first case, minimum standards of quality were specified in terms of nurse staffing levels, a structural measure of quality. The critics are not questioning the choice of measure, nor should they, since structural meas- ures are well suited to detecting lack of capacity to deliver care of accept- able quality. In this case, hospitals that do not meet minimum staffing levels by definition cannot deliver care of acceptable quality (safe care). Put another way, the critics do not challenge nurse staffing levels as a criterion for assessing quality of care. The evidence would have to come from properly controlled studies show- ing that quality of care falls below what can be considered safe levels when Basic Concepts of Healthcare Quality 39 nurse staffing ratios are reduced, holding all else constant.

Fatigue and depression Anemia and depressed platelet and WBC counts may also occur with long-term administration and are dose-limiting effects purchase micardis 40 mg with mastercard. With aldesleukin, observe for capillary leak syndrome Adverse effects are frequent, often serious, and sometimes fatal. Capillary leak edema, respiratory distress, gastrointestinal bleeding, renal in- syndrome, which may begin soon after treatment starts, is charac- sufficiency, mental status changes). Other effects may involve terized by a loss of plasma proteins and fluids into extravascular most body systems, such as chills and fever, blood (anemia, space. Signs and symptoms result from decreased organ perfusion, thrombocytopenia, eosinophilia), central nervous system (CNS) and most patients can be treated with vasopressor drugs, cautious (seizures, psychiatric symptoms), skin (erythema, burning, fluid replacement, diuretics, and supplemental oxygen. In addition, drug-induced tumor breakdown may cause hypocalcemia, hyperkalemia, hyper- phosphatemia, hyperuricemia, renal failure, and electro- cardiogram changes. With intravesical BCG, assess for symptoms of bladder These effects occur in more than 50% of patients, usually starting irritation (eg, frequency, urgency, dysuria, hematuria) and sys- a few hours after administration and lasting 2 to 3 d. Drugs that increase effects of sargramostim: (1) Corticosteroids, lithium These drugs have myeloproliferative (bone marrow stimulating) effects of their own, which may add to those of sargramostim. Drugs that increase effects of aldesleukin: All of the listed drug groups may potentiate adverse effects of aldesleukin. Aldesleukin otrexate) is usually given as a single antineoplastic agent; its use in combina- tion with other antineoplastic drugs is being evaluated. What are the hematopoietic, colony-stimulating cytokines, and how do they function in the body? Answer: G-CSF is given to decrease the length and severity of bone marrow suppression after chemotherapy.

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Drug holidays (stopping drug administration) are con- gravated by the cardiac-stimulating effects of the drugs buy micardis 80mg with amex, in- troversial. Some clinicians say they are indicated only if cluding dietary caffeine. In general, reduced doses are safer no significant problems occur during the drug-free pe- in older adults. NURSING Central Nervous System Stimulants ACTIONS NURSING ACTIONS RATIONALE/EXPLANATION 1. Give amphetamines and methylphenidate early in the day, To avoid interference with sleep. Do not crush or open and instruct clients not to bite or chew Breaking the tablets or capsules destroys the extended-release long-acting forms of methylphenidate (Concerta, Metadate feature and allows the drug to be absorbed faster. Observe for therapeutic effects Therapeutic effects depend on the reason for use. Improved behavior and performance of cognitive and psy- chomotor tasks with ADHD c. Observe for adverse effects Adverse effects may occur with acute or chronic ingestion of any CNS stimulant drugs. Excessive central nervous system (CNS) stimulation— These reactions are more likely to occur with large doses. Cardiovascular effects—tachycardia, other dysrhythmias, These reactions are caused by the sympathomimetic effects of the hypertension drugs. Gastrointestinal effects—anorexia, gastritis, weight loss, nausea, diarrhea, constipation (continued) 258 SECTION 2 DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM NURSING ACTIONS RATIONALE/EXPLANATION 4. Drugs that increase the effects of CNS stimulants: (1) Other CNS stimulant drugs Such combinations are potentially dangerous and should be avoided or minimized. Drugs that decrease effects of CNS stimulants: (1) CNS depressants IV diazepam or lorazepam may be used to decrease agitation, hyper- activity, and seizures occurring with stimulant overdose.

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