Implementation Station Heart Failure Scenario

[@ivanlumu7842]

I love the way you beat the time!! Something i need to copy

[@maryamk8711]

Dear Unified, your channel is the only channel which answered my questions patiently. Thank you so much 🙏🙏🙏 I passed OSCE yesterday and I really appreciate your help. Keep up the hard work😊

[@unifiedosce5580]

HI @ mariam, Congratulations, more wins🏆 🏆

[@Prospersayong]

I will grateful for your videos. Your videos helped me to passed my OSCE. I used only videos for preparation and by God's grace i passed. Thank you

[@unifiedosce5580]

Congratulations 🎊 👏, keep winning. Thanks for your feedback.

[@MaryAsamoahMansohSam]

I enjoyed every step of the procedure.well done

[@iXmorph]

1.⁠ ⁠Patient received codeine maleate (or another analgesic, excluding Co-Codamol & PCM) 1-2 hours prior to your TIME . ⁠Patient still verbalizes pain and has a PRN order for PCM. Would you administer the PCM, considering the previous analgesic administration? 2. You administer codeine maleate (or any other analgesic excluding co-codamol and Pcm) to the patient during your TIME. The patient has a PRN order for PCM and still verbalizes pain. Would you still administer the PCM since u just gave codeine , or take alternative actions?

[@unifiedosce5580]

Paracetamol and Codiene can be given at the same time. They are 2 different categories of analgesic . Paracetamol and Cocodamol need a minimum of 4 hours before a repeat of either Paracetamol, Codiene, or Cocodamol.

[@iXmorph]

@ thank you 🙏🏾

[@imaobongmoses8394]

Please what code should I use when the route for drug administration is not stated. Secondly can I document code 6 at the last page of omitted drugs if I had incorrect prescription

[@unifiedosce5580]

Hi, code 6 is ok( incorrect prescription) there will be an instruction at the part for coded medicines, just go by the instruction please.

[@sheylatsadenike8526]

So it not neccessary to write date only signature at the given time column

[@unifiedosce5580]

Hi, it's ok to write the date & signature. For the prn indicate the time given.

[@boatenggraceagyenim4316]

Hi please is it right to break tablet into two and give half to your patient if the available dose is 5mg and prescriber is 2.5mg or you will have to code it

[@unifiedosce5580]

Hi, you are not allowed to split Tablet, you will need to code with the right reason.

[@iXmorph]

(1) Pls Ma’am, I have an EOL patient with end-stage congestive heart failure (CHF) and bilateral leg swelling was administered a stat dose of 80mg Furosemide at 8:00. The patient is due for their regular 80mg Furosemide dose at 12:00 (my TIME- 4 hours after the stat dose) and 22:00. Should I still administer the regular dose of 12:00 or code since the stat dose has been given? Ps: The pts vitals are within therapeutic range 2) Also Ma’am, if a medication doesn’t have start date appended, do u code as incorrect/unclear (6)

[@unifiedosce5580]

Hi, it depends on the frequency stated . If bd this might need to be coded. Stat date is part of the requirement on a prescription.

[@iXmorph]

@@unifiedosce5580 Thank You Unified OSCE for your prompt response. However, since Furosemide is a water pill and cause increase urinary frequency and disturb night rest, should I administer by 12:00 for this reason and verbalize that the dose for 22:00 might be skipped so as not to disturb the patients rest/sleep pattern?

[@unifiedosce5580]

Hi ​@Yitzvah , in as much as every other RIGHTS are ok, you can give.

[@preetsabherwal7183]

Hi How to administer regular medicine with code x ?What is indicated by code x?Can you please clarify?

[@unifiedosce5580]

Hi, you are likely to have x in a time before your administration time. It is likely that the medication was given already .

[@preetsabherwal7183]

@@unifiedosce5580 Thank you so much for a swift reply.

[@jinishmjohn1198]

Hi wat is the code for ommision if patient has allergy...is it 6?thanks

[@unifiedosce5580]

Hi, you can ho for code 10

[@unifiedosce5580]

Hi, you can go for code 10

[@cynthiachinenye4967]

God bless you for your good works. I will be writing my osce next week believing God for success. Please what are the control drugs we are not expected to administer in implementation. I wii be glad to get a response from you please

[@unifiedosce5580]

Hi, if you have a controlled medication, just request your assessor to cross-check with you. Waiting for your success story 🎉.

[@iXmorph]

Hello… Thank you for this Video. Pls, why did u administer Digoxin and Furosemide even when the assessor mentioned that the patients HR and BP are within therapeutic range?

[@unifiedosce5580]

Hi, the therapeutic value is about if the value is within the acceptable rate. E.g For, Digoxin HR - 60 & above is safe to give.

[@iXmorph]

I deeply grateful. Thank you for the speedy response 🙏🏾

[@oluwatoyinagbaje3843]

Please, if there is not any allergies reactions, will one still need to sign and write date and bleep number on the allergies column or just need to tick alone?

[@unifiedosce5580]

Hi, the allergy part would have been prefilled with the Doctor's name and bleep number.

[@theodoraanulikaobi6161]

Why did first say that you're happy to give this medication and later said assessor am not giving this medication...please help

[@theodoraanulikaobi6161]

Digoxin

[@unifiedosce5580]

Hi, just making reference to putting the dot, just to clarify that I'm not giving it at that point. But I will be coming back to give it.

[@OnneileRichard-f2n]

Hi, thanks for the great presentation. Please share with us other meds that are likely to come in the chronic cardiac failure, eg: furosemide, bisoprolol, ramipril, .......and what else please?

[@unifiedosce5580]

Hi, you have mentioned the likely ones,wishing you success 🎉.

[@AmandaKelavaDennehy]

@@unifiedosce5580 for example what if I have only furosemide, ramipril and bisoprolol to administer with BP being 120/80 . would you proceed with all 3 if validity and timing is correct ?

[@unifiedosce5580]

Yes it's ok to give as long as all the checks are satisfied

[@poonambhattarai8755]

Do uou have video on evaluation in heart failure

[@unifiedosce5580]

kzbin.info/www/bejne/ZnO1fayFidqapa8si=1i_Uhl1DQLUY9EV2 Hi pls use the link above for A-E assessment on Heart Failure. We will keep you posted when we upload a video on the evaluation station. Thank u

[@preciouskatenga2311]

can you do implementation under end of life

[@josephjohnson5429]

how can have a print out of the MAR sheet?

[@unifiedosce5580]

Hi, you can take a screenshot .

[@ceciliathomson2659]

Thank you for the well elaborated implementation

[@richluvadonu2385]

Do you still have to administer the medication if the pharmacy check is blank?

[@unifiedosce5580]

Hi, you are likely to have pharmacy check in OSCE.

[@richluvadonu2385]

@@unifiedosce5580 Thank you for the reply.

[@Poojachamling]

Thankyou so much❤️got a question If paracetamol is already given in 4:00 hour in stat dose and again in regular same pcm is prescribed at my due time 8:00 hour So can i give pcm its exact 4 hours difference

[@unifiedosce5580]

Hi, Yes. Paracetamol can be given 4 hours minimum interval from the last dose.

[@Poojachamling]

@@unifiedosce5580 thankyou so much ❤️

[@Lauwinky]

hello if the drug has already given or not due my time still need to read out everything ? for digoxin the date its 5 days ago not today still right time ?

[@unifiedosce5580]

Hi, if it is not due at your time of medication administration, you need to read every details, but you will not need to explain the action side effects . Prescription is valid, even though it was started 5days ago. Thanks

[@Lauwinky]

@@unifiedosce5580 thx so nice of u to give me prompt reply

[@maryamk8711]

Thanks for the video! For Furosemide the frequency is QD while the time is only 08:00. The prescription is incorrect. Can we code it?

[@unifiedosce5580]

Hi, in OSCE the 4 timings will be written, however as long your due time is stated, all other validity and legibility are ok. No need to code. Thanks

[@maryamk8711]

So in OSCE if the frequency is QD and just written 08:00 . What should I do? Many thanks for your quick response 🙏🙏🙏

[@unifiedosce5580]

​Hi, It is ok to give, if other legibility & validity are ok.

[@annmonicah3625]

Thank you unified. Got this in implementation unfortunately dint give furosemide

[@unifiedosce5580]

@annmonicah3625 HI, wishing you success, it depends on your reason why you did not give. In this scenario IV was given 5 days ago, if in your scenario IV was given same day, and the regular tablets is daily. It is still OK not to give.

[@aanbivlogs3645]

hi on implementation if there is no duration on regular medicine do we code or give ?? if code what number do we use ,?? is it code 6

[@Poojachamling]

Thankyou mam, for omiting hypertensive medicine,what is the lowest blood pressure value mam

[@unifiedosce5580]

Hi, a general rule might not be applicable, it depends on the clinical situation. I will suggest if systolic is less than 100mmhg.

[@Poojachamling]

@@unifiedosce5580 thankyou so much ☺️

[@zeq2241]

Great presentation, if we have a code of 5 at medication do we have to signed it at omitted doses of medicine? Or that is only for code 10? Thanks.

[@unifiedosce5580]

Hi. the instruction at the back will state if you are to write medication coded 10 or all coded medications. Thanks

[@manishrai9352]

hi thankyou so much for everything if there is no finish date and duration in lactulose i.e senna which is prescribed under REGULAR medication, is it valid or invalid prescription

[@unifiedosce5580]

Hi, Lactulose is different from senna, although action might be similar. If you don't have a start date and finish date or ongoing under regular , that renders the prescription incomplete .

[@issahyassir4259]

Hello When you have a medication under regular medication, start date was given, finish date- ongoing, duration was blank, is the prescription valid.

[@unifiedosce5580]

Hi, the duration is required along with other required details to consider a prescription valid & legible.

[@hannahhanns5027]

Hi dear if duration is not Indicated can I fail to administer and code it instead

[@unifiedosce5580]

Hi, you may not have duration in some prescription, but it may indicate ongoing. If it is ongoing, it is ok in as much as other factors are met.

[@simplynanaadwoa7530]

Hi unified OSCE can you help me clarify y question patient is in pain and PRN paracetamol 1g is due to be given As soon you were about to give PMOL patient started complaining of Nausea Do you have to give the pain med and escalate the Nausea or Stop giving the paracetamol because patient is Nauseous. what do you have to do in this scenario (End of Life Care)

[@unifiedosce5580]

Hi, check if due for PRN antisickness. If not verbalise you will escalate to the medical team. Find out if patient can still manage to take the medication, then you can give the due paracetamol.

[@simplynanaadwoa7530]

@unifiedosce5580 Thank you so much there was no Antisickness prescribed. So I can just verbalise the escalation of Nausea And go ahead with my PRN pain medication I failed because of that

[@Lauwinky]

may I ask qd means everyday or four times a day/?

[@unifiedosce5580]

6 hourly in 24 hours or 4 times in 24 hours.

[@theshadowjack1366]

Great video!!!

[@kafirirosemary1617]

OK thanks very much

[@akwaraochuko2380]

Ma , the last aspect of the chart written Notes with(new,amended,unchanged,supply At home ) what does it mean? Should we ignore it

[@unifiedosce5580]

Hi, not sure of the aspects you are referring to. It is advisable to read every part to avoid missing out on any details .Thanks

[@oluwatoyinagbaje3843]

She mean under regular medicines,by your right hand side, under Notes,that was written New,Amended,Unchanged, Supply at home, what will I tick?

[@favouredfola]

Thank you for this video

[@TheresahKarikari]

Please what is the meaning of delayed doses at the back of the chart. Can you explain please

[@unifiedosce5580]

You wouldn't have any reason to delay a medication in OSCE but in clinical practice,if your patient is on a daily medication and due at maybe 08am but the patient is NBM and you know by noon the patient will be allowed to eat you can delay the medication and to give it later.

[@kafirirosemary1617]

Thanks for the video But furosemide was given at 6.30 o'clock intravenous then under regular it was prescribed to give furosemide at 8.oo o'clock Qds. To my understanding I would code furosemide because of time range 6.30 and 8.oo o'clock difference of two hours and half. Waiting for your response Thanks

[@erikaehibor2406]

Frusemide was given at 16:30hours

[@unifiedosce5580]

Yes it was given a t 16:30 our edit made it appear as 6:30. You can see the time due was 16 hr. Thanks😅

[@maryamk8711]

Hi dear Unified OSCE, thanks for answering my questions whenever I had doubts about some stations🙏🙏🙏 Is the bleep number important? I mean can I give medicine without the bleep in the hospital. Also can we administer low dose Oxycodone or not in OSCE exam? I would really appreciate your support for overseas nurses🙏🙏🙏

[@unifiedosce5580]

Hi, Yes the Bleep number is important for hospital setting, if bleep number is missing, that renders the prescription incomplete. . But sometimes in community settings you may not have the bleep number, this is acceptable but this will be consistent with all your MAR charts. For the oxycodone, it is a controlled medication, if other factors are ok, you will request the assessor to please countersign with you.

[@maryamk8711]

Thanks a lot 🙏🙏🙏

[@giftedgal3615]

If my patient's blood pressure is high and patient was prescribed Antihypertensive due my time every other thing was written but there is no finish date will i serve this medication

[@unifiedosce5580]

There should be a finish date, state that you'll quickly escalate to the Dr to complete the prescription after your procedure and you'll come back to administer it.