 Kerja Khusus : Kerja khusus akan dibuat dalam bentuk persembahan video.

Setiap kumpulan
haruslah membuat rakaman video tentang prosedur berkenaan ubatan mengikut kreteria yang
diberikan :
1) haruslah membahagikan kumpulan kepada 5-6 orang
2) Setiap kumpulan akan diberikan satu scenario kes yang bersangkutan dengan
kumpulan ubatan tertentu
3) Pelajar dikehendaki mencari nama ubatan yang biasanya digunakan di Hospital
Kerajaan berdasarkan scenario yang diberikan.
4) Pelajar dikehendaki melakonkan scenario yang diberikan berserta prosedur tertentu
berkenaan ubatan tersebut.
5) Penilaian akan diberikan berdasarkan :
Nama Prosedur Indikasi Kreativiti Tahap releven Total
Ubatan Pemberian Ubatan Pemberian lakonan dan kandungan
Ubatan persembahan
1% 4% 2% 1% 2% 10%

6) Kerja kursus haruslah dihantar pada :

Tarikh Hantar: 7th March 2011 (Group A ,B,D)
4th March 2011 (Group C)
Hari: Isnin (Group A ,B,D) & Jumaat (Group C)
Masa: Sebelum jam 5 p.m (bagi semua group)
Tarikh Persembahan : 21th -25th March 2011(Group A ,B,D)
7th – 11th March 2011 (Group C)
7) Sebarang kelewatan akan dikurangkan 1 markah bagi 1 hari kelewatan.

Soalan 1 :

Kamu merupakan seorang jururawat yang bertugas di klinik kesihatan Bandar Mas. Pegawai perubatan
telah mengarahkan pemberian STAT infusi IV antibiotic. Apabila kamu menerima bag berisi ubat
antibiotic, didapati ubat tersebut tersalah dos. Bagi membetulkan dos ubat dan menghantar dos ubat
yang baru memerlukan 2 jam.

1. Setelah menerima ubatan dengan dos yang tepat, anda dapati ubat tersebut telah 2 Jam berlalu
sejak ianya di arahkan pemberian STAT. Lakonkan scenario berserta tindakan kejururawatan yang
sesuai.
 This delay would be considered an error because for a stat order you have a 30-minute time frame;
for an order that is for now, 30 minutes is all you have, so in this scenario there would be claim for
medication error. Protocol for handling the situation before giving the drug:
 Monitor the patient.
 Perform and document vital signs and a head-to-toe physical assessment.
 Contact the physician and explain the situation.
 Complete any new orders and make sure that the drug is given on time if that is what the
doctor ordered, meaning if the doctor says to go ahead and give the late drug, then do so
and then have the doctor approve any change in timing of the drug.
 Complete incident report with the explanation for why the drug was late.
 Make sure the name of the pharmacist that filled the order is given to the physician and
noted in the incident report.
 If the other four of the five rights are met, then after the order has been clarified, the
situation handled, and the patient is safe and has received the drug appropriately,
document and report to charge nurse.

Many more general and even more specific suggestions are covered in Chapter 5. Review, read, and
prepare.

Soalan 2

1. Kamu ditugaskan pada shift malam.Kamu ditugaskan untuk memberikan antibiotic kepada seorang
pesakit berumur 86 tahun pada malam itu. Semasa ingin memberikan ubatan yang diarahkan,
pesakit menolak pemberian ubatan dan mengatakan bahawa beliau sudah menerima ubat tersebut
sebentar tadi. Lakonkan scenario berserta tindakan kejururawatan yang sesuai.

Whenever a patient questions a particular medication or mentions something about the medication
that is not in accordance with what the nurse thinks, the nurse should always be prudent—stop,
recheck the doctor’s order against the medication administration record or profile, and check the
medication record/profile to determine if a dose was given and signed off by another nurse. With
this patient, it would be prudent to check the orders against the medication profile as stated above,
just to be safe. If all records and orders have been checked and the nurse is certain that the drug has
not been given, then the nurse should proceed with medication administration. Never assume that
the patient is unaware of his or her medication; always double-check to be safe. A simple
explanation could then be given to the patient. If the patient continues to refuse the medication,
document this in the nurses’ notes and report it to the charge nurse or nurse supervisor and the
physician.
Soalan 3

1. Encik Hazami dimasukkan ke unit kebakaran dengan kecederaan multisystem (multisystem injury)
akibat kemalangan jalanraya. Keputusan pemeriksaan mendapati pesakit mempunyai pelbagai
keputusan yang tidak normal. Beliau mengalami renjatan (shock) dengan symptom-simptom seperti
kurang cardiac output, dan urine output kurang dari 30 ml/L. Pegawai perubatan mengarahkan
pemberian diuretic kepada pesakit. Anda dikehendaki mencadangkan kepada pegawai perubatan
bertugas mengenai kaedah pemberian ubatan yang sesuai bagi pesakit ketika itu. Lakonkan scenario
berserta tindakan kejururawatan yang sesuai.

Intravenous therapy would be most appropriate because it allows immediate access of the drug to
the bloodstream. With IM or SC injectable forms of medications, absorption of the drug from the
vascular area within a muscle, or within subcutaneous tissues, is required before absorption into the
bloodstream. With patients who are in shock or have decreased cardiac output or decreased
peripheral circulation, the IM forms would not be so well absorbed.

Soalan 4

1. Pesakit anda merupakan seorang Orang Asli berumur 56 tahun. Anda dikehendaki memberikan
cardiac glycoside kepada pesakit. Malangnya pesakit tidak memahami bahasa yang anda gunakan.
Anda dikehendaki membuat satu pelan tindakan kejururawatan bagi mengatasi masalah tersebut.
Lakonkan scenario berserta tindakan kejururawatan yang sesuai.

Most plans should reflect the use of an interpreter, but more importantly, the plan of care should
reflect an individualized approach to educating the patient about the toxic effects of this
medication. The following provides a simple guideline for assessment and implementation and the
other phases that depend on the information assessed:
  Assessment: evaluate prior knowledge and some of the following: use of other drugs and
compliance; ability to take pulse rates at home; drug allergies, understanding of materials
presented; support at home; other health problems; financial/economic needs.
 Implementation: teach about taking pulse for 1 minute; journal recording; reporting of
adverse effects or signs and symptoms of toxicity (anorexia, nausea, vomiting, P < 60); side
effects to expect; how to maximize the dosage by taking it before meals and at the same
time every day. For more information please take a look at the information on digoxin and
digitalis in Chapter 21.

Soalan 5

Encik Harun baru selesai menjalani pembedahan arthroscopy. Pegawai perubatan mengarahkan
pemberian opiod analgesic kepada pesakit secara Intravenous (IV). Anda dikehendaki membuat
penilaian sebelum dan selepas pemberian ubatan. Lakonkan scenario berserta tindakan kejururawatan
yang sesuai.

Soalan 6

Seorang pelajar jururawat berusia 19 tahun ditemui tidak sedarkan diri di sebuah bar selepas meminum
beer sepanjang hari di sana. Beliau menghidapi grand mal seizures sejak enam tahun yang lalu.
Mengikut sejarah perubatan beliau, grand mal seizures tersebut berjaya dikawal dengan agen anti-
epileptic . Anda diminta memberikan anti-epileptic kepada pesakit setelah beliau sedarkan diri. Anda
dikehendaki memberikan nasihat dan arahan sebelum pemberian ubatan. Lakonkan scenario berserta
tindakan kejururawatan yang sesuai.

Soalan 7

Puan Maimun berumur 81 tahun menghidapi congestive cardiac failure. Beliau diberikan dengan
furosamide 80 mg bd, tetapi simtom-simtom kesesakan nafas dan peripheral edema tidak
menampakkan sebarang perubahan. Pegawai perubatan bercadang ingin menukarkan furosamide
kepada potassium-sparing diuretic. Anda dikehendaki membuat penilaian sebelum , semasa, dan
selepas pemberian ubat. Lakonkan scenario berserta tindakan kejururawatan yang sesuai.
Soalan 8

Anda ditugaskan menjaga seorang pesakit yang menghidapi darah tinggi. Semasa membuat rondaan,
pesakit mengalami hypertensive crisis. Pegawai perubatan mengarahkan pemberian ubatan dalam
kumpulan nitrogen oxide bagi menurunkan tekanan darah dengan cepat. Anda dikehendaki menilai
perkara yang perlu diambil kira pada pesakit semasa mengalami hypertensive crisis dan diberikan
ubatan yang mengandungi nitrogen oxide. Lakonkan scenario berserta tindakan kejururawatan yang
sesuai.

Soalan 9

1. Seorang pesakit diberikan ubat antipembekuan darah melalui intravenous sejak 3 hari yang lalu.
Semasa anda melakukan pemeriksaan, pesakit mengatakan rasa kebas dan ‘semut-semut’ (tingling
sensation) pada bahagian anggota badan. Apabila anda cuba membangunkan pesakit, didapati,
pesakit lemah dan rebah. Beliau mengatakan bahawa 6 jam lepas beliau boleh melakukan aktiviti.
Apakah tindakan anda. Lakonkan scenario berserta tindakan kejururawatan yang sesuai.

This patient was without these complaints prior to the heparin infusion. The change in neurologic
functioning requires discontinuing the IV heparin, contacting the physician immediately, monitoring
the patient’s vital signs and physical assessment findings (especially neurologic assessment findings),
and completing accurate documentation. The neurologic changes identified in this situation could
represent an intraspinal bleed, and further medication might exacerbate the damage. Contacting
the physician is important. The situation may be explained to the physician and new orders
received. Further assessment of the neurologic and other organ systems and obtaining vital signs
are essential for baseline information. The importance of the situation should be emphasized to the
physician, especially because the patient’s significant findings were not present prior to the drug
therapy.

Soalan 10

1. Seorang pesakit berumur 45 tahun dengan berat badan 120kg telah dimasukkan ke wad kerana
menghidapi Diebetic Type 1. Beliau diarahkan menjalani terapi diet 1500kcal diebetic diet. Pegawai
perubatan mempreskripsikan 18 unit insulin bd dan antidiebetic Second Generation Sulfonylurea
qid.Pada pukul 4 petang , pesakit mengalami perpeluhan yang banyak,kelihatan lemah, dan pucat.
Lakonkan scenario berserta tindakan kejururawatan yang sesuai.

These are symptoms of hypoglycemia that may occur secondary to insulin dosage. A adjustment
downward in dosage may be needed—but only with physician’s orders—to prevent repeated
 episodes of hypoglycemia. Patient teaching should cover how to manage hypoglycemia and
hyperglycemia should they occur once the patient is discharged.

Soalan 11

1. Seorang pesakit perempuan berumur 73 tahun dimasukkan ke wad. Beliau pernah merokok dan
telah memberhentikan tabiat merokok sejak 8 tahun yang lalu dengan cara mengamalkan meminum
teh setiap hari. Pegawai perubatan mengarahkan pemberian xanthine derivatives melalui
intravenous dengan kadar 0.8mg/kg/jam bagi mengawal kesesakan nafas yang dialaminya. Lakonkan
scenario berserta tindakan kejururawatan yang sesuai.

Coffee, tea, chocolate, cocoa, and cola beverages contain xanthine. Consumption of these beverages
will increase or exacerbate CNS stimulation associated with the xanthine-derivative medications.
Overstimulation of the CNS may have a severe impact on the patient and, if excessive, could be life-
threatening.

Soalan 12

Anda bertugas di wad surgical lelaki. Seorang pesakit yang telah menjalani pembedahan pada bahagian
abdomen mengadu sakit pada bahagian abdomen, dan loya. Semasa shift pagi, jururawat bertugas
melaporkan bahawa najis pesakit berwarna hitam. Apabila dilihat apad lembaran sejarah, didapati
pesakit pernah menghidapi peptic ulcer. Beliau juga ada mengambil ubat OTC ibuprofen selain
menerima rawatan IM tramadol prn. Lakonkan scenario berserta tindakan kejururawatan yang sesuai.