An error-which also includes omissions-can seriously affect a patient, even to the point of causing death. Each Hospital Corpsman is responsible for his own actions, and this responsibility cannot be transferred to another. No one individual is expected to know all there is to know about all patients and medications. However, in every healthcare environment, the Hospital Corpsman can access other healthcare providers who can assist in clarifying orders; explaining the purposes, actions, and effects of drugs; and, in general, answering any questions that may arise concerning a particular patient and that patient's medications. There should be basic drug References available to all personnel handling medications, including the Physicians'Desk Reference and a hospital formulary. As a Hospital Corpsman, it is your responsibility to consult these members of the team and these References for assistance in any area in which you are not knowledgeable or whenever you have questions or doubts. You are also responsible for knowing and following local policies and procedures regarding the administration of medications.

Food and Fluid Therapy
The following brief discussion covers food and fluid and how it relates specifically to the medical patient. Loss of appetite, food intolerance, digestive disturbances, lack of exercise, and even excessive weight gain influence a medical patient's intake requirements. Regardless of their medical problems, patients have basic nutritional needs that frequently differ from those of the healthy person. As a part of the patient's therapeutic regimen, food is usually prescribed in the form of a special diet. Regardless of the kind of diet prescribed, the patient must understand why certain foods are ordered or eliminated, and how compliance with the regimen will assist in his total care. It is the responsibility of the Corpsman to assist the patient in understanding the importance of the prescribed diet and to ensure that accurate recording of the patient's dietary intake is made on the clinical record.

In many disease conditions, the patient is unable to tolerate food or fluids or may lose these through vomiting, diarrhea, or both. In these cases, replacement fluids as well as nutrients are an important part of the patient's medical management. Onthe other hand, there are several disease conditions in which fluid restrictions are important aspects of the patient's therapy. In both of these instances, accurate measurement and recording of fluid intake and output must be carefully performed. Very frequently this becomes a major task of the staff Hospital Corpsman.

Patient Teaching
Earlier in this chapter, under "Patient Education," the goals and principles of patient teaching were addressed. When taken in the context of the medical patient, there are some general areas of patient teaching needs that must be considered, particularly as the patient approaches discharge from an inpatient status. Those areas include the following:

Follow-up appointments
Modification in daily living activities and habits
Modification in diet, including fluid intake
Medications and treatment to be continued after discharge

Measures to be taken to promote health and prevent illness

Rest
The primary reason for prescribing rest as a therapeutic measure for the medical patient is to prevent further damage to the body or a part of the body when the normal demand of use exceeds the ability to respond. However, prolonged or indiscriminate use of rest-particularly bed rest-is potentially hazardous. Some of the common complications occurring as a result of prolonged bed rest are

circulatory problems (such as development of thrombi and emboli) and subsequent skin problems (such as decubiti);
respiratory problems (such as atelectasis and pneumonia);

gastrointestinal problems (such as anorexia, constipation, and fecal impactions);
urinary tract problems (such as retention, infection, or the formation of calculi);
musculoskeletal problems (such as weakness, atrophy, and the development of contractures); and
psychological problems (such as apathy, depression, and temporary personality changes).

The prevention of complications is the key concept in therapeutic management for the patient on prolonged bed rest. Awareness of the potential hazards is the first step in prevention. Alert observations are essential: Skin condition, respirations, food and fluid intake, urinary and bowel habits, evidence of discomfort, range of motion, and mood are all critical elements that provide indications of impending problems. When this data is properly reported, the healthcare team has time to employ measures that will arrest the development of preventable complications.