Module 1: Nursing Management of Drug Therapy

Question 1

Drug Indication

Answer 1

Drugs may be prescribed for more than one reason (i.e.):
1. Beta blockers — used to decrease HR, decrease BP, and/or treat migraines

2. Aspirin — used for pain relief and/or prevention of platelet aggregation

Question 2

Nursing Management of Drug Therapy: Assessment

Answer 2

Baseline:

1. Pt’s condition prior to drug admin. — observations (vitals & system assessment) and labs
2. Medical history — liver failure, renal disease, malabsorption syndrome
3. Medication history — what does the pt take at home? What have they taken previously?
4. Allergies — RXNs

Documentation: What are the orders?

Diet:

1. Restrictions (NPO)
2. IV access

Question 3

Nursing Management of Drug Therapy: Planning

Answer 3

Some drugs cannot be given at the same time; must change the order of drug admin. (i.e. calcium antacids impair the absorption of other drugs)

THE FIVE RIGHTS:
1. Right pt — 2 identifiers (name, birthdate, or MRN)

2. Right medication — Check med. (lower & uppercase lettering to differentiate look/sound-alike meds.; DDIs; Generic may not be the same as trade drug), and check expiration
3. Right dose — Compare ordered dose with usual dose; Assess for metabolic (liver disease) or elimination issues (renal disease); Med. (i.e. dopamine) may be dose-weight based; Dose varies with age (especially the very young & old)
4. Right route — Some meds. (i.e. morphine) are affected by first pass effect (a phenomenon of drug metabolism whereby the concentration of a drug, specifically when admin. orally, is greatly reduced before it reaches the systemic circulation)
5. Right time — Note intervals; PRN meds.; Some meds. (i.e. HTN meds., diuretics) can be detrimental if admin. in the morning

Question 4

Nursing Management: Intervention

Answer 4

Right documentation:
1. Document if admin. or not; if not admin - why?

2. If not given, notify team and any adverse issues (i.e. BP med. held because BP <80/50; team notified, new vitals obtained)

Question 5

Nursing Management: Evaluation

Answer 5

Reassess (intended effect):
1. Vitals

2. Glucose — S/S of hypo/hyperglycemia
3. Urine output
4. Lung sounds
5. Adverse effects — i.e. drop in BP, decreased RR, S/S of hypoglycemia

Question 6

Pt Education

Answer 6

Pts and their families need to know:
1. Intended effects

2. AEs
3. Diet restrictions
4. Interactions
5. When to speak to their provider or pharmacist

Question 7

Nurse-Pharmacist Collaboration

Answer 7

Collaborating with a pharmacist can:
1. Provide a correct dose for a pt based on new evidence

2. Decrease pill burden by combining meds.
3. Maintain generic vs. trade meds.
4. Find more affordable drug options
5. Help the nurse look for hidden AEs via lab data