Intro to pharm Flashcards
(37 cards)
NURSING PROCESS
There are 5 steps to the nursing process
1. Assessment
2. Nursing Diagnosis
3. Planning
4. Interventions/Implementation
5. Evaluation
Nursing Process (2)
-Assessment
-Subjective data
-Current health history
-Client symptoms
-Current medications
-Past health history
-Client’s environment
-Primary language and communication needs
Nursing Process (3)
-Assessment
-Objective data
-Physical assessment (VS, physical exam)
-Laboratory tests (CBC, kidney/liver function, etc)
-Diagnostic studies (MRI’s, CTscans, etc)
Nursing Diagnosis
-Formula:
Nursing diagnosis…..related to (R/T)…….as evidenced by (AEB)……
-Common nursing diagnoses related to drug therapy
-Deficient knowledge about drug action, administration, and side effects related to cultural/language barrier
-Ineffective health maintenance related to forgetfulness
-Injury, risk for r/t side effects of drug
Goals
-Characterized by goal setting (or expected outcomes)
-Example: Client EV will independently administer prescribed dose of albuterol by the end of the first session of instruction
-Characteristics of a goal:
Client Centered
Realistic and measurable (quantifiable)
Realistic deadlines (timeframe)
Interventions/ImplementationGuiding the patient
-Nursing actions (interventions) necessary to accomplish the goals (outcomes)
-Client teaching
-General
-Self-administration
-Diet
-Side effects
-Cultural considerations
Evaluation
-Ongoing and related to progress and goal achievement
-Related to achievement of goals; if not met, reassess and continue
-Determine need for follow-up
-Refer to community resources
Checklist for Health Teaching in Drug Therapy
-Comprehensive drug and health history
-Reason for medication therapy
-Expected results
-Side effects and adverse reactions
-When to notify health care provider or pharmacist
-Drug-drug, drug-food, drug-laboratory, drug-environment interactions
Right’s of Drug Administration
1.Right client
2. Right drug
3. Right dose
4. Right time
5.Right route
6.Right documentation
Right reason
Client’s right to refuse
Safety in Medication Administration
Medication errors can result in; serious illness, conditions that prolong hospitalization or require additional treatment, or death.
Common medication errors include:
Giving an incorrect dose
Not giving an ordered medication
Giving an unordered medication
Culture of Safety
Institute of Medicine Report (1999)
To Err Is Human: Building a Safer Health Care System
Bar Code
Computerized prescriber order entry
The Joint Commission (2005)
Evidenced-based nursing – obtaining and analyzing the best scientific research to promote high-quality care to clients
Drug order components
-Date and time order is written
-Drug name
-Drug dosage
-Route of administration
-Frequency and duration of administration
-Any special instructions for withholding or adjusting dosage based on nursing assessment, drug effectiveness or labs
-Physician or other HCP’s signature (PROVIDER)
-Signature of licensed practitioner taking TO or VO
Disposal of Medications
Proper disposal of medications
-Follow specific information on drug label or insert
-Do not flush drugs down toilet unless specifically instructed
-Transfer drug from original container to undesirable substance (i.e. narcotics in kitty litter)
-Return drugs to community “drug take-back” program
-Remove all identifying information on container
-Consult pharmacist
Routes of administration of drugs
Sublingual (under tongue)
Buccal (between cheek & gums)
Oral (PO)
Transdermal (patches)
Topical (cream, ointments)
Instillation (sprays –aerosol, mouth; drops – ear, eye)
Inhalations
Enteral (Nasogastric and gastrostomy tubes)
Suppository (vaginal, rectal)
Parenteral (intradermal, subcutaneous, intramuscular & intravenous)
Intravenous (IV)
Subcutaneous (SQ)
Intramuscular (IM)
Medication Orders
MUST include:
-Patient’s full name
-Full name of drug (not initials)
-Dose
-Route
-Frequency
-Time, date, & signature of prescriber
Order examples
Good example:
-Zofran 4mg IV every(Q) 4 hours PRN
Bad examples:
-MS 4mg IV Q 2 hrs PRN
-Tylenol 650mg PO PRN
-Azithromycin IV Q 12 hrs
Pharmacology
-Effectiveness & usefulness
-Safety: ? 100%
-Selectivity & ability to illicit wanted response
-Predictable
-Ease of administration
-Freedom from drug interactions
-Low cost
-Chemically stable
-All have generic (small case: valacyclovir) & trade name (capitalized: Valtrex)
Drug Classifications and Drug Names
How to use a Nurse’s Drug Guide
Look up the drug Aspirin;
trade name Mechanism of Action (MOA)
generic name Dosage
classification Contraindications
Pregnancy category Adverse Effect
Adverse Reaction
Drug
Drug: Any chemical that can affect processes
Pharmaceutic Phase (Dissolution)
-First phase of drug action
-Solid drugs or tablets disintegrate in the process of dissolution to allow for absorption
-Liquid drugs more readily available for absorption by the body
-Acidic fluids tend to enhance disintegration and absorption
-The decrease in the acidic gastric environment of the young and old often decrease rate of drugs absorbed in the stomach
-Enteric coated tablets do NOT disintegrate well in the acidic stomach and therefore are absorbed in the alkaline small intestine
Pharmaceutic (dissolution)
Tablets and capsules must disintegrate into small particles to dissolve into liquid. Tablets are not 100% drug. Excipients (fillers & inert substances) added to enhance drug dissolution.
Drugs in liquid form are already in solution.
Dissolution: dissolving of smaller particles in the GI fluid before absorption.
Liquid form medications more rapidly available for GI absorption than are
solids.
Pharmaceutic (dissolution) (2)
-Food may enhance or inhibit absorption of medications
-Therefore, medications may often be dispensed with specific instructions for administration with or without food
-Other drugs may irritate the stomach, and taking them with food will reduce this effect
Pharmacokinetics
Four processes
-Absorption: movement of drug particles from GI tract to body fluids
-Distribution: process by which drug becomes available to body fluids and body tissues
-Metabolism (biotransformation): converted or transformed into useable state
Main site of metabolism- LIVER
-Excretion (elimination): main route-KIDNEYS
other routes: hepatic metabolism, bile, feces, lungs, saliva & breast milk
Absorption
Process of time that occurs between when a drug enters the body and the time it enters the blood stream
-Factors that affect absorption
-Enteric coated: (SR, ER & XR)
-Surface area of intestinal tract
-GI transport time
-Blood flow to GI tract
-Lipid soluble
Absorption
-Hepatic First Pass: drug passes to the liver first
-Drugs don’t go directly into systemic circulation
-After oral intake → to intestinal lumen → liver (via portal vein)
-In liver: drugs may be metabolized to inactive form
-Then drugs can be excreted
-RESULT: REDUCED AMOUNT OF ACTIVE DRUG
