before admin. any meds. what must the nurse have?
current license, policy statement that authorizes the act, med order signed by Dx w/ prescriptive privileges, understand the Pt's Diagnosis and symptoms, and correlate w/ the rationale for drug use, know why med is ordered, expected actions, usual dosing, proper dilution, route and rate of asmin. side effects to expect/report, contraindications of the drug, if IV know how to calculate the drip factor, and the compatibility, site be confirmed before admin, accurate calculations, and Pt teaching
claiming unfamiliarity w/ any nursing responsibililites, when avoidable complications, is what?
unacceptable and is considered negligence of nursing responsibility
gives Pt's name, address, dob, attending physician, gender, marital status, allergies, nearest relative, occupation and employer, insurance carrier, religion, date of admin, Dx, previous hospital admissions
Physician's Order form
all procedures and treatments are ordered by the Doc. are on this form...they MUST be on this form
History & physical Exam form
full exam/interviewed and all findings are listed (recorded) on this form
also referred to as integrated care plans, care or clinical maps... this describes a multidisciplinary plan used by all caregivers to tract the Pt's progress
head to toe physical assessment and a Pt and family History, cultural data...spiritual needs
Nursing Care Plan
incorporate nursing Diagnosis, Critical Pathway information and physician ordered & nursing ordered care
Medication Administration Record (MAR)
printed from Pt database, insuring that the Pharmacist and the nurse have identical medication profiles for the PT, it also provides space for recording the time the med was administered and who gave it. nurse also records her initials and time admin
to coordinate Pt care provided to individuals, their families and sig. others on a continuum
Kardex (this is not legal doc)
large index card kept on flip file of seperate holder that contains personal info, Dx, allergies, schedule of current meds, w/ stop dates,treatments, Pt's name, and the current meds
Floor or Ward Stock System
no charges, small hospitals, dangerous drugs are kept at the nursing station, gov. hospitals, increased danger of of unnoticed passing of expiration date, increased amts of expired drugs to be discarded, INCREASED POTENTIAL FOR MEDICATION ERRORS BECAUSE OF THE LARGE ARRAY OF DRUGS STOCKED IN THE CART....PHAMASISTS DOES NOT GET THE OPPORTUNITY TO OVERSEE WHAT IS HANDED OUT
individual prescription order system
meds are dispensed from the pahrm. upon receipt of prescription or drug order for an individual Pt, usually a 3-5 day supply
Computer Controlled Dispensing System
newer, that is supplied by pharmacy daily, and stocked w/ singel unit packages of meds. scanners are used, barcodes, i the wrong med for that Pt is selected an alarm will sound to stop the nurse...this is the SAFEST AND MOST ECOMICAL METHOD TODAY
Unit Dose System
single unit dose, placed in drawers assigned to that Pt,, pharmacists can over see and make any adjustments or watch for contraindications, no dose calculations, credit is given for unused unopened meds....THE ONLY PROBLEM IS THAT THESE MEDS WERE PREPARED BY SOMEONE "OTHER" THAN THE NURSE
Long Term Care Unit Dose System
1 weeks worth......Pt has drawer, used in acute care, this may have a color code system as well that is used...for PRN, AM, PM, Noon...etc
ADE's Adverse Drug Reaction
serious drug complications...mostly happen at the ordering and administration stage
nurse is to be sure med is Ok to admin. if not notify the prescriber and give an explanation as to why the order should not be executed
after the order is verified, then the nurse transcribes the order from the Doc's order sheet onto the Cardex or onto an MAR
why are standards of care essential to nursing practice?
they are guidelines developed for the practice of nursing , developed by each state, nurses must adhere to minimum standards of state regulatory authorities, so all is sure that nurses are educated to to all the necessary tasks that are needed in their medical field...calculations, preparations, administrations of meds etc
if Pt refuses an essential heart med that has been prescribed,,,,what should the nurse so?
seek Pt reasons
general guidelines for entering nurses' notes includes nursing entries whenever?
periodically throughout the shift as care needs dictate.....ASAP
Computerized Prescriber Order Entry (CPOE) is good for what?
checking (electronically) for potential drug interactions, assoc w/ Lab. values and appropriateness of drugs ordered
if nurse can not read a Doc's order for med...what should the nurse do?
call the Doc to have the order clarified
drugs form chemical bonds with specific sites, this bond forms only if the drug and its receptor have similar shape....lock and key idea...
the study of interactions between drugs and their receptors and the series of events that result in a pharmacologic response
drugs that interact w/ a receptor to stimulate a response BUT, inhibit other responses
this is what happens to drugs once they are administered....ABSORPTION, DISTRIBUTION, METABOLISM, EXCTRETION
is process a drug is transferred from its site of entry into the body to the circulating fluids of the body for distro (ie blood and lymph)
refers to ways drugs are transported by the circulating body fluids to the sites of action (receptors), metabolism, & excretion
drug blood level
when a drug is circulating in the blood, a sample may be drawn and assayed to determine the amt. of drug present
elimination of the drug...2 primary routes...GI tract to the feces & thru the renal tubules into the Urine....other routes can be evaporation thru the skin, exhalation, secretion to saliva and breast milk
when circulation is impaired should you give an injection?
circulatory insufficiency & respiratory distress may lead to HYPOXIA & further complicate the situation by resulting in vasoconstriction
what organs receive distro. of drugs more rapidly?
the ones w/ most extensive blood supply....heart, liver, kidneys, & brain
only free or unbound portion of a drug is able to diffuse into tissues, interact w/ receptors and produce physiological effects or be metabolized and excreted...T?F
what about drugs that are bound to plasma proteins?
they are pharmacologically inactive because the large size of the complex keeps them in the bloodstream & prevents them from reaching the sites of action, metabolism, and exctretion
a Pt w/ renal failure often has an increase in what? (when it comes to excretion)
in the action & duration of a drug is the dosage & frequency of admin. are not adjusted to allow for the Pt's reduced renal function
therapeutic actions to expect, side effects to expect , adverse effects to REPORT, & possible drug interactions
aka hypersensitivity....it occurs when PT's have been previously exposed to a drug and have developed antibodies to it from their immune system
life threatening reaction...causes respiratory distress & cardiovascular collapse....this is a medical emergency
is a person weighs allot, will they need a stronger drug...or more of it?
yes....may require increased dosage to attain effect
negative expectation of a drug can produce this, resulting in less than optimal results
begins when a person requires a higher dosage to provide the same effects that a lower dosage once provided
accumulation in the body may occur if the next dose is admin. before the previously admin. dose has been metabolized or excreted
combined effects of 2 drugs is greater than the sum of the effect of each drug given alone ____________
the 1st drug inhibits the metabolism of excretion of the 2nd drug, causing increased activity of the 1st drug
1st drug is chemically incompatible w/ the 2nds drug, causing deterioration when both drugs are mixed in the same syringe or solution......signs of incompatibility are haziness...a precipitate ..or change of color of solution when mixed
a person who has an increased metabolic rate (hyperthyroidism) would generally require a dosage that is ?
higher than normal
a PT takes 50 mg of a drug that has a 1/2 life of 12 hours....what % dose remains in the body after 35 hours of the drug being administered?
6.25% it is reduced by 1/2 every 12 hourss
gender specific medicine
is a developing science that studies the diff. in normal function of men and women and how people of each sex perceive and experience diseasec
study of how drug response may vary according to inherited differences on drug metabolism
naturally occurring variations in the structures of genes and the products they make for the body
absorption this way is across the membranes and gastric emptying time depend on the pH of the environment
is reduced in preterm infants because of decreased plasma protein concentrations.....because serum protein binding is diminished, the drugs are distributed over a wider area of the neonates body, and a larger loading dose is required than in older children to achieve therapeutic affect
metabolites (drug excretion)
of drugs and , in some cases, the active drug itself, are eventually excreted from the body
therapeutic drug monitoring
is measurement of drug's concentrations in biologic fluids to correlate the dosage admin. & the level of med. in the body w/ the pharmacologic response (saliva samples can give this)
do peds and geriatric Pt's require specail considerations for medication admin?
yes, usually 1/2 the strength or 1/3rd
is topical admin. Ok with peds?
yes, because the outer layer of skin is not fully developed (thin)...skin is more hydrated at this age
premature infants and geri Pt's have a slower gastric emptying time; partly because of reduced acid secretionT/ F???
True this may allow for drug to stay in contact with absortive tissue longer....allowing increased absorption and higher serum levels....toxicity could be a problem
women's stomachs empty solids more SLOWLY than men...and women have a greater gastric acidity...thus slowing the absorption of certain types of med...like aspirin.....T / F
TRUE....the slower gastric emptying time may allow the drug to stay in contact w/ absorptive tissue....= higher serum levels = could go into toxicity
Distribution depends on what?
pH, body water concentrations, (intra and extracellular & total body water)
assoc. w/ aspirin...do not admin aspirin to peds. from infancy to teenage years....this can happen after a viral infection of chickenpox or the flu
what are factors that put geri Pt's at a higher risk? (in regards to admin. drugs)
reduced renal and hepatic function,chronic illnesses that require multiple drug therapy (ploypharmacy) and a greater likelihood of malnutrition
enteric-coated and sublingual tablets should NEVER be what?
crushed...because of the effect on the absorption rate
protein binding is ________in preterm infants; therefore __________dosage adjustment on a mg/kg basis would be required.
reduced; higher load
enzyme systems are primarily found in the ________therefore lab values to assess functioning of teh organ may be a required premedication assessment.
geri and infants have lower gastric acids in stomach.....what impact does this (can it) have on drugs?
because they have lower gastric acids, drugs are absorbed slower and they are in contact w/ tissues....creating higher serum concentration levels...which can lead to toxicity...caused by extended contact time is the stomach
diaphragm that surrounds the pupil and gives the eye its color, blue, green, hazel, brown, or gray
within the iris encircles the pupil 7 is innervated by the parasympathetic nervous system PNS
runs radially from teh pupillary margin tot eh iris periphery, is SYMPATHETICALLY innervated
is contraction of the dialtor muscle & relaxation of the sphincter muscle, which causes the pupil to dilate
transparent , gelatinous mass of fibers encased in an elastic capsule situated behind the iris....function is to ensure that the image on the retina is in sharp focus
these are the ligaments around the edge of the lens, that connect with the cilary body.....tension on these zonal fibers helps change the shape of the lens
paralysis of the ciliary muscle, this muscle is innervated by PARASYMPATHETIC nerve fibers (PNS)
this is where tear fluid is lost.....these are the 2 small ducts at the inner corners of the eyelids. Tear fluid is also lost from evaporation
(IOP) glaucoma is an eye disease characterized by abnormally elevated (IOP), which may result from excessive production of the aqueous humor or from diminished ocular fluid outflow
(primary glaucoma) occurs when there is a sudden increase in IOP caused by a mechanical obstruction of the trabecular network network in the iridocorneal angle...this occurs in Pt's who have narrow anterior chamber angles......symptoms appear intermittently for short periods , especially when the pupil is dilated. (dialationof pupil pushes the iris against the trabecular meshwork, causing the obstruction) S&S are blurred vision, halos around white lights, frontal headache, & eye pain. Stress and fatigue can also play a part
(primary glaucoma) there is reduced outflow of aqueous humor through the trabecular network and Schlemm's canal because of resistance of the aqueous humor outflow: the iridocorneal angle is open
a state in which a drug user needs larger and larger amounts of the drug to get the same effect
occurs unexpectedly in a particular patient; a genetically determined abnormal response to normal dosages of a drug
?????the increased activity demonstrated by a drug when repeated doses accumulate in the body and exert a greater biologic effect than the initial dose?????
of or relating to substances or agents that can interfere with normal embryonic development
REYE'S SYMDROME DEFINED
Swelling of the liver and brain...aspirin has been linked with this syndrome....BASIC RULE (Mayo) do not give aspirin to anyone age 18 or younger, unless specifically recommended by the child's Doc
the tendency of an agent, usually a drug or alcohol, to have a destructive effect on the liver
the 3 layers of the eyeball
the protective external, or corneoscleral coat; the nutritive middle vascular layer, called Choroid; and the light sensitive inner layer, or retina
does the cornea have blood vessels?
no, it recieves nutrients from aqueous humor and its oxygen supply by diffusion from the air and surrounding vascular structures
what is an abraded cornea?
the thin layer of epithelial cells (the layer that is quite resistant to infection) is damaged and is highly susceptible to infection
for near vision....
the cilary muscle fibers contract, relaxing the pull on the ligaments, & allowing the lens to become thick
what bathes and feeds the lens?
ciliary body secretes aqueous humor...it is drained out the meshwork that leads to the Schlemm's canal
what is the most common route of administration for opthalmic drugs?
topical application....but they do not penetrate adequately for posterior eye diseases.....so topical admin. is not used for diseases with the optic nerve or retina
if meds are to admin. at about teh same time what are you to do?
wait 5 min after the 1st one. this ensures that the 1st med is not washed away by the 2nd, or that the 2nds med. is not diluted by the 1st. ALSO to minimize systemic absortion of opthalmic drops...compress the lacrimal sac for 3-5 min after instillation
when should drops be administered?
before ointments....they (the oint) impede delivery of other opthalmic drugs....they are a barrier as they are thick
what is the most common drug to treat OPEN ANGLE glaucoma?
it is the maintenance of the IOP to prevent further blindness.......MIOTIC AGENTS ...(pilocarpine)...this drug increases the outflow of aqueous humor.........recent years beta adrenergic blocking agents (timolol maleate)...have become the initial drug choice.........other agents that may be used are SYMPATHOMIMETIC AGENTS (brimonidine)CARBONIC ANHYDRASE INHIBITORS (acetazolamide), and CHOLINESTERASE INHIBITORS ( echothiophate iodide)
Acute closure glaucoma requires immediate treatment w/ admin. of Miotic AGENTS to relieve pressure of iris against the trabecular network, & allow drainage or aqueous humor....what drug helps this?
MANNITOL.......an osmotic diuretic.....and ACETAZOLAMIDE may be admin. to reduce formation of aqueous humor
If the Pt is being treated for glaucoma what do you need to stress?
the need for lifelong treatment and the use of meds.......adherence w/ the drug regimen can help prevent blindness
when an infection is present, how do you prevent cross contamination?
always use s separate source of medication and droppers for each eye
what do you never what to touch with the tip of the dropper?
the eyeball or face....and the opening of the of the ointment container
Osmotic Agents....tell about them
can be admin. IV, orally, or topically to reduce IOP. these agents elevate the osmitic pressure of the plasma, causing fluid from the extravascular spaces to be drawn into the blood, the effect on the eye is reduction of volume of intraocular fluid, which produces a decrease in IOP
Osmotic Agents uses?
used to reduce IOP in Pt's w/ ACUTE NARROW-ANGLE GLAUCOMA; before iridectomy; pre-op and post-op in conditions like congenital glaucoma, retinal detachment, cataract extraction, & keratoplasty
check the mannitol solution for crystals....do not admin. if present. Use an in-line filter because mannitol has a tendency to crystallize
CARBONIC ANHYDRASE INHIBITORS action?
inhibitors of the enzyme carbonic anhydrase.....result in a decrease in the production of aqueous humor...lowering IOP
Carbonic Anhydrase Inhibitors uses?
used in conjunction with other treatments to control IOP in cases of intraocular hypertension & CLOSED-ANGLE & OPEN-ANGLE glaucoma
what to check for with carbonic anhydrase?
check for allergy to SULFONAMIDE ANTIBIOTICS.....w/hold the med & contact Doc
what electolytes are altered w/ Carbonic Anhydrase Inhibitors?
K+, Na+, and Cl- Hypokalemia is most likely to occur
deficiency of K+. The K+ diffuses out of the myocytes, their membrane potential is more negative than normal, and they are harder to stimulate
CHOLINERGIC AGENTS actions?
produce strong contractions of the iris (miosis) & ciliary body musculature
Cholinergic Agents uses?
lower IOP in Pt's w/ glaucoma by widening the filtration angle, which permits outflow of aqueous humor........they give better control of IOP w/ fewer fluctuation in pressure
Cholinergic Agents effects to expect?
difficulty in adjusting quickly to changes in light intensity....reduced visual acuity may be most noticeable at night, particularly in area of poor lighting, in older Pt's lens opacities may develope, blurred vision occurs particlarly during the 1st 1-2 hours after instilling the med. Ability to read to long periods is decreased because of impairment of NEAR-VISION accommodation
CHOLINESTERASE INHIBITORS ....PHOSPHOLINE IODIDE action?
Cholinesterase is an enzyme that destroys acethlcholine, the cholinergic neurotransmitter......this prevents the metabolism of acetylcholine w/in the eye.....causing increased cholinergic activity, which results in decreased IOP and miosis
Uses for Cholinesterase Inhibitors?
treatment of OPEN-ANGLE glaucoma ...onset may occur w/in 10-45 min and may last for several days. Tolerance may develope...rest period will restore response.....THIS DRUG IS RESERVED FOR PT's WHO DO NOT RESPOND WELL TO CHOLINERGIC AGENTS
Cholinesterase Inhibitors effects to expect?
difficulty in adjusting quickly to changes in light intensity, reduced visual acuity...most noticeable at night, particularly in area of poor lighting, older Pt's develope lens opacities
ADRENERGIC AGENTS action?
Sympathomimetic agents cause pupil dilation, increase outflow of aqueous humor, vasoconstriction, relaxation of ciliary muscle, & a decreased in the formation of aqueous humor
Adrenergic Agents uses?
lower IOP in OPENANGLE glaucoma, relieve congestion and hyperemia, & produce mydriasis for ocular examinations.....and reduce redness of eyes form irritation
when to use caution w/ Adrenergic Agents?
in Pt's w/ hypertension, diabetes mellitus, hyperthyrodism, heart disease, arteriosclerosis, or long standing bronchial asthma
Beta-Adrenergic Blocking Agents actions?
to reduce elevate IOP...exact mech. is not known...but they are thought to reduce production of aqueous humor
Beta-Adrenergic blocker uses?
reduce IOP in Pt's w/ CHRONIC OPEN-ANGLE glaucoma or OCULAR HYPERTENSION....unlike anticholinergic agents, there is NO blurred or dim vision or night blindness because IOP is reduced w/ little or no effect on pupil size or visual acuity
reduce IOP in Pt's w/ CHRONIC OPEN-ANGLE glaucoma or OCULAR HYPERTENSION, who have NOT responded well to other IOP lowering agents
Prostaglandin Agonist admin not to do?
do not admin. in eyes while wearing contacts....they may be reinserted 15 min following administration
the therapeutic outcome when instilling an adrenergic agent in the eyes is to?
what to check for before admin. beta-adrenergic blocker for reducing IOP...the nurse should check to see if the Pt has a Hx of?
diabetes mellitus, cardiac disease, hypertension or respiratory disorders
how do you minimize systemic absorption of ophthalmic drops?
compress the lacrimal sac for 1-2 min. after instillation
what to teach the Pt after an eye surgery?
notify the Doc of pain not relieved by pain meds, use of aseptic tech. when changing dressings or admin. meds, the Pt should notify the Doc as any signs of infection
centrally acting skel muscle relaxants...actions?
to relieve acute muscle spasm....exact mechanism not known, except that they act on the CNS.....they do not have any direct effect on muscles, nerve conduction, or neuromuscular junctions.....most HC providers believe that the benefit of these agents come from their sedative effects rather than actual muscle relaxation
Centrally acting skel muscle relaxant ...uses?
used in combo w/ physical threrapy, rest, and analgesics to relieve muscle spasm assoc. w/ acute painful musculoskeletal conditions......they should not be used in muscle spasticity associated w/ cerebral or spinal cord diseases because they may reduce the strength of remaining active muscle fibers and produce further impairment and debilitation
skel muscle relaxant that acts differently from centrally acting musculoskeletal agents.......it's mechanism is unknown....although reflex activity at the spinal cord is partially inhibited
mgmnt. of muscle spasticity resulting from MS, spinal cord injures, & other spinal cord diseases...not recommended for use in spasticity assoc. w/ Parkinson's, cerebral palsy, stroke, or rheumatic disorders
muscle relaxant that acts DIRECTLY on skel. muscle...produce...mild weakness of muscles and decreases the force of reflex of muscle contractions, muscle stiffness, involuntary muscle movements, and spasticity........also hyperreflexia & clonus
used to control the spasticity if chronic disorders like Cerebral Palsy, MS, Spinal cord injury and Stroke Symdrome
Neuromuscular Blocking Agents....action?Neuromusd
act by interrupting transmission of impulses from motor nerves to muscles a the skeletal neuromuscular junction......they have no effect on consciousness, memory, or pain threshold.....these Pt's may suffer from extreme pain & may be unable to ask for analgesics
Neuromuscular Blocking agents uses?
used to produce adequate muscle relaxation during anesthesia to reduces and use (and side effects) of general anesthetics, ease intubation.
Centrally acting skel muscle relaxants drugs should NOT be given to Pt's having?
Cerebral or Spinal Cord diseases
Neuromuscular blocking agents require availability of what to treat an overdose?
neostigmine methylsulfate (Prostigmin)
Which antibiotics can potentiate neuromuscular blocking activity?
Tetracyclines & aminoglycosides