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Chapter 2 Application of Pharmacology in Nursing Practice
Terms in this set (42)
What are the Five Rights of Drug Administration?
-the patient's right to education
-the patient's right of refusal
(the right's guarantee that a drug will be administered as prescribed)
To observe and evaluate drug responses, and to intervene rapidly and appropriately, you must know in advance what exactly?
the responses that a medication is likely to elicit. To put another way, to provide professional care, you must understand drugs.
What is the responsibility of a nurse when it comes to handling drugs?
it is our responsibility to detect mistakes made by pharmacists and prescribers. The reason why it is our responsibility is because we are the patient's last line of defense against medication errors.
What are the two major areas that nurses can apply pharmacologic knowledge?
1. patient care
2. patient education
What are the 7 aspects of drug therapy in patient care?
1. preadministration assessment
2. dosage and administration
3. evaluating and promoting therapeutic effects
4. minimizing adverse effects
5.minimizing adverse interactions
6. making "as needed" (PRN) decisions
7. managing toxicity
What are the 3 basic goals of assessment?
1) collecting baseline data needed to evaluate therapeutic and adverse responses
2) identifying high-risk patients
3) assessing the patients capacity for self-care
why is collecting baseline data important?
are needed to evaluate both therapeutic and adverse drug responses.
-Without the data, we would have no way of determining the effectiveness of our drug.
What is the importance of identifying high-risk patients?
-multiple factors can predispose an individual to adverse reactions from specific drugs.
-important predisposing factors include pathophysiology, genetic factors, drug allergies, and lifespan consideration such as pregnancy, advanced age, and extreme youth.
-use 3 principal tools: patient history, physical examination, and laboratory data.
ex. a patient is allergic to penecillin you ask him what type of reaction does he have and when did it occur in the past.
What are some points about pharmacology that every nurse should know without making any medication errors?
1. certain drugs have more than one indication, and dosage may differ depending on which indication the drug is used for.
2. Many drugs can be administered by more than one route, and dosage may differ depending upon the route selected. Oral dosage are generally much larger than injected doses.
3. Certain Intravenous agents can cause severe local injury if the drug extravasates (seeps into surrounding tissue). Therefore, infusion must be monitored closely and if extravasates occur then corrective steps must take place immediately.
4. The following guidelines helps ensure correct administration:
- read the medication order carefully. If order is unclear then verify with the prescriber.
-Verify the identity of the patient by comparing the name on the wristband with the name of the drug order or medication administration record.
-read the medication label carefully. Verify the identity of the drug, the amount of drug, and its suitability for administration by the intended route.
-verify dosage calculations
- implement any special handling on the drug may require.
- Don't administer any drug if you don't understand the reason for its use.
Why is evaluating therapeutic responses important?
-process that tells us whether a drug is beneficial or is causing harm.
-to make an evaluation, you must know the rationale for treatment and the nature and time course of the intended response.
- when evaluating responses to a drug with more than one application, you can do so only if you know the specific indication for which the drug is being used.
also known as compliance or concordance may be defined as the extent to which a patient's behavior concides with medical advice.
Why is adherence essential in order to acheive the therapeutic objective?
-drugs that are self-administered in the wrong dose, by the wrong route or at the wrong time cannot produce maximum benefit-and may even prove harmful.
-successful therapy requires active and informed participation by the patient.
Implementing nondrug measures
-drug therapy can often be enhanced by nonpharmacologic measures.
ex. asthmatic patient uses breathing techniques to enhance breathing,exercises, and biofeedback.
Minimizing adverse effects
-all drugs have the potential to produce undesired effects.
-When drugs are employed properly, the incidence and severity of such events can be reduced.
-Measures to reduce adverse events include identifying high-risk patients through the patient history, ensuring proper administration through patient education, and teaching patients about activities that might precipitate an adverse event.
-Knowledge of adverse drug effects will enable the patient to avoid some adverse effects and minimize others through early detection.
To help reduce adverse effects, you must know the following about the drugs you are working with:
-major adverse effects the drug can produce
-when these reactions are likely to occur
-early signs that an adverse reaction is developing
-interventions that can minimize discomfort and harm
Minimizing adverse interactions
-when a patient is taking 2 or more drugs, those drugs may interact with one another to diminish therapeutic effects or intensify adverse effects.
- Some ways to reduce drug interactions and effects include thorough drug history, advising the patient to avoid OTC drugs that can interact with the prescribed drug, monitoring for adverse interactions known to occur b/n the drugs the patient is taking, and being alert for as yet unknown interactions.
-patient education can help avoid hazardous drug-drug and drug-food interactions. Ex) NSAID and aspirin; Alcohol and opiods
Making PRN (as needed) decisions
-a PRN medication order is one in which the nurse has discretion regarding when to give a drug, and in some situations, how much drug to give.
-PRN orders are common for drugs that promote sleep, relieve pain, and reduce anxiety.
-To implement a PRN order rationally, you must know the reason for drug use and be able to assess the patient's medication needs.
-some adverse drug reactions are extremely dangerous. Hence, if toxicity is not diagnosed early and responded to quickly, irreversible injury or death can result.
-to minimize harm, you must know the early signs of toxicity and the procedure for toxicity management.
In your nursing role as educator, you must give the patient the following information:
-drug name and therapeutic category
-route and technique of administration
-expected therapeutic response and when it should develop
-nondrug measures to enhance therapeutic responses
-duration of treatment
-method of drug storage
-symptoms of major adverse effects, and measures to minimize discomfort and harm
-major adverse drug-drug and drug-food interactions
-whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions.
the patient should know the name of the medication he or she is taking. If the drug has been prescribed by trade name, the patient should be given its generic name, too. This can prevent two similar medications from overdosing patient due to generic name.
Dosage and Schedule of Administration
-patients must be told how much drug to take and when to take it. For some medications, dosage must be adjusted by the patient.
-With PRN medication, the schedule of administration is not fixed. Rather, these drugs are taken as conditions require.
-The patient should know what to do if a dose is missed.
-some patients have difficulty remembering whether or not they have taken their medication.
Technique of administration
-patients must be taught how to administer their drugs. This is especially important for routes that may be unfamiliar. Patients taking oral medications may require special instructions. Careful attention must be paid to the patient who because of a disability may find self-medication difficult.
Duration of drug use
Just as patients know when to take their medicine, they must know when to stop.
-In some cases patients should discontinue drug use as soon as symptoms subside.
-other cases may include lifelong drug therapy
-For some conditions medication may be prescribed for a specific time intervals, after which the patient should return for reevaluation.
Certain medications are chemically unstable and deteriorate rapidly if stored improperly. Patients who are using unstable drugs must be taught how to store them correctly. (stored somewhere where kids cannot reach them).
Promoting therapeutic effects
-To participate fully in acheiving the therapeutic objectives patients must know the nature and time course of expected beneficial effects. (patients can evaluate success or failure of treatment; if a failure of treatment=patient will be recommended an alternative drug therapy).
-Awareness that treatment may not produce immediate results allows the patient to have realistic expectations and helps reduce anxiety about therapeutic failure.
What are the 5 steps in the nursing process:
-consists of collecting data about the patient. These data are used to identify actual and potential health problems.
- The database established during assessment provides a foundation for subsequent steps in the process.
Important method of collecting data: patient interview, medical and drug-use histories, the physical examinations, observation of the patient, and laboratory tests.
Analysis: Nursing Diagnosis
-Nurse analyzes information in the database to determine actual and potential health problems. These problems may be physiologic, psychologic, or sociologic.
A complete nursing diagnosis consists of 3 statements:
1. a statement of the patient's actual or potential health problem
2. A statement of the problems probable cause or risk factors
3. signs, symptoms, or other evidence of the problem.
-the nurse delineates specific interventions directed at solving or preventing the problems identified in analysis.
-plan must be individualized for each patient
-when creating a care plan, the nurse must define goals, set priorities, identify nursing interventions, and establish criteria for evaluating success
-must be modified as new data is gathered
-begins with carrying out the interventions identified during planning.
-Some interventions are collaborative while others are independent.
-requires a healthcare providers order, whereas independent interventions do not.
-is completed by observing and document the outcomes of treatment. Documentation should be thorough and precise.
-Step is performed to determine the degree to which treatment has succeeded. This is accomplished by analyzing the data collected following implementation.
-completes the initial cycle of the nursing process and provides the basis for beginning the cycle anew.
establishes the baseline data needed to tailor drug therapy to the individual. By identifying the variables that can affect an individuals responses to drugs, we can adapt treatment so as to maxmize benefits and minimize harm.
Preassessment has 4 basic goals:
1. collection of baseline data needed to evaluate therapeutic effects.
-drugs are administered to achieve a desired response. To know if we produced a response, we need to establish a baseline measurement of the parameter that therapy is directed at changing.
2. collection of baseline data needed to evaluate adverse effects.
-all drugs have the ability to produce undesired effects.
3. identification of high-risk patients
-just which individual characteristics will predispose a patient to an adverse reaction depends on the drug under consideration.
-multiple factors can increase patients risk for adverse reactions to a particular drug. (age, body composition, pregnancy, diet, genetic heritage, other drugs being used adn practically pathophysiologic conditions.
-contraindication or precaution
4. Assessment of the patient's capacity for self-care.
-defined as a preexisting condition that precludes use of a particular drug under all but the most critical of circumstances.
ex) penicillin allergic reaction isn't used due unless a pt. develops an infection that can't use any other antibiotic but penicillin.
defined as a preexisting condition that significantly increases the risk of an adverse reaction to a particular drug, but not to a degree that is life threatening.
Analysis and Nursing Diagnosis
First, you must judge the appropriateness of the prescribed regimen. Second, you must identify potential health problems that the drug might cause. Third, you must determine the patients capacity for self care.
-analysis determines to see if the patient is able to mentally and physically take the medication without any help or complication.
you should question the drug's appropriateness if :
1. drug has no actions that are known to benefit individuals with the patient's medical diagnosis
2. the patient failed to respond to the drug in the past.
3. the patient had a serious adverse reaction to the drug in the past.
4. the patient has a condition or is using a contraindicates the prescribed drug.
What does planning consist of ?
-defining goals (maximize benefit and minimize harm)
-establishing priorities (highest priority is given to life threatening conditions, or severe/acute reactions =long term harm)
-identifying specific interventions
- establishing criteria for evaluating success (measure drug responses to see if it was doing anything useful)
-good planning will allow you to promote beneficial drug effects.
What are the 4 major components in implementation?
1. drug administration
2. patient education
3. interventions to promote therapeutic effects
4. interventions to minimize adverse effects.
In the evaluation stage, the objective is to evaluate...
1. therapeutic responses
2. adverse reactions and interactions
3. patient adherence
4.patient satisfaction with treatment.
Evolution of Nursing Responsibilities Regarding Drugs
-Correct administration, without additional interventions, cannot ensure that treatment will result in the therapeutic objective
-Proper delivery is only the beginning of a nurse's responsibility
-Nurses and healthcare providers must participate in a system of checks and balances designed to promote beneficial effects and to minimize harm to patients
-The nurse must know:
-What medications are appropriate for the patient
-What drugs are contraindicated for the patient
-The probable consequences of the interactions between the drug and the patient
-The nurse's role as advocate
-Last line of defense for the patient
-Ethically and legally unacceptable to administer a drug that is harmful to the patient, even though the medication has been prescribed by a licensed prescriber and dispensed by a licensed pharmacist
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