Pharm/Patho Exam 1 Study guide

What is Pathophysiology?

It the combination of the terms pathology and physiology; the study of the body’s response to disease, dysfunction, or mechanism of disease.

Why should nurses understand pathophysiology?

• Aids in the understanding of how medication work

• Assists in care management and decision making

• assists in understanding changes in health assessment

• links to everything we do as nurses

• major part in the development of a nursing diagnosis

• provides a basis for the development of nursing interventions while providing patient-centered care

• Provides context for identifying acute and chronic conditions, as well as the progression of disease states

What is disease?

The functional impairment of cells, tissues, organs or organ systems; is acquired or innate

What is Diagnostic testing

Abnormal VS. normal- History, physical exams

What is etiology?

Cause of disease, what sets disease into motion

Ex- Biological factors(Pathogens, viruses), Chemical agent, genetic factors, innate vs. acquired, nutritional defects or excesses, physical forces, singles vs. multiple organs or organ system

What is Pathogenesis?

How the disease begins and evolves

Risk factors- Vulnerabilities either modifiable or non modifiable

Histology and morphology- form(or structure) of cells or tissues, study of cells and extracellular metric

What is Pharmacology?

Is the study of chemicals that alter the function of living organisms

-encompasses information from many different disciplines

What is the medication administration process?

Involves provider prescription and transcription of the prescribed treatment, followed by the preparation, distribution and administration of the medication to the client

What is safety- related technology?

Reduces the incidence of medication administration errors, reforming the rights of medication administration

Electronic medication administration record (eMAR)

Barcode medication administration

What are the rights of medication administration ?

Original 5- Right client, Right medication, Right dose, Right time, Right route

Additional- Right education,Right to refuse, Right assessment, Right documentation, Right evaluation

Medication Reconciliation Goals

Aids in the prevention of errors and drug interactions

Should occur upon first contact and then throughout client care.

What to include in medication reconciliation

Important that the nurse cover all client medication( in addition to OTC medication and supplements)

prompts can be placed throughout the workflow to remind the health care team to continually update and verify the medication list

What is medication administration Errors(MAEs)

Can occur during any part of the process; and occur when there is a discrepancy from the prescription noted on the client’s chart, incorrect preparation or administration from the manufacturer recommendation, or failure to comply with organization policies and procedures

THIS CAN RESULT IN SENTINEL EVENTS: CAUSE CLIENT HARM

What are the key elects in the culture of client safety?

Benefits, Elements; teamwork, leadership,evidence0based practice, just culture, client centered care, communication and learning

What is the response to medication administration errors?

Assess the client, document the incident, notify the provider; ethical and lead responsibility to report the error, and through the appropriate facility reposting channels

What are common factors associated with Medication Errors?

Deficiency of client records, Distractions or interruptions, inadequate communication with clients and providers, increased workload, lack of standard procedures, lack of medication knowledge , language barriers

What is ruled based error?

failure to adhere to standards of practice

What is knowledge based error?

Absence of learning about medication used in practice, client history or administration of the medication

What is activity based errors ?

‘slip errors’ distractions

Ex- Social media, emails or text messages, multitasking, socializing, hunger, fatigue,device alarm

What is the adverse drug reaction monitoring?

Multifactorial can be related to dosage or medication- specific error

Allergic reactions- Most severe, unintended or unwanted, occurs t therapeutic doses, range from minor to life threatening; diarrhea to anaphylaxis

Idiosyncratic drug reaction: Target the bone marrow or liver, leads to liver failure which causes agranulocytosis

What should you include in client education?

Why the client is taking the medication, generic and brand name of the medication, appropriate route and schedule for administration, possible adverse drug reactions precaution the client needs to take during therapy

What are different approaches to teach a client?

Cognitive status, developmental level, preferred learning style and language, willingness to learn

How to evaluate a clients understanding?

Ask specific question, have the client perform a return demonstration, use the teach-back method

What are the benefits of inter-professional collaboration?

Knowledge from each other; can develop relationships to improve collaboration strengthen teamwork, prevents fragmentation; focus on holistic care, improve job satisfaction

What are the best practices of inter-professional collaboration?

Open communication, team approach, holistic care, team based rounding, interprofessional education

What are the benefits of effective communication?

Client safety, better quality of care, improved outcomes

What is verbal communication of effective communication?

Clarification and confirmation, ‘read back’ verification

What is the written communication in effective communication?

use standard abbreviation;legible writing, ask clarifying question

What is the hand-off communication in effective communication?

ISBARR; effective transfer of client information between team members

What is a provider?

Provides accurate, clear and complete medication prescriptions

unit of measurements, route of administration, duration of treatment

What is a pharmacist?

Review prescription information, verify allergies, verify current medication, dosages, drug interactions, and contraindications to medication therapy

What is a nurse?

Conduct final verification prior to administration of medication to client, ensures medication administration is distributed in accordance with rights of medication administration, client education

What is assistive personnel(AP)?

perform administrative task

What are the prioritization interruptions of medication tasks?

Change in the clients condition, need to ask or validate questions related to medication, questions asked by the client or support

What is the prioritization of medication timing in emergency situations?

Time-critical medication must be administered within thirty-minutes of due time, PRN medications administered based on client individualized status and needs, rather than administered at scheduled intervals

What are the priority frameworks?

ABCs; Prioritize airway, breathing and circulation

Maslow’s Hierarchy of needs: focus on address most basic needs first

What is electronic task management system?

Coordinate multiple tasks across the client care continuum into one location, ensuring tasks are not missed throughout client care

What is management of nursing responsibilities?

You must understand how to prioritize care and have time to manage skills, use of delegation

What is organization of medication tasks?

To be mindful of time-sensitive medication, typically timed within the cleint’s health care record

What is inpatient care?

Transitions of care

e.g discharge; nurse is an essential in medication reconciliation, working as a partner with client and provider, and client education

What is ambulatory care?

Challenges associated with sparser interactions

e.g clinics and schools setting; less frequent interaction with the client, client is more likely to adjust their medication

what is out-of-hospital care ?

governed by multiple regulatory bodies

e.g nursing homes

What is PICOT?

Framework for the development of evidence-based research questions that seek to address a desire to improve practices

acronym: Population, intervention, comparison, outcomes, time

What is locating evidence in EBP?

Scholarly database

Must understand how to find quality research articles to answer questions related to practice

use cation with web-based search engines; must contain credible information

what is Evaluation evidence in EBP?

Critical thought and clinical judgement to rank the strength of evidence

What are Study Designs in EBP?

Case reports and series: describe a clinical event or diagnosis

Case-control studies:look at two different groups who many or may not have a disease and compare them with risk factors for the disease

Cross-sectional studies:gather population data at an identifies time and measure exposure and outcome

cohort studies:both retrospective and prospective

Observational studies: describe current practices

Randomized controlled trails: compare placebo with an existing process in a prospective manner

Systematic reviews and meta-analyses: Synthesize currently available evidence from multiple studies

Levels of evidence In EBP

Level I to III:Strong

Level IV to VI:Moderate

Level VII: Weak

What is integrating evidence in EBP?

Inter-professional collaborating: Smooths integration of the change into practice organizational support:crucial to successful implementation

What is evaluating Outcomes in EBP?

Data must be gathered to assess the effect of change; some changes may not

Result in an immediate display of improvement in client outcomes, but it is still important to collect data

What is disseminating findings in EBP

Must consider multiple factors when preparing to disseminate information- with whom the information should be shared, when information should be shared, what information must be shared , and how the information should be shared conference presentations: e.g poster presentation, journal articles :must review submission guidelines for each journal

What is clinical judgement?

The process of using critical thought and decision-making skills to assess, plan, and provide appropriate care of clients

Assessment(recognizing Cues)

; assess client and collect relevant client data

Key Questions; are there any lab results or test that could influence the effectiveness of the medication?

what client behaviors or statements might suggest misunderstanding or issues about their medication

Analysis 1 (Analyze Cues)

Check for potential risk and addition issues that can affect the clients needs

Does the client’s lab values suggest a need for a dosage adjustment or hold on the medication ?

What trends in the client’s manifestations, lab values or vital signs over time can indicate that the medication is effective?

Analysis 2 (prioritize Hypothesis)

Analysis of trend in client data to determine the likelihood of a condition of complication

In what order should medications be administered based on clinical concerns, issues and urgency of the situation?

Which clinical information on is most critical to consider before administration of the medication?

Planning (generates solutions)

Collaboration with other members of the interprofessinal team to define desirable outcomes and develop a plan of care tailored to the client’s needs

What other medication could be considered if the current medication is contraindicated or not effective?

Who else on the health care team should be consulted to optimize the clients mediation treatment plan?

Implementation(take action)

Implement previously determined plan of care ad document the interventions

How will I involve the client to ensure they understand their medications?

What immediate actions should be done if the client experiences an adverse drug reactions?

Evaluate(evaluate outcomes)

Involves reassessment and monitoring of the client’s response to the implemented actions to determine whether the client’s conditions is improving worsening or remains unchanged and why?

What indicators need to be monitored to evaluate the clients response to the medication?

how will the client response to the medication be documented and communicated with the health care team?

What is the FDA?

They are responsible for ensuring efficacy and safety of drugs before they can be put in the market

They have 5 different phases(Phase 0-4)

Approve various prescriptions and over-the-counter drugs; annually

Determine black box warning label;serious adverse effects

Recall drugs deemed unsafe

What are the pregnancy risk categories the FDA puts out?

A, B, D, X= NO

What are dosage adjustments for pediatrics?

For Pediatrics its usually weight based

What are the dosage adjustments for adults?

Body-weight, concurrent medications and organ functions

what are the dosage adjustments for people who are pregnant?

Physiological change alters absorption, distribution, metabolism, and excretion

What are the formulations of medications in pediatrics?

alternate formulation of medications(e.g liquid)

What are the formulations of medications in adults?

Alteration in gastrointestinal, hepatic, and renal function influence pharmacodynamics and pharmacokinetics of medication

What are formulations of medications for people who are pregnant?

They increased absorption in inhaled and parenteral medications

What are the formulations of medication for lactation?

Non-systemic formulation to limit and reduce the risk of medication concentration in milk

What are the monitoring parameters in age?

Age- Adverse reactions most common in pediatrics clients; vigilant precautions, monitoring, and reporting

Older clients have various factors influencing the efficacy of medication regimen

E.g- Cognitive decline, comorbidities; require drug-drug interaction monitoration, hepatic and renal dysfunction; risk for toxicity, nutritional deficiencies; affect metabolism, increased sensitivity

What are the monitoring parameters in lactation?

monitor infant for adverse reactions related to maternal medication

What are the monitoring parameters in pregnancy ?

Close monitoring of fetal movement, laboratory test, weight and vital signs as physiological changes to the cardiovascular, endocrine, gastrointestinal and renal system affects pharmacodynamics, pharmacokinetics and exposure of the fetus to increased medication levels

What are the monitoring parameters in polypharmacy?

Use of multiple medications

Most common I elder adults, or in those with multiple chronic conditions; also common within children with multiple comorbidities or diagnosis that are medically intricate

preventions include; medication reconciliation, regular update and verification of medication list throughout transitions of care

what is the BEERs list?

Identifies medications and their classifications that are potentially inappropriate for older adults due to substantial risk of adverse effects, drug-dryg interactions or limited effectiveness

beers list is updated every three to four years

What is the Kids list?

Key potential inappropriate drugs in pediatrics

Used to minimize medications related harm in pediatrics clicks by promoting evidence based prescribing practices; ensures treatments are effective and safe

What are the pregnancy and lactation labeling rule?

Provide clearer more comprehensive framework regarding the use of medications during pregnancy and lactation

What are each Caterogies of pregnancy and lactation labeling?

Caterogies

A; no well-controlled studies indicating risk to fetus in the first trimester

B; Animal studies have not demonstrated risk to fetus, but no well controlled studies in pregnant women

C; No studies. benefits may outweigh the risk in pregnant women

D; Evidence to the risk of the fetus have been demonstrated but use may outweigh the risk in life-threatening situations

X; studies in human have demonstrated fetal abnormalities or evidence of fetal risk, risk outweigh the benefits

What is medication incompatibility?

Refers to a situation in which an intravenous medication has a reaction when it is combined with another substance

What is chemical and physical in medications incompatibility and drug-drug interactions?

Alter medications from their original form, creating poetical for unintended effects for the client

Decreased efficacy of the medication administered

Adverse effects

What are drug-drug Interactions?

Occurs when one medication affects the pharmacodynamics or pharmacokinetics of another medication, potentially leading to reduce effectiveness, or increased risk of adverse effects and side effects

Can be identified within medication database(e.g. drug interaction database)

effects; increase risk of adverse of effects of one or both medications due to antagonistic, additive or synergistic effect, leaning to discomfort or serious health issues

What are the steps of medication reconciliation?

Obtain accurate and complete list of all medications the client is currently taking; over-the counter and prescriptions medications as well as dietary and herbal supplements

Review said list and validate hat each medication, dosage, and frequency is accurate; also verify that the client is taking medication as prescribed

Compare current list in the medical record with clients medication list at home; identify discrepancies; if new medication is prescribed compare the medication against the cleats current list check for potential medication interactions

communicate changes to the client and all members of the health care team

What are the principles of medication administrations?

Adhere to best practice and establish protocols; minimizes medication errors, enhances client safety

Understand indications, contraindications and precautions associated with each medication

Knowledge of each medication classes mechanism of action; help recognize when a medication may cause harm or be ineffective

check for possible drug-drug interactions

Know what effects to monitor for, as well as what effects to prepare the client for; done after mediation administration

What are the rights of medication administration?

• Right Client: two client identifiers

• Right Medication: check medication label

• Right Dosage: too low versus too high, unique dosage considerations (e.g. hepatic and renal function)

• Right Route: medication obtained matches route indicated on medication order

• Right Time: know medication schedule, administer as closely as possible to the time ordered to maintain blood levels 

• Right Assessment: perform appropriate assessments before, during, and after administration

• Right Documentation: document fully and in a timely manner

• Right to Refuse: provide education about the purpose of medication, respect client’s decline to consume

• Right Education: cover medication’s purpose, adverse and side effects to monitor for, and instructions for use

• Right Evaluation: determine whether the client is experiencing a therapeutic effect or undesirable response to medication

What are different route of medication administration?

• Oral: enteral medication, most common route; include capsules, softgels, tablets and liquids, client must be able to swallow; rate of absorption differs between client

• Buccal and Sublingual:

• Buccal: administered to the buccal mucosa

• Sublingual: administered under the tongue, enteral medication; do not experience first-pass elimination effect as they are absorbed directly through the oral mucosa; fast rate of absorption

• Rectal: enteral medication, administered via insertion directly into the rectum; absorbed via rectal mucosa, decreased first-pass elimination effect

• Intravenous:parenteral medication, administered directly into bloodstream; bypass first-pass elimination effect, resulting in quick onset of action

• Intramuscular:parenteral medication, administered via injection into the muscle (e.g. deltoid, vastus lateralis, ventrogluteal muscle); often painful administration and potential for complications,not subject to the first-pass elimination effect

• Subcutaneous:parenteral administration, administered via injection into the cutis layer; common injection sites are low abdomen, upper outer arm, and thigh

• Intradermal: parenteral administration, administered via superficial injection into the dermis; most common site is inside of forearm, slow absorption rate

• Inhalation: delivered directly into client’s respiratory tract, avoid first-pass elimination effect; fast absorption rate

• Otic:administered directly into the ear canal, must be classified as ototoxic; should only be administered in clients with intact tympanic membranes

• Ophthalmic:topical medication, administered to the subconjunctiva of the eye; common forms of medication include drops and ointments

• Transdermal: topical medication, administered to client’s skin; bypass first-pass elimination effect

• Nasal: administered into nasal cavity; common forms of medication include nasal drops and sprays, avoid first-pass elimination effect; fast rate of absorption due to permeability of nasal mucosa

• Vaginal:inserted into client’s vagina; bypass first-pass elimination effect

What is monitoring therapeutic effect?

It is intended effect of medication

What is assessment in a role of a nurse in client monitoring?

Assessment:

• assess for indications that the client’s condition has improved, worsened, or remained unchanged

• monitor laboratory values and vital signs

What is indications of therapeutic effect in client monitoring?

• reduction or resolution of manifestations

• increased functionality

• stabilization of the client’s condition

• prevention of disease conditions or manifestations

What is the DEA

• enforces control substance act: regulates the manufacturing and distribution of anabolic steroids, depressants, hallucinogens, narcotics, stimulants

What are the different schedule of drugs?

• Schedule I: no medical purpose with a high misuse potential (e.g. heroin)

• Schedule II: high potential for misuse, but do have a medical purpose when used as prescribed (e.g. opioid analgesic; morphine)

• Schedule III: medical use with a moderate to low potential for dependency and misuse (e.g. anabolic steroids; testosterone)

• Schedule IV: medical use with less potential for dependency and misuse than schedule III (e.g. benzodiazepines; tramadol)

• Schedule V: have less potential for misuse than schedule IV (e.g. anti-diarrheal medications; pepto)

What are the requirements for prescribing medications?

• prescriber must register with the drug enforcement administration prior to the prescription of a scheduled drug; pharmacists are then responsible for verifying the prescriber has a registration number before dispensing the medication  

• Schedule II: require prescriber to sign a written prescription or use approved software; cannot be called in unless an emergency

• Schedule III, IV, and V: provider can call in prescription, refills allowed for schedule III and IV; up to five times over the course of six months from prescription issued date

What are controlled substances?

A substance that has potential for misuse

What are factors than are considered when determining a drug status?

• use of a substance in a way that is potentially hazardous to their health, or that puts the community at risk

• diverting the substance from the legal methods of distribution

• use of a substance without a prescription from a medical provider

• substance is similar in action or function to other substances already present on a drug schedule

What are controlled substances prescriptions?

• provider must apply for registration number prior to the prescription of a controlled substance

• prescriber must have license to prescribe any controlled substance; pharmacies must have controlled substance license to receive and fill prescription

• medication monitoring program; provider can check to ensure client does not already have a controlled prescription

What are the components/requirements of a prescription?

• date of issue

• client’s name, date of birth, and address

• provider’s name, address, and DEA number

• medication name and concentration

• how the medication is prepared

• how much to prescribe

• how to use the medicine

• how many refills are provided

• prescriber’s signature; can sometimes be an e-signature

What is the role of a nurse when checking for prescription requirements?

• upon discharge, provide client with information regarding prescription

• safety checks:check prescription for accuracy and safety; e.g. inappropriate dosage, potential allergic reactions, clarify anything unclear; e.g. illegible writing

What is autonomy?

The right to choose for self

What is the role of pharmacological practice?

Right to refuse medication

What is the role of a nurse in ethical principle guiding practices?

• assess whether the client has the decision-making capacity to make informed decisions for themselves

• if yes, accept; if no, surrogate decision maker

What is beneficence?

Promoting the best outcome for the client and protecting the client from mistreatment

Role in Pharmacological Practice:selection of medications for a client that promote the greatest benefit while minimizing adverse effects, timely administration

Role of the Nurse:

• client education

• advocate for vulnerable clients

• alert prescriber if the client experiences an adverse effect

• verifying the accuracy of a prescription of appropriateness of a medication for administration

What are roles in pharmacological practices?

• selection of medications for a client that promote the greatest benefit while minimizing adverse effects

• timely administration

What is the role of the nurse in ethical, legal, and cultural considerations?

• client education

• advocate for vulnerable clients

• alert prescriber if the client experiences an adverse effect

• verifying the accuracy of a prescription of appropriateness of a medication for administration

What is non-maleficence?

Acting in the best I treat of the client to avoid harm

What are role in pharmacological practices?Decisions about end-of-life care and withdrawal of care

Selecting between two medications with similar efficacy.

What is the role of a nurse? Client education, advocate for vulnerable clients, alert prescriber if the client experience Amy adverse effect, verifying the accuracy of prescription of appropriateness of a medication for administration

What is beneficence?

• promoting the best outcome for the client and protecting the client from mistreatment

Role in Pharmacological Practice:selection of medications for a client that promote the greatest benefit while minimizing adverse effects, timely administration

Role of the Nurse:client education, advocate for vulnerable clients, alert prescriber if the client experiences an adverse effect, verifying the accuracy of a prescription of appropriateness of a medication for administration