Pharmacology Quit 1

Nursing Processes

Nursing Processes

Concept, assess, diagnose, plan, implement, evaluate

Assessment

Gather subjective and objective data

Subjective data

• what the patient tells you

• current health history

• patient signs and symptoms

• current medications and concerns

• allergies

• financial barriers, home safety, support system concers

• cultural dietary barriers

Objective data

• what you see

• physical health assessment

• laboratory and diagnostic test results

• vital signs

• body language

Patient Problems

• identifies patient needs

• better identifies clinical practice and plan of care

• ex. confusion, cognitive decline, pain

• take Maslow’s Hierarchy of needs into account when planning

Diagnosis

pain related to … as evidenced by …

Planning

• smart goal setting

• promoting therapeutic drug effects

• minimize adverse effects

• maximize patient ability for self care

Nurse interventions

• is patient ready to learn? do they want to?

• barriers of learning

Implementation

do the plan

Evaluation

monitoring, see if a therapeutic response

Informed Consent

• mutual sharing of information

• expresses respect for the person

• promotes patient involvement in their care

• respects patient’s right to self determination

Beneficence

duty to protect research subjects from harm

Justice

requires that the selection of research subjects be fair

Autonomy

providing adequate info to allow patients to make their own decisions

Veracity

truth telling

Placebo

drug with no effect

Controlled Substance

categorized into 5 schedules

Schedule I

not approved for medical use, have high abuse potential

Schedule II - V

have acceptable medical use and decreasing potential for abuse

Health Insurance Portability and Accountability Act (HIPPA)

protects and enforces patient information confidentiality

drug names - chemical

structure of drug

drug names - generic

official name of drug, ex. ibuprofen

drug names - trade

brand name of drug, ex. Advil, Tylenol

Over-the-counter (OTC) drugs

drugs found to be safe and appropriate for use without supervision of healthcare provider

Pharmacokinetics

• what body does to drug

• Absorption, Distribution, Metabolism, Elimination

Pharmacodynamics

• what drug does to body

• wanted effects

• unwanted effects

Therapeutic Index

• relationship between therapeutic does and toxic dose

• peak close to toxic level

Potency

amount of drug needed to elicit specific physiologic response

Therapeutic Range

length of time drug has a therapeutic effect

Onset

when drug stops working

Peak Drug Level

• highest level in body

• drawn 30 minutes after dose

Trough Drug Level

• lowest level in body

• drawn before dose given

• first

Duration of Action

time it takes drug to stop working

Agonist

drug occupies receptors and activates them

Antagonist

drug blocks others by occupying receptor, no activation

Side Effect

ex. getting sleepy from Benadryl

Adverse Reaction

severe effect

Teratogenic

effects on pregnant

Carcinogenic

cancerous

Drug Toxicity

occurs when drug levels exceed therapeutic range

First Pass Effect

• only with enteral drugs

• drug not absorbed all the way in first pass, need to give again

Tolerance

capacity of body to endure or become less responsive to a drug

Drug Interaction

drug interacts with another, bad effect

Synergistic Effect

Two or more drugs having a greater effect together than separately, positive response

Additive Effect

when two drugs are administered and response is increased beyond what either could produce alone, can be desirable or undesirable

Pharmacogenetics

how a person’s gene structure impacts drug response

Phytomedicine

therapeutic value of plants

Decoction

• tea made from boiling plant material in water

• bark, rhizomes, roots, other woody parts

infusion

• tea made by pouring water over plant material, then mixture is left to steep

• usually boiling, but can be cold

• dried flowers, fruit, leaves, other parts

tincture

• extract made by soaking herbs in dark place with desired amount of either glycerin, alcohol, or vinegar for 2-6 weeks

• liquid strained and used

liniment

• extract of plant added to either alcohol or vinegar

• applied topically

poultice

• soft, moist mass of plant material, usually wrapped in fine woven cloth

• topically applied

essential oils

aromatic volatile oils extracted from leaves, stems, flowers, and other parts of plants

herb infused oils

process of extraction in which the volatile oils of plant are obtained by soaking plant in carrier oil for approximately 2 weeks and straining oil

percolation

• process to extract liquid from plant with gravity

• material moistened and evenly packed into tall vessel, liquid poured in and steeped for certain length of time

• small opening is made in bottom of vessel, allowing extract to slowly flow out

Family-centered care

teaching directed toward both family members or caregivers and patients

Principle of Atraumatic Care

philosophy of providing therapeutic care through the use of interventions that eliminate or minimize the psychological and physical distress experienced by children and families

Polypharmacy

use of more medications than medically necessary

Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

document developed to aid healthcare providers in the safe prescription and administration of drugs to older adults

Adherence

following a drug regimen, especially hard for geriatric patients

Barriers to Effective Drug Used by Older Adults

• taking too many drugs at different times

• failure to understand purpose or reason for drug

• impaired memory

• decreased mobility and dexterity

• visual and hearing disturbances

• high dose of prescription

• childproof drug bottles

• side effects or adverse reactions from drug

Elderspeak

infantilizing patient

Substance Use Disorder

when recurrent use of alcohol/drugs causes clinically and functionally significant impairment

abstinence

refraining from drug use

craving

strong desire for drug or effects of drug

intoxication

results in disturbances in level of consciousness, cognition, perception, judgment

stabilization

acute treatment for substance use disorder involving supervision, observation, support, intensive education, and counseling that involves multidisciplinary treatment interactions

tolerance

requiring a significantly increased amount of drug to achieve desired effect

withdrawal syndrome

group of symptoms of varying severity that occur upon ending or reducing use of drug that has been taken repeatedly, usually for a prolonged period and/or in high doses

remission

none of the 11 criteria for substance use for at least 3 months

controlled environment

environment where access to drugs is restricted

impaired control

diminished ability of an individual to control his or her use of a drug in terms of onset, level, or termination

social impairment

recurrent drug use despite problems at work, school, or other personal issues

risky use

recurrent drug use despite the difficulty it’s causing

recovery

a process of change through which an individual improves health and wellness, lives a self directed life, and strives to reach full potential

relapse

return to drug use after period of abstinence

Vaping Cannabis - Why is this a public health concern?

• most commonly used recreational drug in US

• 4.2 million 12 yrs and older meet criteria for cannabis use disorder

What is Tobacco Use Disorder?

dependency on use of cigarettes, e cigs, and other similar products

Six Rights of Medication Administration

Right patient, drug, dose, time, route, and documentation

Root Cause Analysis

method of problem solving used to identify potential workplace errors

Sentinel Event

when an unanticipated event in a healthcare setting results in death or serious harm to a patient unrelated to natural course of patient illness

Drug Reconciliation

process of identifying most accurate list of all meds patient is taking at all stages of care

Why do we have Food and Drug Administration Pregnancy Categories?

So mother can know what drugs will effect course of pregnancy, fetus, breastfeeding, etc.

High Alert Medicaition

can affect patient organ systems if given in error and cause significant harm

do not use… q.d., Q.D. qd, QD

Use daily

do not use… q.o.d, Q.O.D, qod, QOD

Use every other day

do not use… U, u

Use unit

do not use… IU

International Unit

do not use… MS

Use morphine sulfate

do not use… MgSO4, MSO4

Magnesium sulfate

do not use… lack of leading zero (.X mg)

Use zero before decimal point when dose is less than whole unit

do not use… trailing zero (X.0 mg)

Do not use decimal point after whole number