Week 1

5 steps of the nursing process

assessment, human needs statements (formerly nursing diagnoses), planning, implementation, evaluation

the rights of administering medication

right drug, right dose, right time, right route, right patient, right documentation (may also include right reason, right response, right to refuse)

drug

any chemical that affects the physiologic processes of a living organism

pharmacology

study or science of drugs, encompasses a variety of topics

chemical name

describes the drug’s chemical composition and molecular structure

generic name (nonproprietary name)

name given by the US adopted names council

trade name (proprietary name)

the drug has a registered trademark; use of the name is restricted by the drug’s patent owner

drug classifications

structure, therapeutic use, prototypical drugs

pharmaceutics

the science of preparing and dispensing drugs, including dosage form design

pharmacokinetics

the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body, effect of body on drug

pharmacodynamics

the study of the biochemical and physiologic interactions of drugs at their sites of activity, effect of drug on body

pharmacogenomics (pharmacogenetics)

the study of the influence of genetic factors on drug response that result in the absence, overabundance or insufficiency of drug metabolizing enzymes

pharmacotherapeutics

the treatment of pathologic conditions through the use of drugs

pharmacognosy

the study of drugs that are obtained from natural plant and animal sources

Pharmacoeconomics

the study of economic factors affecting the cost of drug therapy

toxicology

the study of poisons, including toxic drug effects and applicable treatments

enteral route

the drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine

enteral routes

oral (very slow), sublingual, buccal, rectal (can also be topical)

parenteral route

intravenous (fastest delivery into the blood circulation), intramuscular, subcutaneous

Blood Brain Barrier

the barrier system that restricts the passage of various chemicals and microscopic entities between the bloodstream and the CNS, it still allows for the passage of essential substances such as oxygen

allergic reaction

an immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication; a type of adverse drug event

dissolution

 The process by which solid forms of drugs disintegrate in the gastrointestinal tract and become soluble before being absorbed into the circulation

bioavailability

the extent of drug absorption

antagonist

a drug that binds to and inhibits the activity of one or more receptors in the body, also called inhibitors

agonist

a drug that binds to and stimulates the activity of one or more receptors in the body

additive effects

drug interactions in which the effect of a combination of 2 or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given along, 1+1=2

adverse drug reaction

pharmacologic- having an adverse reaction, hypersensitivity (allergic)- having an allergic reaction, idiosyncratic reaction, drug interaction

compliance

 Implementation or fulfillment of a prescriber’s/caregiver’s prescribed course of treatment or therapeutic plan by a patient. Use of compliance versus the term adherence acknowledges the consideration/acceptance of patient/family/caregiver participation in the use of the nursing process

outcomes

 Implementation or fulfillment of a prescriber’s/caregiver’s prescribed course of treatment or therapeutic plan by a patient. Use of compliance versus the term adherence acknowledges the consideration/acceptance of patient/family/caregiver participation in the use of the nursing process

medication error

any preventable event that may cause or lead to inappropriate medication use or patient harm, can be patient related or system related

incompatibility

create an adverse effect, the characteristic that causes two parenteral drugs or solutions to undergo a reaction when mixed or given together that results in the chemical deterioration of at least one of the drugs

trough level

lowest blood level of a drug

receptor

A molecular structure within or on the outer surface of a cell. Receptors bind specific substances (e.g., drug molecules), and one or more corresponding cellular effects (drug actions) occur as a result of this drug-receptor interaction

polypharmacy

multiple doctors at multiple places who may not communicate with each other

peak level

highest blood level of a drug

metabolite

a chemical form of a drug that is the product of one or more biochemical reactions involving the parent drug

active metabolite

those that have pharmacologic activity of their own, even if the parent drug is inactive

inactive metabolites

lack pharmacologic activity and are simply drug waste products awaiting excretion from the body

Iatrogenic effects

unintentional adverse effects that are caused by the actions of a prescriber or other health care professional, or by specific treatment

synergistic effects

drug interactions in which the effect of a combination of 2 or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone, 1+1>2

active transport

  The active (energy-requiring) movement of a substance between different tissues via pumping mechanisms contained within cell membranes

diffusion

The passive movement of a substance (e.g., a drug) between different tissues from areas of higher concentration to areas of lower concentration

first pass effect

large proportion of a drug is chemically changed into inactive metabolites by liver, much smaller amount will be bioavailable

veracity

the duty to tell the truth

confidentiality

the duty to respect privileged info about a patient, HIPAA

beneficence

the ethical principle of doing or actively promoting good

autonomy

self-determination and the ability to act on one’s own

drug classes that interact with beta blockers

result from either the additive effects of co-administered medications with similar mechanisms of action or the antagonistic effects of various drugs, nonselective beta blockers may mask the tachycardia from hypoglycemia

patient safety when transferring from bed to wheelchair

You know this

ergonomic measures for lifting to prevent injury

You know this: lift from hips not back

best method for pain assessment

older than 9- 0-10 numeric rating scale

wong baker FACES for older than 3

beyer oucher for children who can point

CRIES for 0-6 mnths

FLACC for 2mnths-7 years who are unable to validate prescece, quantitiy and quality of pain

COMFORT for people unable to use numeric scale

behavioral for intubated/critically ill

critical care pain observation tool

PAINAD for advanced demetia

methods for keeping the patient’s privacy in healthcare

you know this

what information can be found on the drug label

active ingredients, purpose, uses, warnings, side effects, if pregnant or breastfeeding, keep out of reach of children, directions for different ages, how to store it, inactive ingredients

nursing considerations for OTC drugs

may postpone effective treatment of more chronic disease states, may delay treatment of serious life-threatening disorders, may relieve symptoms or a disorder but not the cause, toxicity, interaction with current prescription medications may occur, abuse

considerations for older adults

decline in organ function occurs when advancing age, drug therapy in older adults is most likely to result in adverse effects and toxicity, high use of medications, polypharmacy, noncompliance, nonadherence, increased incidence of chronic illnesses, sensory and motor deficits, gastric pH less acidic, gastric emptying and movement through GI tract slowed, blood flow to GI tract reduced, absorptive surface of GI tract reduced, lower total body water percentages, increased fat content, decreased production of proteins by the liver, aging liver produces fewer microsomal enzymes (affects drug metabolism), reduced blood flow to liver, decreased glomerular filtration rate, decreased number of nephrons, drugs are cleared less effectively

what is the role of the FDA

regulates the approval and clinical use of all drugs in the US, including the requirement of an expiration date on all drugs

what does the Drug Enforcement Administration agency monitor

the DEA is in charge of enforcing the controlled substances laws of the US

HIPAA

An act that protects health insurance coverage for workers and their families when they change jobs. It also protects patient information. If confidentiality of a patient is breached, severe fines may be imposed

what does the package insert tell you about the drug

the package insert is a summary of all the preclinical and clinical data accumulated during the successful development of a new drug

safe medication administration considerations

3 checks, medication rights, 2 patient identifiers, check for allergies, monitor, especially after 1st and 2nd dose

where do you find info about specific drugs

drug books, lexicom, drug package insert

cultural considerations in healthcare

pharmacogenomics, drug polymorphism, adherence to therapy, environmental and economic considerations, pharmacokinetics, pharmacodynamics, varying drug responses in different racial or ethnic groups, health beliefs and practices, barriers to adequate health care for the culturally diverse US patient population (language, pride, poverty, access, beliefs regarding medical practices)

QSEN competencies

Patient-centered care, Teamwork and collaboration, Evidence based practice (EBP), Quality improvement (QI), Safety, Informatics  

isoproterenol

beta 1 and 2 adrenergic agonist, catecholamine, used to treat bradycardia conditions, similar to epinephrine, injection or IV

propranolol

Inderal, protypical nonselective beta 1 and 2, used for: tachydysrhythmia, subaortic stenosis, migraine headaches, essential tremor, oral and injectable

clonidine

used to treat high blood pressure, central alpha 2 receptor agonist

nadolol

Corgard, treats high blood pressure and angina, beta blockers nonselective

tamsulosin

Flomax, used by men to treat the symptoms of an enlarged prostate, alpha 1 adrenoceptor antagonist

Dopamine

increases BP, naturally occurring catecholamine neurotransmitter, potent dopaminergic as well as beta 1 and alpha 1 adrenergic receptor activity, low dosages can dilate BVs in the brain, heart, kidneys, and mesentery, which increases blood flow to these areas, higher infusion rates (improve cardiac contractility and output), highest doses (vasoconstriction), dopaminergic increase BP, increased HR as an adverse effect always choose that answer

phentolamine

alpha adrenergic antagonist, used to treat high blood pressure due to pheochromocytoma

epinephrine

increases BP, endogenous vasoactive catecholamine, acts directly on both alpha and beta adrenergic receptors of tissues innervated by the SNS, prototypical nonselective adrenergic agonist, administered in emergency situations, one of the primary vasoactive drugs used in many advanced cardiac life support protocols

over the counter antihistamines

may be contained in OTC sleeping aids or pain relievers, CNS depressant effect,

diphenhydramine

Benadryl, antihistamine medication, used to relieve symptoms of allergy, hay fever, and the common cold

acute therapy

treats acute conditions

maintenance therapy

ongoing treatment of cancer with medication after the cancer has responded to the first recommended treatment

supplemental therapy

the use of vitamins and mineral supplements to prevent disease

supportive therapy

a form of psychotherapy to help the patient cope with symptoms, stressors, and challenges

prophylactic therapy

a preventative therapy that aims to improve or maintain a person’s health

empiric therapy

treatment given based on experience, without precise knowledge of the cause or nature of a disorder

alpha 1

located on postsynaptic effector cells

alpha 2

located on presynaptic nerve terminals, control the release of neurotransmitters

beta 1

located in the heart

beta 2

located in smooth muscle of the bronchioles, arterioles and visceral organs

catecholamines

substances that can produce a sympathomimetic response

Stimulation of alpha-adrenergic receptors on smooth muscles results in  

* Vasoconstriction of blood vessels 
* Relaxation of GI smooth muscles (decreased motility) 
* Constriction of bladder sphincter 
* Constriction of uterus 
* Male ejaculation 
* Contraction of pupillary muscles of the eye (dilated pupils) 

Stimulation of beta 1-adrenergic receptors on the myocardium, AV node, and SA node results in cardiac stimulation 

* Increased force of contraction (positive inotropic (force) effect) 
* Increased heart rate (positive chronotropic (time) effect) 
* Increased conduction through AV node (positive dromotropic (conduction) effect) 

Stimulation of beta 2- adrenergic receptors results in

* Bronchodilation (relaxation of the bronchi)


* Uterine relaxation 
* Glycogenolysis in the liver 
* Increased renin secretion in the kidneys 
* Relaxation of GI smooth muscles (decreased motility) 

adverse effects of alpha

* Headache, restlessness, excitement, insomnia, euphoria 
* Chest pain, vasoconstriction, reflexive bradycardia, palpitations, dysrhythmias 
* Anorexia, dry mouth, nausea, vomiting, taste changes 

adverse effects of beta

* Mild tremors, headache, nervousness, dizziness, 
* Increased heart rate, palpitations, fluctuations of blood pressure 
* Sweating, nausea, vomiting, muscle cramps 

Cardioselective beta blockers (beta1) 

* Reduce SNS stimulation of the heart 
* Decrease heart rate 
* Prolong sinoatrial (SA) node recovery 
* Slow conduction rate through the AV node 
* Decrease myocardial contractility, thus reducing myocardial oxygen demand

Nonselective beta blockers (beta 1 and beta 2) 

* Cause same effects on heart as cardioselective beta blockers 
* Constrict bronchioles, resulting in narrowing of airways and shortness of breath 
* Produce vasoconstriction of blood vessels 
* Other effects 

beta blockers indications

angina, cardioprotective, dysrhythmia, migraine headaches, antihypertensive, heart failure, glaucoma

beta blockers contraindications

drug allergy, heart failure, cardiogenic shock, heart blocks, bradycardia, pregnancy, severe pulmonary disease, Raynaud’s disease

carvedilol

Coreg, nonselective beta blocker, alpha 1 blocker, calcium channel blocker, used for heart failure, hypertension, angina

labetalol

Noremodyne, Trandate, hypertension, alpha beta blocker

Sotalol

Betapace, beta blocker, used for sustained ventricular tachycardia, atrial fibrillation

Timolol

Blocadren, Timoptic, ophthalmic, glaucoma