NR293 Week 1 Pharmacology Nursing Process and Basics
Five Steps of the Nursing Process in Pharmacology
Assessment - Definition: The process of collecting data before administering or evaluating a medication. - Examples of Assessment Data: - Known allergies. - Current medications being taken. - Use of Over-the-counter (OTC) medications and herbal supplements. - Laboratory results, specifically focusing on kidney and liver function. - Vital signs. - Pregnancy status. - Current pain level. - Ability to swallow. - Test Clue: When a question asks, "What should the nurse do first?", the answer is usually to assess.
Identification of Human Need Statements - Description: This serves as the nursing diagnosis or problem statement. - Definition: The act of identifying a patient’s specific medication-related problem or need. - Examples: - Risk for injury related to medication side effects. - Knowledge deficit related to new medication. - Acute pain related to inflammation. - Risk for ineffective medication management. - Test Clue: This step is the focus when asked what problem the nurse should identify following an assessment.
Planning / Outcome Identification - Definition: The act of setting goals prior to providing care. - Examples: - Patient will report pain less than within . - Blood pressure will remain within the ordered range. - Patient will verbalize correct medication instructions before discharge. - Test Clue: Look for keywords such as "goal," "expected outcome," or "plan."
Implementation - Definition: Taking concrete action. - Examples: - Administering the medication. - Teaching the patient. - Holding a medication and contacting the provider when administration seems unsafe. - Utilizing the "9 rights" of medication administration. - Documenting the administration. - Note: Patient education is considered a core part of the implementation phase.
Evaluation - Definition: Checking to determine if the medication was effective and if any harm occurred. - Examples: - Did the patient's pain decrease? - Did the Blood Pressure (BP) improve? - Presence of adverse signs like rash, swelling, nausea, or dizziness. - Signs of toxicity. - Verification of the patient's understanding of prior teaching. - Test Clue: The phrase "determine drug effectiveness" equates to evaluation.
Nine Rights of Medication Administration
Right Patient: Use two unique identifiers, such as the patient's name and Date of Birth (DOB).
Right Medication: Compare the medication label directly against the Medication Administration Record (MAR) or provider order.
Right Dose: Ensure the amount is correct.
Right Route: (e.g., PO, IV, IM, SQ, topical). The nurse is prohibited from changing the route without a provider’s order.
Right Time: Adhere to the correct schedule and frequency.
Right Documentation: Document the medication immediately after it is given.
Right Reason / Indication: Understand the specific reason why the patient is receiving the drug.
Right Response / Evaluation: Determine if the drug worked and check for adverse effects.
Right Education: Teach the patient the purpose of the drug, side effects, safety considerations, and when they should call a provider.
Test Trap: If any element (route, frequency, or dose) is missing from an order, the nurse must clarify it before administration.
Key Pharmacological Terms
Drug: Any substance, other than food, that alters body function. Includes prescription meds, OTC meds, herbs, vitamins, alcohol, and marijuana.
Pharmacology: The study of drugs and their effects on the body.
Generic Name: The official, non-brand name of a drug. - Example: Ibuprofen is the generic for brand names Advil and Motrin. - Example: Acetaminophen is the generic for brand name Tylenol. - Test Tip: Generic names frequently follow specific suffix patterns.
Trade / Brand Name: The specific name given to a drug by the company that manufactured it. - Example: Amlodipine is the generic for brand name Norvasc.
Pharmacokinetics
Definition: What the body does to the drug.
Memory Aid: ADME (Absorption, Distribution, Metabolism, Excretion).
Absorption - Definition: How the drug enters the bloodstream (e.g., a pill dissolving in the stomach). - Bioavailability: The percentage or amount of drug that reaches the bloodstream. IV drugs have bioavailability as they enter the blood directly. - Routes of Administration: - Enteral: Passes through the GI tract (Oral/PO, Sublingual [under tongue], Buccal [in cheek], Rectal). - Parenteral: Injected; bypasses the GI tract (IV, IM, Subcutaneous, Intradermal). - Topical: Applied to skin or mucous membranes (Creams, Patches, Eye drops, Ear drops, Inhalers). - Factors Affecting Absorption: - Food in the stomach. - GI motility. - Blood flow. - Drug form (liquids absorb faster than tablets). - Route (IV is the fastest). - First-pass effect. - Delayed gastric emptying (affects absorption rate). - Vomiting or diarrhea. - First-Pass Effect: Oral drugs go to the liver first via the portal circulation. The liver breaks down some of the drug before it reaches general circulation, resulting in less active drug being available. Some oral medications require higher doses because of this effect.
Distribution - Definition: The movement of the drug from the bloodstream into body tissues. - Influencing Factors: Blood flow, protein binding, body fat, body water, the blood-brain barrier, and the pregnancy/placenta status. - Example: A drug that is highly protein-bound may remain in the bloodstream for a longer duration.
Metabolism / Biotransformation - Definition: The chemical alteration of the drug by the body. - Primary Organ: The Liver. - Test Tip: Liver disease results in slower metabolism, which increases the risk of toxicity.
Excretion - Definition: The removal of the drug from the body. - Primary Organ: The Kidneys. - Other Routes: Bile, lungs, sweat, and breast milk. - Test Tip: Kidney disease results in decreased excretion, which increases the risk of toxicity.
Pharmacodynamics
Definition: What the drug does to the body.
Agonist: A drug that activates a receptor and triggers a response. - Example: Albuterol activates beta-2 receptors to open airways. - Memory Aid: Agonist = Activates.
Antagonist: A drug that blocks a receptor and prevents a response. - Example: Beta blockers block beta receptors to lower heart rate and BP. - Memory Aid: Antagonist = Anti/Blocks.
Pharmacotherapeutics and Monitoring
Definition: The reason why a medication is being used therapeutically.
Types of Therapies: - Acute: For sudden, serious, short-term illness (e.g., IV antibiotics for sepsis). - Maintenance: Controls chronic conditions (e.g., daily BP medication). - Supplemental / Replacement: Replaces lacking substances (e.g., Insulin, Iron for anemia, Estrogen for menopause). - Palliative: Focuses on comfort rather than a cure (e.g., pain meds for terminal cancer). - Supportive: Supports body function during recovery (e.g., IV fluids, blood products, oxygen). - Prophylactic: Prevents illness/infection (e.g., pre-surgery antibiotics). - Empiric: Treatment started before a formal diagnosis is confirmed, based on the likely cause (e.g., antibiotics for a suspected UTI before culture results are back).
Monitoring Parameters: - Therapeutic Effect: The desired outcome (e.g., ibuprofen stopping a headache). - Adverse Effects: Unwanted and harmful effects (e.g., hives, severe hypotension). - Therapeutic Index: The safety range between an effective dose and a toxic dose. - High Index: Safer. - Low/Narrow Index: Dangerous; requires close monitoring. - Toxicity: Drug levels are high enough to cause harm. Risks include kidney/liver disease, older age, high doses, and drug interactions. - Tolerance: Requiring higher doses to achieve the same effect. - Dependence: - Physical: Withdrawal symptoms occur upon cessation. - Psychological: Cravings and emotional need.
Drug Interaction Effects: - Additive: Two drugs with similar effects add together (e.g., two BP meds combined). - Synergistic: Two drugs create an effect stronger than the sum of their individual effects (e.g., alcohol plus sedatives causing dangerous CNS depression). - Antagonistic: One drug reduces or blocks another (e.g., an antidote). - Incompatibility: Drugs that do not mix chemically or physically; often seen in IV meds as precipitation or cloudiness.
Timing and Action of Drugs
Pharmacognosy: The study of natural drug sources (plants, herbs, animals, minerals). Note: Herbs like St. John’s wort can interact with many prescription drugs.
Onset of Action: The time required for a drug to begin working.
Duration of Action: How long the drug's effect lasts.
Peak Level: The highest concentration/effect of a drug. This correlates with the highest risk for side effects and toxicity.
Trough Level: The lowest drug level, measured immediately before the next dose, to ensure enough drug remains in the body.
Lifespan and Diversity Considerations
Infants: High risk due to immature organs. - Immature liver (slow metabolism) and kidneys (slow excretion). - Skin absorbs more easily. - Dosing is typically weight-based.
Older Adults: High risk due to physiological changes. - Decreased kidney and liver function. - Less body water and more body fat. - Lower albumin levels (less protein binding). - Polypharmacy (multiple meds) increases interaction risk.
Pregnancy Safety Categories: - A: Safest; no risk shown in controlled studies. - B: No evidence of risk in humans. - C: Risk cannot be ruled out. - D: Evidence of fetal risk exists, but benefits may outweigh risks. - X: Contraindicated; risk clearly outweighs any benefit.
Problematic Meds for Elderly: Sedatives (falls), Anticholinergics (confusion/urinary retention), NSAIDs (GI bleed/kidney issues), Opioids (respiratory depression/falls).
Pharmacogenomics: The study of how genetics influence local response to drugs (e.g., metabolizing codeine too fast or slow).
Cultural Considerations: Impact of beliefs, language, diet, and health practices. Nurses should use open-ended questions, avoid judgment, use interpreters, and check for interactions with cultural herbal remedies.
Legal and Ethical Considerations
FDA (Food and Drug Administration): Regulates safety, approval, and labeling. - Black Box Warning: The strongest warning for serious or life-threatening risks.
DEA (Drug Enforcement Administration): Regulates controlled substances (opioids, benzos, stimulants). Nurses must follow strict counting and wasting policies.
State Laws: Define the nursing scope of practice.
HIPAA: Protects patient privacy; violations include sharing info in public or online.
Malpractice Elements: Duty (responsibility), Breach of Duty (failure to meet standard), Causation (action caused harm), and Damage (patient suffered injury).
Ethical Terms: - Autonomy: Right to make decisions (e.g., medication refusal). - Beneficence: Doing good. - Confidentiality: Keeping info private. - Justice: Fair treatment for all. - Nonmaleficence: Do no harm (e.g., holding med for low BP). - Veracity: Truthfulness. - Fidelity: Keeping promises (e.g., returning to reassess pain).
Medication Errors and Safety
Prevention: Use 9 rights, check allergies, verify unclear orders, use barcode scanning, medication reconciliation, and avoid unsafe abbreviations.
Response to Error: 1. Assess the patient (Priority #1). 2. Protect from harm. 3. Notify provider/charge nurse. 4. Monitor patient. 5. Document facts. 6. Complete incident report (do NOT document that an incident report was completed in the patient's chart).
Adverse Drug Reactions: Side effects are expected/mild; Adverse effects are harmful/dangerous (e.g., swelling, difficulty breathing). Action involves stopping the med and assessing ABCs (Airway, Breathing, Circulation).
Reversal Agents: - Opioids: Naloxone. - Benzodiazepines: Flumazenil. - Warfarin: Vitamin K. - Heparin: Protamine sulfate. - Acetaminophen: Acetylcysteine.
Needle Sticks: Wash area with soap and water immediately, report to supervisor, follow protocol, and obtain baseline labs. To prevent, use safety devices and never recap needles.
High-Yield Summary
Pharmacokinetics is what the body does to the drug; Pharmacodynamics is what the drug does to the body.
Liver = Metabolism; Kidneys = Excretion.
Peak is the highest effect/toxicity risk; Trough is the lowest level.
Agonists activate; Antagonists block.
Low therapeutic index meds are narrow/dangerous.
Always assess the patient first in the event of an error.
Older adults and infants are at high risk for toxicity.