pharmacology

Patient-Centered Model of Care

  • Shift from disease-centered to patient-centered care
    • Focuses on caring for individual patients, their families, and communities
    • Influences organization of patient information and delivery of care through nursing processes
    • Incorporates health, illness, health promotion, support for preventative, primary, acute, and chronic healthcare

Assessment Data

  • Difference between Subjective and Objective Data

    • Subjective Data:

    • Information provided verbally by the patient or their family and friends

    • Includes personal experiences related to medications, health problems, and lifestyle choices

    • Examples: "I'm in pain," "I'm anxious," "I'm worried about my procedure," "How will I afford this?"

    • Objective Data:

    • Measurable data collected through observation, such as vital signs and lab results

    • Obtained through the nursing assessment process using the senses

    • Examples: vital signs, lab values indicating kidney function (e.g., creatinine levels in nephrotoxic drug administration)

Nursing Diagnosis and Goals

  • Nursing diagnosis focuses on the patient as a whole, not just the disease
    • Examples of nursing diagnoses might include cognitive decline or non-adherence to medication plans
  • Goals should be SMART:
    • Specific: Clear in focus.
    • Measurable: Quantifiable outcomes.
      • Example of measurable outcome: by the end of education, the patient will administer insulin independently.
    • Attainable: Realistically achievable goals based on patient’s condition.
      • Example: A patient with terminal illness may not achieve recovery as an attainable goal.
    • Realistic: Goals must be realistic and feasible.
    • Timely: Goals should have a timeframe for achievement, such as during the hospital stay or weeks after discharge.

Implementation of Nursing Interventions

  • Interventions include education, administering medications, additional assessments, and documentation
    • Importance of documentation: "If it’s not documented, it didn’t happen."
    • Requesting provider prescriptions and collaborating with the healthcare team are crucial actions.

Patient Engagement and Learning

  • Effective education involves engagement from both the nurse and the patient
    • Nurses must be attentive and interested in their patients
    • Timing of teaching is critical; patient comfort (e.g., pain control) is essential for effective learning
    • Learning Environment: Should be quiet and comfortable (e.g., TV off)
    • Language barriers must be addressed by using certified interpreters

Teaching and Health Literacy

  • Assess health literacy before teaching (ability to read, write, communicate)
    • Tailor education to patients' understandable levels (aim for 5th-6th grade comprehension)
    • Use simple language and allow time for patients to demonstrate skills they have learned
    • Open-ended questions are essential to gauge understanding rather than simply asking if they understand

Evaluation of Care

  • Evaluate whether patient's interventions achieve expected outcomes
    • Adjust nursing interventions if outcomes are unmet
    • Document successful outcomes in patient’s plan of care

Adherence Versus Compliance

  • Prefer to use “adherence” when discussing how well patients follow care plans, to encourage a collaborative approach
  • Non-adherence often occurs due to:
    • Financial constraints or lack of understanding about the importance of medications
    • Transportation access issues

Drug Pharmacokinetics and Pharmacodynamics

  • Key pharmacokinetic terms:
    • Half-life: Time for the plasma concentration of a drug to reduce by half
      • Example: Ibuprofen with a 2-hour half-life
    • Loading dose: Higher initial dose to quickly achieve therapeutic effects
      • Common with drugs like Methadone and Phenytoin
    • Maintenance dose: Doses used to maintain constant drug levels in the body
  • Distribution: Movement of drugs from circulation to tissues; affected by blood flow and protein binding
    • High protein-bound drugs (e.g., Warfarin is 99% protein-bound) versus low protein-bound drugs

Drug Interactions

  • Understand potential interactions:
    • Additive Effect: Drug effects can be beneficial or harmful based on combined pharmacological actions
    • Antagonistic Effect: Prevent receptor activation (e.g., using naloxone for heroin overdose)

Adverse Reactions and Toxicity

  • Always monitor for side effects, adverse reactions, and toxic levels of medications
  • Drug toxicity can lead to unexpected reactions and may need immediate intervention
  • Consider factors that contribute to adverse reactions, such as drug interactions and patient-specific factors (age, genetics, renal function)

Teaching Patients About Medications

  • Encourage open communication and facilitate collaborative relationships with patients
  • Educate about the necessity of adhering to prescribed medication regimens
  • Monitor therapeutic effects and adverse reactions closely, especially in at-risk populations (e.g., older adults, those with renal or liver dysfunction)

Common Laboratory Tests for Drug Monitoring

  • Common Renal Function Tests:
    • Creatinine, Blood Urea Nitrogen (BUN), Glomerular Filtration Rate (GFR)
  • Creatinine levels are important for understanding kidney function and adjusting medication doses appropriately

Conclusion

  • Always remind patients the importance of reporting side effects and engaging them in the educational process to enhance their understanding and adherence.