305 exam 2 Flashcards
Understand the steps of the nursing process.
ADPIE
Assessment
- Collecting data
Diagnosis
- Analyze data, Identify health risks
Planning
- Prioritize problems
Implementation
- Implement nursing interventions
Evaluation
- Collected data related to outcomes
What assessment would be important
Subjective Data: What patient Describes
Objective Data: Physical Assessment, Laboratory tests, other diagnostic sources
Health History
What nursing diagnosis would pertain to medications
Deficient Knowledge:
*Patient not properly educated about medication
Noncompliance
*Patient properly educated but chooses not to take medication
What outcome would you want to see for the patient depending on the medication?
Once pharmacotherapy is initiated, assessment focuses on reaction to medication. Watch for:
◦Desired response
◦Adverse effects
◦Patient capability of assuming responsibility for self-administration
What interventions would you use for medication administration
Administer medication
Continue assessment of patient
Monitor drug effects
Carry out interventions in planning phase
Provide patient teaching
How would you evaluate medication effectiveness
Reassess Patient
*Physical condition
*Vital signs
*Body weight
*Lab values
*Serum drug levels
Monitor for identified therapeutic effects
Monitor side effects or adverse reactions
What is the most important step to the nursing process
Assessment
Assessment of the Patient
Systematic collection, organization, validation, and documentation of patient data
Health history and physical assessment
Baseline data gathered; will be compared to later information from observations
Nursing Diagnosis
Often most challenging part of nursing
Focus is on patients needs, not nurses
Three main areas of concern
*Promoting therapeutic drug effects
*Minimizing adverse drug effects and toxicity
*Maximizing patient ability for self-care (including knowledge, skills, and resources necessary for safe and effective drug administration)
Risk Diagnosis
Diagnostic Statement
Related Factors
Actual Diagnosis
Diagnostic Statement
Related Factors
As Evidence By
Diagnoses for Drug Administration
Activity intolerance
Pain, acute or chronic
Risk for falls
Urinary incontinence
Outcomes for patients receiving medications
Provide specific, measurable criteria
Evaluate degree to which goal is met
Focus on what patient will achieve or do
Discussed with patient and caregiver
Should be written and include
- Subject, Action required by subject, circumstances, expected performance, specific time frame
Documentation of Medication Administration
Administration of medication
Therapeutic and adverse effects
Patient statements
Objective assessment data
Patient education
Primary role for nurses
Think about individual learning styles related to what is being taught
Directly related to
◦Deficient knowledge
◦Noncompliance
Evaluation
Begins new cycle
New assessment data are gathered and analyzed
Nursing diagnoses are reviewed or rewritten
Goals and outcomes are refined
New interventions are carried out
Review what should be included for a medication reconciliation.
Complete List of Current Medications
- Name of all Meds, OTC meds, Supplements, Vitamins, Herbal products, Tea
- Frequency, Date, Last time taken
- Dosage and Route
- Reason for taking
- Place for provider to document review or for RN to document provider was notified
What constitutes an error or a near miss
Omitting: One of the rights of drug administration
Failing: To perform an agency system check
Failing: To analyze patient variables such as age, body size, and renal or hepatic functions
Giving: Giving medication based on verbal orders or phone orders
Giving: Giving medication based on an incomplete order or an illegible order
Practicing: Practicing under stressful work conditions
What should you do in the event of an error
First assess patient (Vital signs, monitor for adverse reactions)
Inform provider
Administer antidote (If available)
Document all the names of individuals who were notified
Patient must be informed of the error
How can you prevent errors when preparing medications
Avoid use of abbreviations
*Pay special attention to
*Watch for look-alikes (TALL letters)
*Black box warnings
*Narrow therapeutic indexes
*Clarify any order you do not understand
*Do not accept verbal orders or phone orders if possible to avoid
*Limit distractions during med admin (vest)
*ALWAYS identify client using 2 means of identification
*Calculate dosages correctly (ask a peer or pharmacist to double check when needed)
What are some methods hospitals use to prevent errors
*Look up the medication (dosage range, contraindications, …)
*Assess the patient (know the patient’s baseline findings)
*5 rights & 3 checks
*Follow the pharmaceutical instructions and RN Scope of Practice Standards for preparing and administering the medication
*Educate the client about the medication BEFORE administering the first dose
*Reassess the client after administration to determine if:
*Adverse reactions are occurring
*Therapeutic effectiveness is occurring
Methods for reporting
*RN’s legal and ethical responsibility to report all errors
*The RN’s errors and near misses, and
*The errors and near misses the RN observes
*FDA coordinates the reporting of medication errors
*MedWatch
*NCC MERP
*DMEPA
Follow the healthcare facilities policy on reporting medication errors.
This policy will specify who to report the incident to and the documents that must be completed (example: incident report).
Infant development stages and how to promote compliance (Discussion from Sakai)
Held upright and cuddled while administering medication
Often administered via drops into the eyes, ears, nose, or mouth
Oral meds should be directed to posterior portion of inner cheek, give time to swallow to avoid choking
If rectal suppository is used, hold buttocks together to prevent expulsion
Smaller needles for Parenteral meds, Vastus lateralis is most preferred
Rotate injection sites
Underdeveloped liver, possible risk for toxicity
Toddler development stages and how to promote compliance (Discussion from Sakai)
Use fun colored equipment
Physical comfort: Hugging, touching, verbal praise
Mix medications with something more tasty if possible
Offer choices
Young and middle aged adult development stages and how to promote compliance (Discussion from Sakai)
Promote healthy lifestyle
providing information on what type of medication the client is taking and what they are taking it for. Advise clients of side effects and adverse effects of medication and possible polypharmacy.
Advise clients on drug-food interactions to prevent adverse medication effects.
Encouraging the client to attend regular doctor appointments and reaching out if things change
Suggest medication organization boxes for memorizing when to take medications
Older Adult development stages and how to promote compliance (Discussion from Sakai)
Pill storage due to memory loss
Regular allergy testing
Keep a list of medications
Bring all medications with them to the doctor
Preschool and school age development stages and how to promote compliance (Discussion from Sakai)
Stickers
Crush or mix meds into foods
Incorporate small choices when possible to give sense of autonomy
Provide education
High metabolism, higher risk for toxicity
Absorption reduced due to shorter intestinal transit time
High body water composition, low body fat
Increased hepatic blood flow affects metabolism
Adolescents development stages and how to promote compliance (Discussion from Sakai)
ADME peak, similar to young adults
Focus on education and self advocacy
Most common use of meds is for eating disorders, depression, headaches, skin issues, sports injuries
Set a good routine for taking meds
Understand recreational drug use can have serious adverse drug interactions
Heavily influenced by peers
Pregnancy development stages and how to promote compliance (Discussion from Sakai)
Embryonic Stages of development: 3-8 weeks post conception, Rapid development of internal structures occur during this stage and is the period of maximum sensitivity to teratogens
Absorptive Properties: Increase levels of progesterone can cause delayed gastric emptying, allowing longer time periods for absorption of oral meds. Reduced gastric acidity is also decreased affecting absorption.
Increased cardiac output, increased plasma volume and altered regional blood flow causes dilution of drugs and decreased plasma protein concentrations also affecting drug distribution
Drug metabolism increases in certain drugs, most noticeable in anticonvulsants (Phenytoin) Fat soluble drugs are passed in lipid rich breast milk and may be passed to a lactating infant
By third trimester blood flow to the mothers kidneys increases by 50% affecting glomerular filtration, renal absorption, and renal plasma flow which may increase the rate of excretion and doses may need to be adjusted
Instruct client to contact the provider before taking medications while pregnant
Lactating Patients development stages and how to promote compliance (Discussion from Sakai)
pharmacotherapy should be postponed until the infant is weaned
Try relaxing music for anxiety instead of medication
Try massage for pain instead of medication
Administer the drug immediately after breastfeeding
○ Reduces the concentration of drug before next feeding
Avoid illicit drugs, alcohol, and tobacco products during lactation period
Monitor lactating clients and infants for any signs of adverse effects.
Infant factors that may affect medication administration
Liver not fully mature, unable to breakdown drugs
IM injections- Use caution due to low body mass
Geriatric factors that may affect medication administration
Absorption slows
More body fat
Reduced plasma levels
Enzymes in liver is reduced
Reduced half lives of drugs
Decreased metabolism
Decreased Excretion (Drug stays in body longer)
What would you advise a breastfeeding woman who is taking medications while breastfeeding?
If medication is prescribed take it at a point of the day when the baby may be napping, or won’t be feeding for a while
Trust vs Mistrust
(Infant-12 months)
Dependent on caregiver
Autonomy vs Shame and Doubt
(1-3 years)
Rapid motor development
More at risk for choking
Asserting independence
Limited ability to reason
Initiative vs Guilt
(3-5 years)
Gross and fine motor skills
New activities and socially involved
If walking for 1 year use ventrogluteal site for injections, if not vastus lateralis
Choking is less common
Poisonings are more common
Industry vs Inferiority
(5-12 years)
Rapid physical development, social growth
Sense of pride
Likes choices and praise
Identity vs Confusion
(12-18 years)
Rapid physical growth
Psychological maturity
Personality development
Sense of independence
Skin problems, menstrual problems, headaches, contraception, alcohol, sports injuries
Rely on peers for support
Peak metabolism
Intimacy vs Isolation
(18-40 years)
Minimal need for prescription drugs
Intimate loving relationships
Start families
Sexually active
Contraception, STD prevention
Substance abuse
Generativity vs Stagnation
(40-65 years)
Build lives with careers
Stressors
Sandwich generation
Health impairments around 45
Integrity vs Despair
(65-Death)
Polypharmacy (Multiple drugs)
Some may experience cognitive decline
Independence and dignity
Fulfillment, review accomplishments
Absorption slows
Reduced plasma levels
Enzymes in liver is reduced
Reduced half life of drugs
More body fat
Thalidomide
Used to reduce headaches and morning sickness, caused babies to be born with missing limbs
Hormones can affect ADME
Decreased absorption
Progesterone
Increased tidal volume = Increased effect, increased pulmonary vasodilation
Inhaled drugs absorbed to a greater extent
Increased blood supply to abdominal organs
Affects absorption (Accelerated)
Increased in blood volume
Diluting drugs affecting distribution
Drug Categories
Category A: Adequate well controlled studies have shown no risks in any trimester during the pregnancy
Category B: Animal studies have revealed no evidence of fetal harm
Category C: Animal studies have demonstrated risk to fetus
Category D: Observation in pregnant women demonstrated risks to fetus, but benefits may outweigh the risk
Category X: Contraindicated for pregnancy
Teratogen
Causes abnormality, permanent damage
Dose response relationship
Embryonic stage: Most risk for development issues
Mexican American
- Traditional diet high intake of fruit, vegetables, and fiber (such as grains and legumes),
- less meat intake
- Traditional meals usually include coffee, beans, meat, and rice is usually served first before the main meal
- Mexican American diet and meals typically eat more meat and less fruits and vegetables
- more likely to have pain underestimated by physicians
- family often plays significant roles in health care decisions
- Usually seek out a folk healer or practitioner before consulting Western medicine
- have increased CYP450 enzymes which effects metabolism of drugs and can reduce therapeutic concentration of a drug
Asian Americans
Family collectivism
Maintain strong ties to traditional medicine
High respect for medical providers
Diet heavy in seafood
Rice is main source of carbohydrates
Food is seasonally based
Review ways in which a nurse can be culturally aware.
Practice self awareness and examine personal attitudes related to various aspects of culture, identify possible bias
Be knowledgeable about cultures in your area
Apply culturally appropriate care
Understand and address entire culture
Do not impose your own cultural beliefs on others
Understand medication change that is needed for someone considered a slow acetylator, slow metabolizer, Fast metabolizer
Slow acetylator:
the rate at which a person acetylates certain drugs is slower than regular
Allows drugs to stay in the body longer increasing risk for toxicity
Slow Metabolizers
Slow metabolizers have a reduced ability to process and eliminate certain drugs, which means these drugs stay in the bloodstream for longer periods and can reach higher concentrations
Fast Metabolizers
This can lead to lower drug levels in the bloodstream and reduced drug efficacy, as the drug is cleared from the system before it has time to produce its full therapeutic effect.
Understand holistic care and incorporating it in caring for patients
Caring for the entire patient, physically, spiritually, emotionally
Use inclusive language
Provide resources for spiritual practice if appropriate
Active listening
Use of pharmacological and nonpharmacological practices
Cultural influences, Environmental factors, Psychosocial variables, Gender, Genetics
Genetic Polymorphism
*Two or more versions of the same enzyme
*Pharmacogenetics—study of genetic variations that cause differences in the way patients handle medications
*Enzyme function changes
What is a psychosocial influence of pharmacotherapy
Psychosocial: Ones psychological development in the context of one’s social environment
Ill health, Suffering, Loneliness, Despair, Death
Barriers to culturally responsive nursing care
Language
Culturally inappropriate tests
Genetic polymorphism
Poor access to healthcare
Prejudice and Discrimination
Health disparities
Garlic:
Medicinal Part: Bulb
Primary Use: Reduce blood cholesterol, reduce blood pressure, anticoagulant
Ginger:
Medicinal Part: Root
Primary Use: Antiemetic, Antithrombotic, Diuretic, Promote gastric secretions, Antiinflammatory, Increase blood glucose, Stimulation of Peripheral circulation
Ginkgo:
Medicinal Part: Leaves and Seeds
Primary Use: Improve memory, Reduce Dizziness
Ginseng:
Medicinal Part: Root
Primary Use: Relieve stress, Enhance immune system, decrease fatigue
Echinacea:
Medicinal Part: Entire Plant
Primary Use: Enhance immune system, treat the common cold
Know how dietary supplements can support health
*Non Herbal dietary products are used to enhance a wide variety of body functions
*Occur naturally in the body
*Excessive amounts may have harmful effects
*Example—chondroitin and glucosamine (Reduces symptoms of arthritis and other joint problems)
*Link with benefits is unclear
Co-Q10:
Primary Use: Prevents heart disease, provides antioxidant therapy
Fish Oil:
Primary Use: Reduces cholesterol levels, enhance brain function, increase visual acuity (Due to presence of Omega-3 fatty acids)
Lactobacillus Acidophilus:
Primary Use: Maintains intestinal Health
Vitamin C:
Primary Use: Prevents Colds
Know the regulations on labels for dietary supplements
*Manufacturers of dietary supplements required to evaluate the identity, purity, potency, and composition of their products and report on label
Dietary Supplement and Nonprescription Drug Consumer Protection Act (2007)
Companies must
*Include contact information on product labels for reporting adverse events
*Notify the F D A of any serious adverse event reports within 15 days of receiving such reports
*Keep extensive records on reports
D S H E A Weaknesses
*Not necessary to demonstrate effectiveness prior to marketing
*Manufacturer not required to prove safety
*Labels not monitored for accuracy in product amounts or claims of benefits of product
Dietary Supplement Health and Education Act of 1994 (D S H E A)
*Regulatory act for dietary supplements
*Less rigid than the Food, Drug, and Cosmetic Act (F D & C Act)
*Dietary supplements are exempted from F D & C Act standards
*Gives Food and Drug Administration power to remove products considered harmful
Complementary, Alternative, Integrative medicine
*Complementary – non mainstream practice is used together with conventional medicine
*Alternative – non mainstream practice is used in place of conventional medicine
*Integrative medicine – traditional and complementary approaches are used together
Review gastric lavage and when it would be a good treatment option and when you should withhold the treatment.
*Used if patient has ingested a potentially life-threatening amount of poison
*Must be done within 60 minutes
It involves the introduction of a large volume of normal saline or water into the stomach through a tube, which is then aspirated to evacuate stomach contents.
Elevate head of bed to 20 degrees
Continuous setting until return is clear, then set to intermittent
Withhold if:
Client is throwing up
Single-Dose Activated Charcoal
*Used if poison is carbon-based (binds to substance to prevent absorption)
*Greatest benefit within 60 minutes
Whole Bowel Irrigation
*For potentially toxic ingestions of sustained-release or enteric-coated drugs
*For toxic ingestions of iron, lead, zinc, or illicit drugs
*Solutions such as GoLytely administered via NG tube
*May also have solutions ordered per rectum
Review nerve agents and antidotes
Can cause convulsions and loss of consciousness within seconds, respiratory failure within minutes
Blocks Ach E, increasing action of acetylcholine in the synaptic space
*G A (Tabun), G B (Sarin), G D (Soman), V X treatment
–Give atropine injection
–Flush eyes with water
–Apply sodium bicarbonate or 5% liquid bleach solution to skin
–Do not induce vomiting (Mix with stomach acids and form a gas)
Review the different levels of patient triage
Red: Patient requires immediate attention within 60 minutes or death will occur
Black: Patient is dead or will die, move on
Yellow: Delayed, Patient still requires treatment but is able to wait a few hours
Green: Minor, Walking wounded
Review role of nurse in emergency preparedness
*You will be called upon—duty to respond regardless of training
*virtually no resources and very long hours
*RN role in prevention for:
- self
- community: disaster plans, hospitals etc…
*1. mitigate, 2. Triage 3. treat 4. reassess
*Mitigation-Assessment of Populations at Risk
Education: *Current knowledge/understanding of emergency management
Resources: *Current list of contacts in health and law enforcement
Diagnosis and Treatment: *Awareness of signs, symptoms, and treatment of chemical/biologic agents
Planning: *Involvement in emergency-management plans
