305 Exam 2 Flashcards
ADPIE Parts
-Assessment
-Diagnosis
-Planning
-Implementation
-Evaluation
Assessment
-Collection of health history data and physical assessment
-Med use, otc drugs, illicit drug use, lifestyle habits
-Most important step - reference for everything in the future
Reassessment
-After pharmacotherapy assess for response
-Desired response
-Adverse effects
-Patient capability of assuming responsibility
for self admin
Diagnoses (Nursing)
-Focus on patient needs
-3 main parts
1. Promote therapeutic drug effect
2. Minimize adverse effects and toxicity
3. Maximize patient ability for self care
Risk Diagnoses
- Diagnostic statement
- Related factor or inferred cause
Actual Diagnoses
- Diagnostic statement
- Related factor or inferred cause
- Evidence to support statement
Planning
Goals for Patient Receiving Meds
-Bases on nursing diagnoses
-Focused on what pt will do/achieve
-Discussed with pt or caregiver
-Can be short or long term
Outcomes for Patient
-Provide specific and measurable criteria
-Evaluate level of completion of goal
-Focus on what patient will do
Implementation
- Administer
- Continue
- Monitor
- Carry out
- Provide (education)
Monitoring Drug Effects
-Monitor for therapeutic effect
-Reassess patient (condition, vs, weight, labs)
-Monitor side/adverse effects
Document
-Admin of med
-Therapeutic/adverse effects
-Pt statements
-Objective assessment data
Evaluation
-Compares current status with goals
Evaluation Begins New Cycle When
-New assessment data gathered and analyzed
-Nursing diagnoses reviewed/rewritten
-Goals or outcomes are refined
-New interventions are carried out
Factors that Contribute to Med Errors
- Omitting (one of the rights)
- Failing (to perform safety check)
- Failing (to identify patient variables age, weight, liver function)
- Giving (meds on verbal orders)
- Giving meds (on incomplete/illegible orders)
- Practicing (under stressful conditions)
Methods For Reporting Med Errors
-RN’s legal and ethical responsibility to report all errors (near misses and errors, near miss and errors the RN observes)
FDA coordinates the reporting of med errors
-MedWatch
-NCC MERP
-DMEPA
Documenting Med Errors
-Med given
-Monitor VS
-Asses for Adverse Effects
-Notify Provider
-Admin antidote
-Document everyone notified
-Inform patient
Med Reconciliation
-Can reduce med errors
-Accurate collection of all meds and substances the client has taken within the past month
Done when:
-Proceeds form one provider to another
-On admission to a facility
-When transferring facilities or units
-When discharged
Electronic Health Records (EHR)
-Used to reduce med errors
e-prescribing
-Increase accuracy of orders
-Allows for accurate records keeping
-Increase efficiency in checking contraindications and drug-drug interactions
-Allows for electronic transmission of orders to pharmacy
Patient Teaching Reduces Med Errors
Every patient, every dose
-Patient must receive info/education prior to receiving first dose of a med
-Allows patient to decide if they want to take it
Reinforce Patient Education with Each Dose
Client should be able to state
-Name of med, why taking, dose, time route
-Adverse reactions and what to do
-Teach back
-Have patient demonstrate specific skill related to administering med
Erikson’s Developmental Stages
- Trust vs Mistrust ( birth-18mo)
- Autonomy vs Shame and doubt (18mo-3yr)
- Initiative vs Guilt (3-5yr)
- Industry vs Inferiority (5-12yr)
- Identity vs Confusion (12-18yr)
- Intimacy vs Isolation (18-40yr)
- Generativity vs Stagnation (40-65yr)
- Integrity vs Despair (65-death)
Pregnancy Pharmacotherapy Considerations
-Drug therapy postponed until after pregnancy and lactation
-Non pharmacological alternatives used
-Only use pharmacotherapy in pregnant pt if preexisting condition exists (epilepsy, hypertension, psychiatric disorder)
Conditions That May Arise During Pregnancy That Need Treatment
-Gestational diabetes
-Gestational hypertension
-Acute UTI (use antibiotics)
-STI
-Estimated 90% of preg women take med and 70% take at least one prescription med
What Can Affect Absorption During Pregnancy
-Hormones
-Pressure of expanding uterus on blood supply to abdominal organs
-Gastric Acidity decreased
-Increase progesterone can delay gastric emptying (more absorption time)
-Progesterone causes greater tidal volume (inhaled drugs absorbed more)
What Can Affect Distribution and Metabolism During Pregnancy
Increased cardiac output, plasma volume, altered blood flow
-Dilution of drugs
-Decreased plasma protein concentration
Altered lipid levels
-Affect drug transport and distribution
-Fat soluble drugs ma be passed to infant via breast milk
What Can Affect Excretion During Pregnancy
Increased blood flow through kidneys by over 50%
-Drug excretion may increased
-Doses and med may need to be adjusted
Teratogen Definition
Substance, organism, or physical agent that can cause permanent abnormality in structure or function, causes growth retardation, or results in death
Thalidomide
Causes birth defects between days 35-48
35-37 days: No ears
39-41 days: No arms
41-43 days: no uterus
45-47 days: No tibia
47-49 days: Triphalangeal thumbs
Preimplantation Period
-Weeks 1-2
-“All or none” period
-Exposure to teratogen either causes death or has no effect
-Nicotine can cause intrauterine growth retardation
Embryonic Period
-Weeks 3-8
-Rapid internal development
-Maximum sensitivity to teratogens
-Teratogen exposure can lead to structural malformation or spontaneous abortion
Fetal Period
-Weeks 9-40
Blood flow to placenta increases and placental vascular membranes thin
-Max the transfer of substances to fetus
-Fetus can receive larger dose of med and substances
-Meds will have prolonged duration within fetus (lack metabolic enzymes and efficient excretion)
Teratogen exposure will cause slowed growth or impaired organ function rather than malformation
FDA Pregnancy Category Ratings
-A: No increased risk of fetal abnormalities
-B: No evidence of harm to fetus in animal studies
-C: Animal studies show no adverse effect. No well controlled studies in pregnant women
-D: Demonstrated risk to fetus in pregnant women. Benefits may outweigh risks
-X: No indication for use in pregnancy. Abnormalities and risks to fetus
Effective Pharmacotherapy Includes
-Culture
-Environment
-Genetics
-Gender
-Psychosocial
Nurse must take all of these into consideration
Psychosocial Influences on Pharmacotherapy
-Concerns when illness threatens health
-Ill health
-Suffering
-Loneliness
-Despair
-Death
Spiritual or Religious Beliefs Affecting Pharmacological Outcomes
-Meaning
-Hope
-Value
-Capacity to love, give, forgive
-Compassion and empathy
-Enjoyment of life
-Ability to find peace of mind
-Fulfillment of living
Ethnic Influences on Pharmacotherapy
-Biologic and genetic similarities
Cultural Influences on Pharmacotherapy
-Beliefs, values, and norms that provide meaning
Ethnic and Cultural Influences on Pharmacotherapy
-Influence on med outcomes
-Dietary considerations
-Alternative Therapies
-Beliefs about health and illness
-Genetic differences
Cultural Awareness
Aware of different cultures and beliefs
Cultural Sensitivity
Knowledgeable about relevant cultures
Cultural Appropriateness
Apply cultural knowledge to deliver care
Cultural Competence
Understand and address entire cultural context
Cultural Imposition
Impose rules of your culture onto another
Genetic Polymorphism
-2 or more versions of the same enzyme
-Caused by single base mutation in DNA
-Amino acid change in enzyme
-Enzyme functions change
Pharmacogenetics
-Study of genetic variations that cause differences in the way patients handle meds
-99.8% of DNA is that same
