(A) NURSING PROCESS - PHARMA Flashcards
It’s used by nurses for the appropriate delivery
of patient care and drug administration.
➢ The nurse has supporting role to administer
proper care/medication administration.
➢ Nurses have many important tasks, yet drug
administration is the number one priority, about
40% of the nurse’s time is spent administering
medication
➢ drug administration (top of the list)
NURSING PROCESS IN PHARMACOLOGY
NURSING PROCESS
ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
ASSESSMENT
COLLECTION
DIAGNOSIS
ANALYSING COLLECTED DATA
PLANNING
GENERATE SOLUTION/PLAN
IMPLEMENTATION
TAKING ACTIONS/IMPLEMENT PLAN
EVALUATION
ASSESSING OUTCOMES
PATIENT PROBLEM
DIAGNOSIS
Holistic view rather than disease model
➢ Include preventive, primary, acute and chronic
health care among all ill patients
➢ Organizing patient’s HEALTH PROBLEM
➢ Then taking necessary actions by using the
nursing process
CONCEPT
Gathers info (subjective and objective data)
➢ Nurse perform complete systemic assessment,
adding on query related to illness and drug
regimen
➢ Info can be from patients, relative, health
provider and medical records
ASSESSMENT
Provided verbally by patients or thru fam
members, friends and other sources
➢ Nurse can ask open ended questions
▪ Current health hx/fam hx
▪ Symptoms or even signs he/she
experienced
▪ Discussion of his health concern,
medications/SE, OTC remedies used,
nutritional supplements, herbal medicines,
contraception
* Attitude and beliefs about taking Rx
* Allergies
* Financial barriers
* Tobacco use, alcohol/caffeine
* Caregiver and support system
(compliance/SE monitoring/notifiers)
SUBJECTIVE
➢ What nurses directly observe from the
consultation period
➢ Collecting data from personal senses (hearing,
seeing, smell, touch)
➢ Provide additional information about the
symptom
▪ Target organ most likely to be affected
▪ PE, VS, Patient’s body language
➢ Correlation with laboratory work-ups reviewed
OBJECTIVE
➢ Based on analysis of the assessment
➢ Determines the type of care the patient shall
receive
➢ Nurse formulates the patient problem which
will guide on the development of plan of care
➢ Ex: of common patient problem related to drug
therapy:
▪ abdominal pain
▪ Vivid dreams\confusion
▪ Decrease adherence
▪ Hesitancy
PATIENT PROBLEM
➢ Data are used to set goals and plans
➢ Goals: patient centered, realistic, specific, with time
frames, measurable for achievement and
reevaluation
➢ Development of nursing intervention that will be
both acceptable to patient and nurse
➢ Ex:
▪ the patient will independently administer the
prescribed doses per day of insulin after 4th
session of instruction
▪ The patient will prepare medication recording
sheet after second session of instruction
PLANNING
➢ Part of nursing process, where nurses provide
EDUCATION, DRUG ADMINISTRATION,
PATIENT CARE AND OTHER INTERVENTION
necessary to assist the patient in accomplishing the
establish medication goal
➢ Nurse’s role: administering medications and
monitoring its effectiveness
IMPLEMENTATION
➢ Patient teaching/when to learn/where to learn, is it
conducive (comfortable and quiet)
➢ ▪ Know obstacles:
▪ pain must first be relieved,
▪ Language barrier
▪ Age (young or elderly)
➢ Patient teaching is very important to patient’s
recovery (both parents and relatives or caregivers)
*side effects
➢ General information shall be provided on how to
take the drug
▪ Written information or instruction shall be
provided (Patient teaching card)
* Name of drug
* Reason for taking the Rx
* Time sched when to take the medicines
* Possible side effects/adverse events
* Notification of HCP if side effects
occur
* Health care provider’s telephone
number
* Warning information (pregnant, not to
take with alcohol)
NURSE RESPONSIBILITIES
➢ Give instructions on what SE will be expected
➢ what will help minimize it
➢ Eg: change in the color of urine/stool, counsel on
dizziness after intake, orthostatic hypotension etc
SIDE EFFECTS
➢ Perform assessment of patient’s motor skills and
abilities so as to provide modifications that will be
necessary which will be added in the teaching plan
➢ ROUTE
➢ Use of drug cards
SELF ADMINISTRATION
➢ Advise on food to include and to avoid
➢ Many foods interact with certain medications
▪ Can decrease drug absorption, increase risk
of toxicity or create other problems
DIET
OTHER IMPORTANT NURSING CONSIDERATIONS: DECS
➢ Drug allergies
➢ Expiration
➢ Cultural beliefs/ religious
➢ Additional:
▪ Flexibility of timing schedule (WORK
SCHEDULE ETC)
▪ Use of pill box if with multiple drugs or
recording sheet
▪ Evaluation of understanding re: regimen in
a regular basis
▪ Empower patients re responsibility to take
their pill
▪ ID patients with risk of noncompliance
➢ Determine if whether goals has been met through
improvement of complaint and evaluation of
objective data
EVALUATION
PROCESS OF BRINGING A NEW
PHARMACEUTICAL DRUG TO THE MARKET
DRUG DEVELOPMENT
DRUG DEVELOPMENT PROCESS
BASIC RESEARCH
PRE-CLINICAL
CLINICAL STUDIES (3 PHASES)
APPROVAL
POST-CLINICAL
PHARMACEUTICAL RESEARCH
FDA AND BFAD
➢ Done prior to the implementation of the clinical
trials (using human subjects)
➢ Determine TOXIC and PHARMACOLOGICAL
efficacy through/using ANIMAL TESTING in a
laboratory
➢ Able to determine genotoxicity (damage genetic
information in a cell in addition to drug absorption,
distribution, metabolism and excretion
PRE-CLINICAL TRIALS
: help to establish guidelines in
including women/minorities in clinical trials and that to
be included in appropriate numbers in National Institute
of Health -supported researches
NIH REVITALIZATION
➢ Multidisciplinary team approach (nurses,
physician, pharmacologist, statistician and
➢ research associates)
➢ Required to ENSURE SAFETY and QUALITY in
all phases of the clinical trial
HUMAN EXPERIMENTATION
Small group of people /First time to
evaluate safety (dosage range) and side
effects
PHASE 1
Larger group to see if its effective,
further evaluate safety (used in larger
group)
PHASE 2
Large group confirm
EFFECTIVENESS, MONITOR SIDE
EFFECTS, COMPARE WITH COMMONLY
USED KNOWN TREATMENTS/Collect
information that will allow the drug to be used
safely
PHASE 3
Drug effect studies after it has been
marketed (effects in various population,
assess side effects associated with LONG
TERM USE
PHASE 4
CORE ETHICAL PRINCIPLES/GUIDELINES FOR RESEARCH INVOLVING HUMANS
- RESPECT FOR PERSON
- BENEFICENCE
- JUSTICE
- RESPECT FOR PERSON
➢ Incorporates at least two ethical convictions
- SHOULD BE TREATED AS AUTONOMOUS AGENTS
- PERSONS WITH DIMINISHED AUTONOMY ARE ENTITLED TO PROTECTION
The principle of respect for persons thus divides
into two separate moral requirements:
the requirement to acknowledge autonomy and the
requirement to protect those with diminished
autonomy.
- Right to refuse to participate in a research
- Right to withdraw anytime without penalty
- Right to refuse to participate in a research
- Right to withdraw anytime without penalty
➢ Integral part of respect for person
➢ Should have decision of their own
➢ Patient can refuse any or all treatment except
decision will pose threat to others
➢ Right to refuse to participate in a research study
➢ Right to withdraw from study at anytime without
penalty
AUTONOMY
➢ Roots: Nuremberg Code in 1947 (Right to be
informed and that participation is voluntary,
➢ without coercion
* Need to sign the informed consent
* If with legal age; but if 12-15 years old: needs
assent form
* Children 11 and below: with parents consent
➢ If coercion is suspected, nurses are obligated to
report it promptly
➢ Health care provider need to explain what is
expected; respond to query
➢ Provided with Inclusion and exclusion criteria,
study protocol, study related documentation
INFORMED CONSENT
INFORMED CONSENT CHECKLIST:
➢ Statement that the study involves research
➢ Purpose of the study, explanation
➢ Duration of participation
➢ Id, description of procedures and experiments
➢ Description of reasonable foreseeable
risk/discomfort and benefits
➢ Disclosure of appropriate alternative
procedure/courses of treatment or courses of
treatment if any
➢ Confidentiality records and to what extent
➢ Explanation of any compensation or whether any
medical treatment is available when injury occurs
➢ Contact person to answer when with query
➢ That the participation is voluntary
➢ Duty to protect the research subjects from harm
* Ensures risk and possible benefits in
participating to the study were divulge during
orientation
➢ RISK BENEFIT RATIO
* Risk benefit ratio is one of the most complex
problems faced by the researcher
* Benefits > Risk or vise versa
➢ No matter how noble the intentions > calculation of
risk
* Requirement of Dept of Health and Human
Services: Institutional Review Boards
BENEFICENCE
➢ Selection of research subject shall be FAIR
➢ Research are conducted so that the distribution of
benefits and burden is equitable
* Justice requires the fair and equal distribution
of benefits and risks of participation in a
research study.
* Recruitment and selection of participants must
be done in a fair and equal manner.
* Justice forbids exposing one group of people
to the risks of the research solely for the
benefit of another group. *Community
representatives have the responsibility to ensure
that community participation in a research
study is justified.
➢ Appropriate protections for research participants
(pay special attention to the benefits that the
➢ participants or their communities will receive as a
result of their participation in the research and
➢ advise the research team so that incentives offered
by the research will not influence the decision
➢ to participate.
JUSTICE
Nurse foremost duty is to care for the patient
FLORENCE NIGHTINGALE PRINCIPLE
responsible for BOTH the safety of the
subjects/patients and integrity of the research
protocol
NURSE
➢ Nurse (key creating a culture of
safety/accountability related to controlled
substances
* Verification of orders before administration
* Accounting of all controlled drugs
* Documentation of all discarded/waste
medications; patients record after
administration
* Keep all controlled drugs in a locked storage
area (narcotics under double lock)
COMPREHENSIVE DRUG ABUSE PREVENTION AND CONTROL ACT (1970)
S2 License is solely given to
any authoritative person who is acknowledged by
law that can prescribe dangerous drugs.
* This group of professionals who can prescribe
regulated drugs are physicians,
veterinarians, and dentists
S2 PRESCRIPTION
➢ This Act, consisting of 15 sections
➢ Declares the policy to promote, require and ensure
the production of adequate supply, use and
acceptance of drugs (including for animal use)
identified by their generic names.
➢ Its objectives are: to PROMOTE, ENCOURAGE
AND REQUIRE THE USE OF GENERIC
TERMINOLOGY IN THE IMPORTATION,
MANUFACTURE, DISTRIBUTION,
MARKETING, ADVERTISING
AND PROMOTION, PRESCRIPTION AND
DISPENSING OF DRUGS; to ensure the
ADEQUATE SUPPLY OF DRUGS WITH
GENERIC NAMES AT THE LOWEST
POSSIBLE COST;
➢ To encourage the extensive use of drugs with
generic names through a national system of
procurement and distribution; to emphasize the
scientific basis for the use of drugs; and to promote
drug safety by minimizing duplication in
medications and/or use of drugs with potentially
adverse drug interactions.
GENERIC ACT OF 1988 (RA 6675)
➢ Generally: Nurses cannot prescribe or administer
drugs WITHOUT A HEALTH PROVIDER
ORDER
➢ License revocation if found to administer without
order
➢ Can be prosecuted for giving the wrong
drug/dosage/ omitting a drug dose or giving a drug
by a wrong route
NURSE PRACTICE ACTS
➢ Worldwide, estimated as >10% of all drugs
available are counterfeit/fake
➢ May contain incorrect ingredient, insufficient
amount of active ingredient, no active
➢ ingredient, contain impurities and
contaminants/distributed in fake packaging
➢ Nurse to instruct patients to report any differences
in taste or appearance of the drug or
➢ its packaging
DRUG COUNTERFEITING (>10%)
must be approved by FDA BEFORE
THEY CAN BE MARKETED
➢ Non proprietary; universally accepted
➢ Not owned by any drug company
➢ Given in “Lower case letters”
GENERIC NAME
➢ Proprietary name
➢ Chosen by drug company, usually a registered
trademark
➢ Always begin with a capital letter
BRAND NAME
➢ Over-the-counter medicine, also known as OTC or
nonprescription medicine, refers to medicine that
you can buy without a prescription.
➢ Nonprescription or OTC drugs are medicines the
FDA determines are safe and effective for use
without a doctor’s prescription
➢ OTCs often do more than just relieve aches, pains,
and itches. Some can prevent diseases like tooth
decay [2], cure diseases like athlete’s foot [3], and
help manage recurring conditions like vaginal yeast
infections [4] or migraines [5].
➢ ***It is the US Food and Drug Administration
(FDA) that determines whether medicines are
prescription or nonprescription.
➢ The term prescription refers to medicines that are
safe and effective when used under a doctor’s care,
NON-PRESCRIPTION DRUGS
OTCs- In 2002, the FDA standardized the OTC
labeling to provide consumers with better information
And describe benefit and risk associated with taking this
OTD
➢ Vitamins
➢ Colds prep
➢ Analgesic
➢ Antacids
➢ Laxatives
➢ Antihistamines
➢ Sleep aids
➢ Nasal Sprays
➢ Weight control drugs
➢ Drugs for dermatitis/fungal infection
➢ Fluoride toothpaste
➢ Corn and callus removal products
➢ Herbal Products
NURSING CONSIDERATIONS RELATED TO
OVERTHE-COUNTER DRUGS (ADVISE
AMONG PATIENTS)
➢ Always read instructions on the label (if not
understood-ask pharmacist)
* Do not use medicines without label
➢ Do not take OTC drugs in higher doses or longer
than label states
➢ Re side effects (though relatively uncommon)
➢ Every person is different, hence responses can also
be different
➢ Drugs may interact with each other/ food/
alcohol/may have effect in other health problem
➢ Throw away expired medicines (throw discolored,
old or those that lost its label)
➢ Children: do not guess amount to be given/ if
instructed to be in ml use ml graduated cups/ follow
➢ age limits
* Always use child resistant cap and relock
* No medicines with alcohol
