(A) NURSING PROCESS - PHARMA Flashcards

1
Q

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)

A

NURSING PROCESS IN PHARMACOLOGY

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2
Q

NURSING PROCESS

A

ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION

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3
Q

ASSESSMENT

A

COLLECTION

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4
Q

DIAGNOSIS

A

ANALYSING COLLECTED DATA

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5
Q

PLANNING

A

GENERATE SOLUTION/PLAN

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6
Q

IMPLEMENTATION

A

TAKING ACTIONS/IMPLEMENT PLAN

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7
Q

EVALUATION

A

ASSESSING OUTCOMES

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8
Q

PATIENT PROBLEM

A

DIAGNOSIS

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9
Q

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

A

CONCEPT

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10
Q

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

A

ASSESSMENT

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11
Q

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)

A

SUBJECTIVE

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12
Q

➢ 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

A

OBJECTIVE

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13
Q

➢ 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

A

PATIENT PROBLEM

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14
Q

➢ 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

A

PLANNING

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15
Q

➢ 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

A

IMPLEMENTATION

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16
Q

➢ 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)

A

NURSE RESPONSIBILITIES

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17
Q

➢ 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

A

SIDE EFFECTS

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18
Q

➢ 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

A

SELF ADMINISTRATION

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19
Q

➢ 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

A

DIET

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20
Q

OTHER IMPORTANT NURSING CONSIDERATIONS: DECS

A

➢ 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

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21
Q

➢ Determine if whether goals has been met through
improvement of complaint and evaluation of
objective data

A

EVALUATION

22
Q

PROCESS OF BRINGING A NEW
PHARMACEUTICAL DRUG TO THE MARKET

A

DRUG DEVELOPMENT

23
Q

DRUG DEVELOPMENT PROCESS

A

BASIC RESEARCH
PRE-CLINICAL
CLINICAL STUDIES (3 PHASES)
APPROVAL
POST-CLINICAL

24
Q

PHARMACEUTICAL RESEARCH

A

FDA AND BFAD

25
➢ 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
26
: 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
27
➢ 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
28
Small group of people /First time to evaluate safety (dosage range) and side effects
PHASE 1
29
Larger group to see if its effective, further evaluate safety (used in larger group)
PHASE 2
30
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
31
Drug effect studies after it has been marketed (effects in various population, assess side effects associated with LONG TERM USE
PHASE 4
32
CORE ETHICAL PRINCIPLES/GUIDELINES FOR RESEARCH INVOLVING HUMANS
1. RESPECT FOR PERSON 2. BENEFICENCE 3. JUSTICE
33
1. RESPECT FOR PERSON ➢ Incorporates at least two ethical convictions
1. SHOULD BE TREATED AS AUTONOMOUS AGENTS 2. PERSONS WITH DIMINISHED AUTONOMY ARE ENTITLED TO PROTECTION
34
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.
35
* 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
36
➢ 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
37
➢ 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
38
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
39
➢ 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
40
➢ 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
41
Nurse foremost duty is to care for the patient
FLORENCE NIGHTINGALE PRINCIPLE
42
responsible for BOTH the safety of the subjects/patients and integrity of the research protocol
NURSE
43
➢ 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)
44
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
45
➢ 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)
46
➢ 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
47
➢ 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%)
48
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
49
➢ Proprietary name ➢ Chosen by drug company, usually a registered trademark ➢ Always begin with a capital letter
BRAND NAME
50
➢ 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
51
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
52
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