Chapter 2 - (Application in Nursing Practice)

Question 1

Five Rights of Drug Administration (the Rights)

Answer 1

1. give the right drug to
2. the right patient in
3. the right dose by
4. the right route at
5. the right time.

Other rights include right assessment, documentation, evaluation, education, refusal.

Question 2

“Baseline Data”

Answer 2

Needed to evaluate both therapeutic and adverse drug responses.

Question 3

“High Risk Patient”

Answer 3

Multiple factors can predispose an individual to adverse reactions from specific drugs–Important predisposing factors are pathophysiology (especially liver and kidney impairment), genetic factors, drug allergies, and life span considerations such as pregnancy, advanced age, and extreme youth.

Question 4

Analysis

Answer 4

The nurse analyzes information in the database to determine actual and potential health problems. Each problem stated in the form of a NURSING DIAGNOSIS. Treatment is directed at 1) judging the appropriateness of the prescribed therapy, 2) identifying potential health problems treatment might cause, 3) characterizing the patient’s capacity for self-care

Question 5

Assessment

Answer 5

Consists of collecting data about the patient, which is used to identify actual and potential health problems. Provides a foundation for subsequent steps in the process.

Question 6

Evaluation

Answer 6

This step is performed to determine the degree to which treatment has succeeded and is accomplished by analyzing the data collected following implementation. The objective is to evaluate 1) therapeutic responses, 2) adverse reactions and interactions, 3) patient adherence, 4) patient satisfaction with treatment.

Question 7

Planning

Answer 7

Consists of defining goals, establishing priorities, identifying specific interventions, and establishing criteria for evaluating success. This will allow promotion of beneficial drug effects and anticipate adverse effects.

Question 8

Implementation

Answer 8

Carrying out the interventions identified during planning. A care plan in drug therapy has four major components:

1) drug administration,
2) patient education,
3) interventions to promote therapeutic effects, and
4) interventions to minimize adverse effects.

Question 9

11 Points of Patient Education

(Very often, the nurse is responsible for educating patients about medications. In your role as educator, you must give the patient the following information)

Answer 9

1. Drug name and therapeutic category (eg, penicillin: antibiotic)
2. Dosage
3. Dosing schedule
4. Route and technique of administration
5. Expected therapeutic response and when it should develop
6. Nondrug measures to enhance therapeutic responses
7. Duration of treatment
8. Method of drug storage
9. Symptoms of major adverse effects, and measures to minimize discomfort and harm
10. Major adverse drug-drug and drug-food interactions
11. Whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions

To communicate this information effectively and accurately, you must first understand it. That is, to be a good drug educator, you must know pharmacology.

Question 10

Ongoing Evaluation and Interventions.

Answer 10

This section summarizes nursing implications that relate to both therapeutic and undesired drug responses.
As the section has five subsections:
(1) summary of monitoring,
(2) evaluating therapeutic effects,
(3) minimizing adverse effects,
(4) minimizing adverse interactions, and
(5) managing toxicity.

The monitoring section summarizes the physiologic and psychologic parameters that must be monitored in order to evaluate therapeutic and adverse responses. The section on therapeutic effects summarizes criteria and procedures for evaluating therapeutic responses. The section on adverse effects summarizes the major adverse reactions that should be monitored for and presents interventions to minimize harm. The section on adverse interactions summarizes the major drug interactions to be alert for and gives interventions to minimize them. The section on toxicity describes major symptoms of toxicity and treatment.

Question 11

Non-pharmacologic measures

Answer 11

Without the use of medications. For example, non-pharmacological approaches may contribute to effective analgesia and are often well accepted by patients. Some simple measures, like hot or cold packs for pain.

Question 12

Therapeutic Response

Answer 12

A therapeutic effect is a consequence of a medical treatment of any kind, the results of which are judged to be desirable and beneficial. This is true whether the result was expected, unexpected, or even an unintended consequence of the treatment

Question 13

Adherence

Answer 13

compliance or concordance-the extent to which a patient’s behavior coincides with medical advice

Question 14

Adverse Effect

Answer 14

undesired effects–predictable for most drugs

Question 15

Adverse Interaction

Answer 15

process in which one drug alters the effects of another in an undesired way

Question 16

Making PRN Decisions

Answer 16

A PRN medication order is one in which the nurse has discretion regarding when to give a drug and, in some situations, how much drug to give. (PRN stands for pro re nata, a Latin phrase meaning as needed.) PRN orders are common for drugs that promote sleep, relieve pain, and reduce anxiety. To implement a PRN order rationally, you must know the reason for drug use and be able to assess the patient’s medication needs. Clearly, the better your knowledge of pharmacology, the better your PRN decisions are likely to be.

Question 17

Pre-administration assessment

All drug therapy begins with assessment.

Answer 17

Assessment has 3 goals:
1) collecting baseline data needed to evaluate therapeutic and adverse responses,
2) identifying high-risk patients,
3) assessing the patient’s capacity for self-care.
The pre-administration assessment establishes the baseline data needed to tailor drug therapy