Chp 1-2 Nursing Process/Pharmacology Flashcards
What are the 5 steps of the Nursing Process?
- Assessment
- Nursing diagnosis
- Planning (goals, outcome criteria)
- Implementation including patient education
- Evaluation
In the Nursing Process, what happens during the assessment?
Data collection, review, and analysis
Medical profile including drug use; prescriptions; OTC meds; vitamins, herbs, and supplements; compliance and adherence
In the Nursing Process, what is the nursing diagnosis used for?
to communicate and share info about the patient and the patient experience
What are common nursing diagnoses related to drug therapy?
Deficient knowledge
Risk for injury
Noncompliance
What are the three steps in the nursing diagnosis process?
- Human response to illness, injury, or significant change
- Factors related to the response (“related to”)
- Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”)
In the Nursing Process, what happens during planning?
- Identification of goals and outcome criteria
- Goals (objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria)
- Outcome criteria (concrete descriptions of patient goals)
What does NPO mean?
Nothing by mouth is a medical instruction meaning to withhold food and fluids. It is also known as nil per os (npo or NPO), a Latin phrase whose English translation is most literally, “nothing through the mouth”.
Could you give a patient the same dosage of a drug via IV as you could orally?
No, the dosage for the IV route would not be the same as for the PO (by mouth) route
In the Nursing Process, what happens during implementation?
- Initiation and completion of specific nursing actions as defined by the nursing diagnoses, goals, and outcome criteria
- Independent, collaborative, dependent
What are the “Six Rights” of medication administration?
- Right drug
- Right dose
- Right time
- Right route
- Right patient
- Right documentation
In the Nursing Process, what happens during evaluation?
- *Ongoing part of the nursing process
- Determine the status of the goals and outcomes of care
- Monitoring the patient’s response to drug therapy (expected and unexpected responses)
- Clear concise documentation
If an error in the administration of medication is made, what steps should be followed?
The nurse should complete an incident report with the entire event, surrounding circumstances, therapeutic response, adverse effects, and notification of the prescriber described in detail. However, the nurse should not record completion of the report in the medical chart themselves.
Compliance
Implementation or fulfillment of a prescriber’s or caregiver’s prescribed course of treatment or therapeutic plan by a patient.
Medication error
Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm.
Noncompliance
An informed decision on the part of the patient not to adhere to or follow a therapeutic plan or suggestion.
Nursing process
An organizational framework for the practice of nursing. It encompasses all steps taken by the nurse in caring for a patient: assessment, nursing, diagnoses, planning, implementation of the plan, and evaluation.
Outcomes
Descriptions of specific patient behaviors or responses that demonstrate meeting of or achievement of behaviors related to each nursing diagnosis. These statements are specific while framed in behavioral terms and are measurable.
Prescriber
Any health care professional licensed by the appropriate regulatory board to prescribe medications.
Objective data
Information available through the senses, such as what is seen, felt, heard, and smelled. (age, height, weight, allergies, medication profile, and health history)
Subjective data
data that includes all spoken information shared by the patient, such as complaints, problems, or stated needs.
QSEN
Quality of Safety Education for Nurses - attempts to address the continued challenge of preparing future nurses with the knowledge, skills, and attitudes needed to continuously improve the quality and safety of patient care within the health care system.
KSA’s
knowledge, skills, and attitudes
EBP
evidence-based practice
QI
Quality improvement
What are the 6 major QSEN initiatives?
- patient-centered care
- teamwork and collaboration
- evidence-based practice
- quality improvement
- safety
- informatics
What seven elements must be checked regarding the medication order?
- patient’s name
- date the drug order was written
- name of drug
- drug dosage amount
- drug dosage frequency
- route of administration
- prescriber’s signature
NANDA-I
North American Nursing Diagnosis Association International
What is the purpose of NANDA-I
to increase the visibility of nursing’s contribution to the care of patients and to further develop, refine, and classify the information and phenomena related to nurses and professional nursing practice.
What is the three-step process of the nursing diagnoses statement?
- the human response of the patient to illness, injury, or significant change
- (defining characteristics; use “related to”) identifies the factor(s) related to the response with more than one factor often named.
- (use “as evidenced by”) listing of clues, cues, evidence, signs, symptoms, or other data that support the nurse’s claim that this diagnosis is accurate.
Common format used when formulating and writing a nursing diagnosis:
(Nursing diagnosis or statement) of problem/strength/or risk… (related to etiologies, circumstance, facts, influences) that have a relationship such as a cause or contributing factor to the nursing diagnosis… (as evidenced by) defining characteristics/signs/symptoms.
Interventions
any treatment based on clinical judgement and knowledge and performed by a nurse to enhance outcomes.
What does prn stand for?
pro re nata or “as required”
drug
any chemical that affects the physiologic processes of a living organism
pharmacology
study or science of drugs
Drug chemical name
describes the drug’s chemical composition and molecular structure
Drug generic name
(nonproprietary name) name given by the United States Adopted Names Council
Drug trade name
(proprietary name) the drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer)
What are the 6 pharmacologic principles?
- Pharmaceutics - The study of how various drug forms influence the way in which the drug affects the body.
- Pharmacokinetics - The study of what the body does to the drug (absorption, distribution, metabolism, excretion)
- Pharmacodynamics - the study of what the drug does to the body (the mechanism of drug actions in living tissues, drug-receptor relationships)
- Pharmacotherapeutics - the clinical use of drugs to prevent and treat diseases
- Pharmacognosy - the study of natural (versus synthetic) drug sources (i.e. plant, animals, minerals)
- Pharmacoeconomics - the study of the economic factors influencing the cost of drug therapy.
What is the first pass effect?
the metabolism of a drug before it becomes systemically available, and it reduces the bio availability of the drug.
What is the path with the 3 phases of drug activity?
(A dose of the formulated drug is administered.)
Phase 1 - Pharmaceutical phase: disintegration of dosage form; dissolution of drug in body
(Drug available for absorption)
Phase 2 - Pharmacokinetic phase: Absorption, distribution, metabolism, excretion
(Drug available for action)
Phase 3 - Pharmacodynamic phase: drug-receptor interaction
(Effect)
What type of classes are drugs organized into?
pharmacologic classes
What is an enteric-coating?
a polymer barrier applied on oral medication that prevents its dissolution or disintegration in the gastric environment (the stomach)
Should you crush an enteric-coated tablet?
no. tablets with an enteric coating should never be crushed. The coating is designed to hold the tablet together in the stomach and may be there to protect the stomach from the medicine, protect the medicine from the acid in the stomach or to release the medicine after the stomach e.g. in the intestine.
What is the definition of absorption in regards to pharmacokinetics?
movement of a drug from its site of administration into the bloodstream for distribution to the tissues. (bioavailability, first-pas effect)
Enteral Route
the drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine. (oral, sublingual, buccal, rectal)
Parenteral Route
Intravenous (fastest deliver into the blood circulation) Intramuscular Subcutaneous Intradermal Intraarterial Intrathecal Intraarticular
Topical Route
Skin Eyes Ears Nose Lungs (inhalation) Rectum Vagina
What is the proper procedure to administer a transdermal patch?
Transdermal drugs should be placed on alternating sites, on a clean and nonirritating area, and only after the previously applied patch has been removed.
Distribution
the transport of a drug by the bloodstream to its site of action.
What are areas of rapid distribution?
heart, liver, kidneys, brain
What are the areas of slow distribution?
muscle, skin, fat
Metabolism
(biotransformation) the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite.
Where does metabolism take place?
Liver (main organ) Skeletal muscle Kidneys Lungs Plasma Intestinal mucosa
What factors decrease metabolism?
Cardiovascular dysfuntion Renal insufficiency Starvation Obstructive jaundice Slow acetylator Ketoconazole therapy
What factors increase metabolism?
Fast acetylator
Barbiturate therapy
Rifampin therapy
Phenytoin therapy
Excretion
the elimination of drugs from the body
- kidneys (main organ)
- Liver
- Bowel
Half-life
the time it takes for one half of the original amount of a drug to be removed from the body. (the measure of the rate at which a drug is removed from the body)
Onset
the time it takes for the drug to elicit a therapeutic response
Peak
the time it takes for a drug to reach its maximum therapeutic response
Duration
the time a drug concentration is sufficient to elicit a therapeutic response
Contraindications
Any characteristic of the patient, especially a disease state, that makes the use of a given medication dangerous for the patient.
What are possible adverse reactions?
- Pharmacologic reactions (adverse effects) - an extension of the drugs normal effects
- Hypersensitivity (allergic) reaction - involves the immune system
- Idiosyncratic reaction - occurs unexpectedly in a particular patient
- Drug interaction
What are the four main sources for drugs?
- Plants
- Animals
- Minerals
- Laboratory Synthesis
Toxicology
the study of poisons and unwanted responses to drugs and other chemicals (overlaps with pharmacotherapeutics)
At what point is a pharmacologic response produced?
Once a drug binds to and interacts with the receptor
Acute therapy
involves more intensive drug treatment and is implemented in the acutely ill or critically ill.
Maintenance Therapy
does not eradicate pre-existing problems, but will prevent progression of a disease or condition
Supplemental Therapy
supplies the body with a substance needed to maintain normal function
Palliative therapy
focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness.
Supportive therapy
maintains the integrity of body functions while the patient is recovering from illness or trauma
Prophylactic/Emipric therapy
provided to prevent illness or other undesirable outcome during planned evnets
Therapeutic index
the ratio of a drug’s toxic level to the level that provides therapeutic benefits
