Exam #1 Flashcards
The Nursing process x5
- Assessment: what data is collected?
- Diagnosis: what is the problem?
- Planning: how to manage the problem?
- Implementation: putting the plan action.
- Evaluation: did the plan work?
Ongoing and constantly evolving process.
Better quality of cave for the patient
Research-support framework fornursing process
The nurse answers a patient’s call light and finds a patient sitting up in bed and requesting pain medication. What should the nurse do first?
A. Check the orders and give the patient the requested pain medication.
B. Provide comfort levels to the patient.
C. Assess the patients pain and pain level.
D. Evaluate the effectiveness of the previous pain medication.
C. Assess the patients pain and pain level
Always assess the patient before any intervention
Smart Goals
S: specific
M: measurable
A: attainable
R: relevant
T: time-bound
Identification of goals and outcome of the criteria
The patient’s medication administration record lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do?
A. Give the medication po with a small sip of water.
B. Give the medication via the iv route because the patient is po.
C. Hold the medication until after the test is completed.
D. Call the health care provider to clarify instructions.
D. Call the health care provider to clarify instructions.
The nurse must never assume the route of medication administration and should consult the physician for clarification of the orders.
The Nine Rights of Medication Administration
1.
2.
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6.
7.
8.
9.
The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at 2100. What will the nurse do first to determine whether the medication was given?
A. Call the night nurse at home.
B. Check the medication administration record.
C. Call the pharmacy.
D. Review the nurse’s documentation.
B. Check the medication administration record.
Legal documentation
Medication Errors
Any preventable event that may cause or lead to inappropriate medication use or patient harm.
Patient vs systemic related events
Evaluation
Part of the nursing process
Monitoring patients response to drug therapy
Clear documentation
A nurse makes an error when administering medications to a patient. Which action by the nurse requires the supervising nurse to intervene?
A. A nurse completes an incident report.
B. The nurse informs the prescriber of the error.
C. The nurse documents the adverse effects to the medication error.
D. The nurse records completion of an incident report in the medical record.
D. The nurse records completion of an incident report in the medical record.
Agonist
a drug that binds to and stimulates the activity of one or more receptors
Antagonist
a drug that binds to and inhibits the activity of one or more receptors
Blood Brain Barrier (BBB)
barrier system that restricts the passage of chemicals to the brain
Dependence
a state in which there is a compulsive or chronic need
Drug
any chemical that affects the physiologic processes of a living organism
Half-life
time it takes for half the drug to be eliminated from the body
Pharmacology
study or science of drugs
Therapeutic Effect
the desired effect / intent
Trough Level
lowest concentration of drug in the body
Chemical name
Describes the drug’s chemical composition and molecular structure
Generic name (nonproprietary name)
Name given by the United States Adopted Names Council
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)
Five steps of the nursing process
- Assessment
- Nursing diagnosis
- Planning
- Implementation, including patient education
- Evaluation
Assessment
Data collection, review, and analysis
Subjective: what the patient says
Objective: what you observe from the client
Compliance: implementation or fulfillment of a prescriber’s prescribed course of treatment by the patient
Implementation
Invitation and completion of specific nursing action as defined by the nursing diagnoses, goals, and outcome criteria
Pharmaceutics
The branch of pharmacology concerned with preparation, use, or sale medicinal drugs.
Pharmacokinetics
The branch of pharmacology that concerned with the movement of drugs within the body
Pharmacodynamics
The branch of pharmacology concened with effects of drugs and the mechanisms of their action.
Pharmacogenomics (pharmacogenetics)
The study of now a patients genome can influence how they respond to medicine
Pharmacotherapeutics
The study of therapeutic uses and effects of drugs
Pharmacognosy
The branch of knowledge concerned with medicacinal drugs obtained from plants or other natural sources
Pharmacoeconomics
Scientific discipline that compares the values of one pharmaceutical drug or drug therapy to another.
Toxicology
How poisonous or harmful A substance can be
Pharmaceutics
The study now various drugs form influence the way in which the drug affects body
Dissolution
Dissolving of solid dosage forms and their absorption
Drug absorption from fastest to slowest
Orals →liquids→suspention solutions → powders→ capsules→tablets → coated tablets → enteric coated tablets
A patient describe ibuprofen, 200 mg PO every four hours as needed for pain. The pharmacy sent up enteric, coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. What will the nurse do?
A. Crush the tablets and mix them with applesauce or pudding.
B. Call the pharmacy and ask for liquid form of the medication.
C. Call the pharmacy and ask for a form of the medication.
D. Encourage the patient to try and swallow the tablets.
B. Call the pharmacy and ask for the liquid form of the medication.
Pharmacokinetics and ADME
The study of what the body does to the drug: how the body gets the drug into the body to where it needs to be
Understands what the drug does to the body and what the body does to the drug
ADME: absorption, distribution, metabolism, excretion
Absorption
Movement of a drug from its site of absorption into blood stream for distribution
Mode of transmissions through bloodstream for absorption
IM or IV does not go through absorption because you have tv put it directly into the bloodstream
Bioavailability
Term used to express the extent of drug absorption (how much will be absorbed)
Distribution
Through blood stream-rapid distribution first (heart)
Blood-heart treat of the body- site of action
Metabolism
Biochemical alteration of a drug into inactive metabolite
Liver is the most responsible organ
Liver conditions will have lesseffectivness fortherapeutic effect =higher dose to reach wanted effect
Excretion
Elimination of the drug from the body
Drug leaving body - changes with half-life alteration
Kidney are primary organ
Enzyme
Cytochrome p-450 is most common enzyme
Drug effects
Physiologic reactions of the body to the drug (indication for use)
Onset of action
Time required for the drug to elicit therapeutic response used in nursing for evaluation in nursing process)
Peak effect
How much drug is need to reach maximum effectiveness
Peak level
Concentration of drug
Trough level
Lowest level of effectiveness
Therapeutic drug monitoring
Monitoring the effectiveness of the drug and not having toxic levels
Duration of action
When you start feeling the medication then when it starts to wear off
Slide 33
Acute
Less than 3-6 months
Chronic
More than 6 months
Pharmacotherpeutics
Acute:improve a life
Emperic: given before test results available
Maintenance:maintain health
Palliative: reduce severity of a condition Or pain
Prophylactic: prevent disease
Replacement: provide chemicals a patient lacks
Supportive: for a condition other than the primary disease
Supplemental: avoid a deficiency
Drug interactions
Alteration of one drug due to and drug
Adverse effect
Unpredictable
Undesired occurrence involvimedication
Medication error
Predictable
Preventable situation in which there is a compromise of the “rights”
Tolerance
Decrease response to repeated drug dose
Dependence
Physiologic or psychological need for a drug
Physical dependence
Physiologic need for a drug to avoid physical withdraw symptoms
Psychological dependence
Also known as addiction and is the obsessive desire for the euphoric effects of a drug
Teratogenic
Unsafe for the fetus
Mutagenic
Cause resistant or mutation to occur
Carcinogenic effect
Cancer outcomes
Toxicology
Toxicity: toxic levels in the system
Science of Th adverse effect of chemicals on living organisms
Clinically toxicology deals specifically with the care of poisoned patients
Pharmacoeconomics
Study of economic factors influencing the cost of drug therapy
Pt. Have resources to get meds?
Pharmaceutics
Different drug dosage have different pharmaceutical properties
Different routes are different forms and administrations effects body differently
Enteral Route
Oral: metabolized by liver
Parenteralroute
Iv: fastest to blood circulation
I’m sub q, intradermal, intraaeterial, intrathecal, intraarticular
Watch for over doses
The nurse is preparing to administer a transdermal patch to a patient in signs that a patient already has a medication patch on his right upper chest. What will the nurse doing?
A. Remove the old medication patch and notify the healthcare provider.
B. Play the new patch without removing the old one.
C. Remove the old patching to play the new patch in the same spot.
D. Remove the old patch and apply the new patch to a different, clean area.
D. Remove the old patch and apply the new patch to a different, clean area.
Topical Route
Skin, eyes, ears, nose, lungs (inhalation), rectum, vagina
The nurse is giving a medication that has a high fast pass effect. The healthcare provider has changed the route from PO to IV. But can the nurse expect with the IV dose?
A. The IV dose will be higher because of the first pass effect.
B. The IV dose will be lower because the first pass effect.
C. The IV dose will be the same as a PO does.
D. The rate of the IV infusion must be faster to do the first pass effect.
B. The iv Bose will be lower because the first pass effect.
A patient is complaining of serve ear pain and has orders for morphine sulfate. The nurse knows that the route will be give the slowest pain relief would be which route?
A. IV
B. IM
C. Subcutaneous
D. PO
D. PO
Lifespan considerations special considerations
Pregnancy
Newborn
Pediatric
Older adult
lots of drugs are not good for the baby
Mom=baby
babies do not have a mature liver or kidneys
Drug theory during pregnancy
-Drugs cross placenta by diffusion
- factors affecting safety are drug properties, fetal gestational age,maternal factors
- FDA has implemented pregnancy saftey categories
- FDA now requires pregnancy labeling to be included in package insert (phase -in process)
- each trimmest was different safe drugs
- labels a-d and x
- a is mild x is absolutely not
- lands are highly not advised unless risk outweighs benefits
- all chemo’s are category X
New role: three subsections in prescribing information
- pregnancy
- Lactation
- Female and males of reproductive potential
New role
- Because this is a phase-in process,nurses may see the A to X classification and the new role
Classification - assume A for pregnancy is the same for lactation, baby, etc.
When teaching a pregnant woman about the use of drugs during pregnancy, which statement will the nurse include?
A. Exposure the fetus to fetus to drugs is most detrimental during the second trimester pregnancy.
B. Pregnant women must never take drugs to control high blood pressure.
C. Drug transfer to a fetus is most likely to occur during the last trimester pregnancy.
D. is it a fetus is at greatest risk for drug induced development defects during the second trimester of pregnancy.
C. Drug transfer to a fetus is most likely to occur during the third trimester of pregnancy.
-the placenta is the biggest-more blood flow= more risk
Drug therapy during breastfeeding
-breastfed infants are at risk for exposure to drugs consumed by mother
-drug levels in breast milk are usually lower than those in the maternal circulation
- consider risk to benefit ratio
- both good and bad
- mom’s natural antibodies
-Babies should not get antibodies because of toxicity
Neonatal and pediatric considerations:pharmacokinetics
- Absorption: gastric ph is less acidic until 1 to 2 years of age, gastric emptying slowed, intramuscular absorption faster and irregular
- Distribution:greater total body water means lower fat content,decreased level of protein binding,immature blood-brain barrier- more drugs enter the brain
- Metabolism:liver immature;does not produce enough microsomal enzymes, older children may have increased metabolism requiring higher doses than infants
- Kidney immaturity affects glomerular filtration rate and tubular secretion,decreased perfusion vale of the kidneys may reduce excretion of drugs
Factors affecting pediatric drug dose
- Skin is thin and permeable
- stomach locks to kill bacteria
- lungs was weaker mucus barriers
- easy dehydration
Methods of dosage calculation for pediatric patients
Always use weight in kg, not lbs.
Always use cm. Not in.
Body weight dosage calculations: use mg/kg
When administering medication‘s pediatric patients, the nurse understands that the dosage calculation for pediatric pediatric patients are different than for adults because pediatric patients.
A. I’m more likely to develop edema.
B. Have more stomach acid.
C. Have skin that is less permeable.
D. Have immature, liver and kidney function, resulting in impaired drug metabolism, and excretion.
D. Have immature liver and kidney function, resulting in impaired, drug metabolism an education
Consideration for older adult patients
Multiple medication administrations
Polypharmacy
How many medications they are taking that interact with eachother and what we can out out
Older adults pharmacokinetics
1.absorption: gastric pH less acidic, gastric emptying slowed, movement through G.I Tract slowed because of decrease muscle tone and activity, blood flow to G.I. tract reduced, absorptive surface of G.I. tract reduced
2. Distribution: lower, total body water, percentages, increase content, decreased production of proteins by the liver, resulting in decrease protein binding of drugs increased circulation of free drugs)
3. Metabolism: aging liver produces fewer microsomal enzymes, affecting drug metabolism, reduced blood flow to the liver.
4. Excretion: decreased glomerular rate, decreased number of nephrons, drugs are cleared, less effectively, because decrease excretion
what does the nurse identify as a pharmacokinetic change that occurs in older adults?
A. Gastric pH is more acidic.
B. Fat content is decrease because increased mean body mass.
C. There is an increase production of proteins by the liver.
D. The number of intact nephrons is decreased.
D. The number of intact nephrons is decreased.
Ethnopharmacology
Body of knowledge for understand the specific impact of cultural factors on patient drug response
Cultural considerations
-Varying drug responses in different racial or ethnic groups
- health beliefs and practices
Pharmacogenomics
Study of how certain genetic traits affect drug response
Drug polymorphism
Multiply drugs taken at a time and a mixture with herbal substances
Cultural assessment
- Ask culture
- any medications they’re taking we should be aware of
Which of the following statements regarding African-Americans response to antihypertensive medication therapy is true?
A. African-Americans respond better to diuretics than to beta blockers.
B. African Americans do not respond to diltiazem.
C. Single drug therapy is effective for African-Americans.
D. Hypertension is uncommon in the African-American population.
A. African-Americans respond better to diuretics than to beta blockers.
Legal considerations
Food and drug administration (FDA)
Drug enforcement agency (dea)
Doctors cannot prescribe medication’s if not approved legally through the FDA, only recommend taking them
HIPAA
Health insurance, portability, and accountability act
New drug development
Food and drug administration, primary purpose of the FDA’s to protect patients and insured drug effectiveness
Takes 10 to 40 years for drugs to go through research and get approved through the FDA 
Test question: U.S. FDA drug approval process
Phase Il test effectiveness for the drug
8-10% of drugs make it to phase iv(4)
A research group is conducting an investigation of drug study on a promising new drug for osteoporosis. It has been difficult to find research participants, who meet the criteria. Just before the conclusion of the study, for participants approach the researchers, and expressed their desire to withdraw from the study. What is the researchers priority intervention?
A. Inform them that they waited too long to withdraw from the study.
B. explore with them the reason for withdrawing from the study.
C. Acknowledge that they can withdraw at any time from the study.
D. Request that they tried to remain with the study until it is completed.
C. Acknowledge that they can withdraw at any time from the study.
Legal consideration related to drug therapy and nursing practice
nursing it’s covering through the governor of each state
State practice act determined to a nurse can do
Controlled substances 1-5
Class 1 is more addicted - class 5 is less addicted
Class one include illegal, drugs, and drugs. That can never be used in a hospital.
Autonomy
Right or condition of
Beneficence
The act of doing good; kindness
Normaleficence
Obligation of a physician not to harm a patient
Veracity
Conformity to facts; accuracy
A nurse does not notice that a patient ID site is swollen, red, painful, and warm to touch, nor that the IV has quit perfusing properly. What ethical principle does this involve?
A. Breach of duty
B. Duty
C. Causation
D. Damage
A. Breach of duty
A nurse has been asked to participate an elective procedure that violates nurses, personal ethical principles. What is the nurses best action?
A. Refused to participate.
B. Asked to switch assignments with another nurse.
C. Speak to the manager or supervisor.
D. Perform the procedure.
C. Speak to the manager or supervisor.
Too err is human
-preventable Ayres were responsible for 7000 deaths this year
-Play report errors to grow from errors
Medication errors in adverse drug events
Adverse:
-allergic reaction often predictable
-Idiosyncratic reaction usually unpredictable
In a 2006 IOM study, it was estimated that some form of medication, and resulted in harm to how many patients?
A. 400,000.
B. 800,000.
C. 1 million.
D. 1.5 million.
D. 1.5 million
Medication errors
-Preventable
- salad: sound a alike-look alike-drugs
- last: look a like, sound alike
Test: what is the most common point in the process at which medication errors occur?
A. Prescribing
B. Dispensing
C. Administering
D. Monitoring
A. Prescribing
Over 50% come from dispensing, administering, and monitoring
Near miss
- Event or situation that did not produce patient injury, but only because of chance
- gave medication to patient but did not cause any have = report
Close call
-an event or situation or Eric that took place but was identified in captured prior to reaching the patient
-Picked up on air before administering medication and put it back = report
Strategies to minimize errors
- Awareness (speak up)
Computerized prescriber order entry (CPOE)
-Bar codes and scammers
-Automated dispensing machines - effective communication
Types of medication errors
- No air, all those circumstances or event occurred that could have led to an error
- Medication error that cause there’s no harm.
- Medication error that causes harm.
- Medication error that result in death.
Preventing medication error
Never use a trailing 0 with medication orders
Commonly used herbal products
Aloe, feverfew, ginkgo, goldenseal, Saint johns, wort, Valerian
Conditions treated with the herbal products
Anxiety, colds and coughs, depression, headache, insomnia, ulcers, premenstrual syndrome
The nurse associate to use of over-the-counter medication‘s with the development of hepatotoxicity?
A. Acetylsalicylic acid: aspirin
B. Ibuprofen: Motrin
C. Pseudoephedrine: Sudafed
D. Acetaminophen: Tylenol
D. Acetaminophen:tylenol
Hey 56 year old man is taking OTC antacid for relief of ingestion. He tells the nurse that he consumes at least one bottle a week and has done stuff for more than one month because “it works for me.” what is the nurse’s primary concern?
A. The self treatments is expensive.
Be. This self treatment may be delaying treatment of a more serious problem.
See. This self treatment may be the best treatment of his ingestion.
D. The long-term use of antacids may make the ingestion worse.
B. This self treatment may be delaying treatment of a more serious problem.
Reclassified over the counter drugs
Prescriptions that have been moved over the counter because they were prescribed a ton and there’s less need to monitor them
Ex. Advil, Aaliyah, Benadryl, Claritin, Pepcid
The nurse is administering a drug that has been ordered as follows:”Give 10 mg on odd numbered days and 5 mg on even numbered days.” When the date changes from May 31 to June 1, what should the nurse do?
A. Give 10 mg because June 1 is an odd number day
B. Holder does until the next odd number day.
C. Change order to read give 10 mg an even number days and 5 mg an odd number days.
D.Consult the prescriber to Phair verified that the dose should alternate each day, no matter whether the day is odd, or even numbered.
D.Consult the prescriber to Phair verified that the dose should alternate each day, no matter whether the day is odd, or even numbered
Reporting medication errors
-Report to prescriber and nursing
-Document air per policy procedure
-Factual documentation only
- External reporting factors ex. Joint commission, Medwatch, etc.
The nursing student realizes that she was given a patient a double dose of a antihypertensive medication. The tablet was supposed to be cut in half, but the student forgotten administer the entire tablet. The patient’s blood pressure just before the dust was 146/98 MM Hg. What should the student nurse do first?
A. Notify the patient position.
B. Notify the clinical faculty.
c. Take the patient’s blood pressure.
D. Continue to monitor the patient.
B. Notify the clinical faculty.
Ethical issues
-Notification of patient’s
-Possible consequences for nurses
Medication reconciliation
-Process in which medication is “reconciled” at all points of entry and exit to or from a healthcare entity
-Process in which medication’s are “reconciled” at all points of entry and exit to or from a healthcare entity
-know what your patient is taking and last time they took the medication, Dose, occurrence, why
Over the counter drug criteria
Indication for use: consumer must be able to easily: diagnose condition, monitor effectiveness/ benefits, of correct usage, most outweigh the risk
Safety profile: drugs must have: favorable, adverse event, profile, limited interaction with other drugs, low potential for abuse, hi therapeutic index
Practicality for over-the-counter use : drugs must be: easy to use, easy to monitor
Ratio of toxic to therapeutic dosage
