Exam 1 & 2 G&D, Teaching & Learning Flashcards
Why do nurses need teaching skills?
ANA standard related to promoting health demands skills in teaching clients.
What is the no. 1 priority of what nurses do?
Safety is the underpinning of what you do.
What does teaching involves?
Planning and implementing instructional activities that allow clients to learn.
What is the goal of teaching?
To meet learner outcomes.
When is the prime time to do teaching and learning?
When the patient asks a question!
What is key to master a skill?
Repitition!
Active process involving more than just giving information.
What are the 3 domains of learning?
Cognitive
Psychomotor
Affective
What is an example of cognitive learning?
Storage & recall of info.
i.e- Facts about disease
What is an example of psychomotor learning?
involves “hands-on” skill.
thinking and doing.
i.e- self administration of insulin/medicine, etc.
What is an example of affective learning?
changing feelings, beliefs, attitudes, and values.
i.e- changing a belief about diet.
Driven by emotions from grief/loss
i.e- disease driven-> causes emotions to want to learn more
What are the 5 stages of illness in death and dying?
- Denial
- Anger
- Bargaining
- Resolution
- Acceptance
What is “present tense” teaching and in what stages?
“REALITY”- Stages 1-4.
i.e- engage with pt: talk with them while administering meds. Not LT, its what is going on now. Provide support.
What stage do you do both present and future teaching?
Stage 5. Acceptance.
What is the study of drugs (chemicals) that alter functions of living organisms?
Pharmacology
What kind of information is it if a physician or nurse observes/sees?
Objective
What kind of information is if the patient states, sees, or describes to nurse?
Subjective
What is the Food and Drug Administration responsible for?
*Ensuring safety & efficacy of drugs before they can be marketed.
Approves many new drugs annually (OTC & prescription)
May change status from prescription to OTC
What law regulates the manufacture, distribution, advertising and labeling of drugs?
The food, drug, and cosmetic act of 1938.
What law designates drugs that must be prescribed by a licensed physician or NP & dispensed by a pharmacist? Who enforces the law?
The Durham-Humphrey Amendment
The FDA is in charge with enforcing the law.
What act regulates the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and anabolic steroids?
The Controlled Substance Act
How are controlled substance dugs categorized?
According to therapeutic usefulness & potential for abuse & are labeled as “control substance”.
What are examples of controlled substances?
Morphine, CII or schedule II drug.
What is the use of drugs to prevent, diagnose, or treat s and sx and disease processes?
Drug Therapy
What are medications?
Drugs given for therapeutic purposes
What is the difference between local and systemic effects of medication?
Local acts mainly @ site of application.
Systemic is circulated via the bloodstream to sites of action and eventually eliminated from the body (in order to work).
Examples of local effects of medication?
Topical ointments or creams
What are the 4 drug sources?
Plants- primary source for meds (Digoxin from digitalis fox plant) for CVD pts
Animals- Insulin: pork or beef derived
Minerals- Mg, Fe,
Synthetic Compounds- constitutes a lot of meds that are synthetically derived
What is an example of a prototype?
Morphine- represents opioid analgesics
Penicillin- represents antibacterial drugs
What is the prototype?
Individual drugs that represent groups of drugs. Often the first drug of a particular group to be developed.
What are the 3 drug names?
Trade or Brand name
Generic Name
Chemical Name
What is the difference between brand and generic drug?
Brand names come out first.
Both drugs are bioequivalent= some constants, chemicals and dosage. Difference might be “MATRIX” in which the way chemicals break down.
Manufactured differently
What are scheduled meds?
Drugs that can pose additive (abuse potential) type of meds.
What are the 5 categories of controlled substances?
Schedule I- not approved for medical use and have high abuse potentials. (LSD, crack, shrooms, heroin) illegal
Schedule II- drugs that are used medically and high abuse potential (opioid analgesics, morphine, oxy)
Schedule III- drugs with less potential for abuse, but also may lead to psychological or physical dependents (androgens, anabolic steroids)
Schedule IV- Diazepam
Schedule V- moderate amts of controlled sub. (Lomotil, b/c atropine assoc with LSD)
If a medication is not lipid soluble (lipid bilayer) what do you need in order for the med to go into the cell?
ATP. Medications are either lipid or h2o soluble, need receptor to get in.
What are the 4 processes involved in pharmacokinetics?
Absorption Distribution Metabolism Excretion "what the body does to the drug" to reach ^.
What two processes are grouped as drug elimination or clearance mechanisms?
Metabolism and Excretion
What involves drug actions on target cells and the resulting alteration s in cellular biochemical reactions and functions?
Pharmacodynamics!
“what the drug does to the body”.
What is absorption?
The process of time it takes for the med to be absorbed in the blood stream. Onset of drug action is determined by rate of absorption.
What factors affect rate and extent of drug absorption?
dosage, route of administration, administration site blood flow and GI function
What is distribution?
The process in which drugs are carried by blood and tissue fluids to action sites, metabolism sites, and excretion sites.
Drugs are now in blood stream and will have its effects.
What meds bypass absorption?
IV meds, they go straight to distribution because directly in blood stream.
What factors affect distribution?
Blood flow, dehydration, blood disorder, and impaired circulation affects rate b/c of body circulation.
What two proteins carries meds to the site?
Globulin, and mostly Albumin
What is the metabolic process?
method by which drugs are inactivated or biotransfromed by the body. After the med reaches it’s active site, need to remove residuals from med.
Where are drug metabolizing enzyme located?
Within the organs.
What is the prime organ to filter/metabolize meds?
Liver!
Skin meds- breathe out
H20 soluble- excrete by Kidneys.
What is excretion?
Elimination of a medication from the body. Turn to metabolites so body can excrete.
Excretion requires adequate functions of what organs?
Liver- circulatory system
Kidneys- urine/bowel. convert lipid sol to h20 sol b/c kidneys c/n excrete fat and needs to be h20 sol, for urine excretion (metabolism).
Lungs and skins-
What is the serum drug level?
A lab measurement of the amount of drug in the blood at a particular time.
Drug absorption
Bioavailabilty, halflife
Rate of metabolism and excretion
What is the serum drug level used for?
To prevent toxicity= excessive level of med in blood stream
MEC- minimum effective concentration must be present for efficacy
Receptor theory of drug action?
Drugs exert their effects by chemically binding with receptor cells via:
activation, inactivation or alteration of intracellular enzymes, changes in permeability of cell memb, modification of the syntheysis of neurohormones.
What drugs do not need/act on receptor sites?
Antacids, osmotic diuretics, several anticancer drugs, and metal chelating agents.
What is dosage?
Refers to the frequency, size, and number of doses. Major determinant of drug actions and responses both therapeutic and adverse.
What characteristics does dosage depend on?
Recipient, age, weight, state of health, funct of cardiovascular, renal, and hepatic systems.
What are two outcomes of drug-diet interactions?
- Some drugs are used therapeutically to decrease food absorption in intestinal tract (fat, cholesterol).
- Some foods contain certain substances that react with certain drugs.
What foods does Tyramine interact with?
Cheese, sauerkraut, shoyu, beer, and red wines.
Interact with MAO inhibiters and causes norepinephrine release= vasoconstriction inactivated by MAO.
MAO inhibitor drugs precent inactivation of norepinephrine (antidep, antiparkinson drugs)
Resulting: sever HTN, intracranial HEMORRHAGE= death.
What drug does grapefruit interact with?
Statin group of cholesterol lowering drugs because grapefruit contains substance that inhibits drug metabolism, resulting TOXICITY.
Tetracyline (TCN) and dairy products?
Combines with Ca++ and excreted in feces. Antibiotic + dairy = combines with Ca== to form a nonabsorbable compound, excreted in feces.
What happens with a drug-drug interaction?
The action of a drug may be increased or decreased by its interaction with another drug in the body.
Additive effects
occur when two drugs with similar pharmacologic actions are take (e.g ethanol+sedative drug increases sedative effects)
Synergism
occurs when to drugs with different sites or mechanisms of action produce greater effects when taken together. (e.g acteminophen [nonopioid analgesic] + codeine [opioid analgesic] increase analgesic effects
Interference
By one drug with the metabolism of a second drug may result in intensified effects of the second drug. Result toxicity b/c blood levels of drug s are higher. (large dose action)
Displacement
(e.g- a drug with a strong attraction to protein binding sites may displace a less tightly bound drug of one drug from plasma protein binding sites by a 2nd drug increases effects of displaced drug.
What are 3 drug related variables that decrease the effects of a drug?
- Antidote- drug can be given to antagonize the toxic effects of another drug.
- Decreased intestinal absorption- occurs when drugs combine to produce nonabsorbable compounds.d
- Activation of drug metabolizing enzymes in lover, increases the metabolism rate of any drug metabolized mainly by that group of enzeymes and therefore decreases the drug’s effects
What is the most common way a drug is administered and why?
ORAL route because it the most economical, efficient, least invasive way, efficient, and most route prescribed.
What is the antidote for Morphine?
Naloxone- NARCAN is the opioid antagonist to relieve CNS and respiratory depression induced by an opioid.
What are the 8 different routes of administration?
- Tablets/capsules
- Sublingual
- SubQ
- IM
- IV
- Ear/eye drops
- Suppository
- Nebulizer
Why can’t thick coding tables be scored?
Coding provides safety so pt take it and does not absorb it until it hits the small intestines.
Onset
when drug hits MEC. start to see therapeutic effect. when drug onsets. i.e insulin has different types with different onsets- fast, long, etc.
Duration
How long drug will be in the body? Needs to be in the body for 4-5 half lifes to perform quality therapeutic effects.
What are the 6 R’s (rights)?
- Right medication
- Right dose
- Right client
- Right route
- Right time
- Right documentation
When should you check all R’s?
At critical times, ALWAYS.
Right reason
right to know
right to refuse