Exam 1: Ch. 1, 2, 3, 4, 5, 7, 8 Flashcards
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
5 phases
an organizational framework for the practice of nursing
all steps taken by the nurse in caring for the patient: ADPIE
A-assessment, nursing
D-diagnoses,
P-planning (w/ goals and outcome criteria),
I-implementation of the plan (w/ pt teaching),
E-evaluation
outcomes
descriptions of specific patient behaviors or responses that demonstrate meeting of or achievement of goals r/t nursing diagnosis
-varifiable, framed in behavioral terms, measurable, and time specific
prescriber
any health care professional licensed by the appropriate regulatory board to prescribe medications
“nine rights” of medication administration
right drug (check 3x) right dose right time right route right patient right documentation right reason right response right to refuse
goals
time specific; what is to be accomplished
ADPIE
Assessment
A- objective (age, ht, wt)
subjective (pt complains of...) data
-interview
-observation
-medical records
-physical assessmentADPIE
Diagnosis
D- 3 step process
- human response to illness
- factors r/t response
- evidence to support RN diagnosis
ADPIE
Planning
P- realistic, time frames, broad/ specific
- prioritize diagnosis (most critical needs to least)
- make goals
- predict outcomes
- develop timeframe
ADPIE
Implementation
I- RN addresses specific pt problems and needs
- specific instructions
- administer drugs “9 rights”
ADPIE
Evaluation
E- monitor if plan is taking place/ being met
- outcome of goals
- response to drugs (therapeutic, adverse, toxic effects)
Appropriate authoritative sources
- references w/in the past 3 years:
- Physicians desk reference
- drug manufacture insert
- nursing drug handbook
- U.S. Pharmacopoeia
- FDA
- Pharmacists
Who can write prescriptions?
- physicians
- dentists
- nurse practitioners
- physician assistants
prescriptions must contain
- patient’s name
- date order was written
- name of the medication
- route of delivery
- dosage (size, freq, #of doses)
- signature of prescriber
What is the responsibility of the professional nurse when applying the nursing process to the care of their patients?
safe, therapeutic, and effective medication administration
additive effects
drug interaction; the effect of a combination of 2 or more drugs with similar actions
pharmaceutics
science of preparing and dispensing drugs
rate of drug absorption (enteral, parenteral, topical)
absorption of oral preparations - rate fastest to slowest:
oral disintegration, buccal, soluble wafer liquids, elixirs, syrups suspension solutions powders capsules tablets coated tablets enteric coated tablets
pharmacokinetics
what the body does to the drug: ADME absorption distribution metabolism excretion
ADME
absorption
getting drug intoblood
1st pass effect: liver before blood; Oral and Enteral
non-1st pass effect: Buccal, Parenteral, Topical
ADME
distribution
getting drug out of blood and into tissues
- drug needs to be non-protein bound
- highly protein bound drug- may need to increase dose in person w/ low albumin (malnourished, burned)
- drug- drug interaction-2 protein binding drugs given at same time will increase unbound or free drug concentration
- difficult areas to reach= low vasculature or barrier (bone and brain)
ADME
metabolism
getting drug into active form
- liver metabolizes
- pt factor affecting metabolism -current drugs= enzyme inducers; cardio, renal, malnourished, genetics, jaundice
ADME
excretion
primarily kidneys
half-life
time initial dose takes to eliminate to 1/2; measurement of rate of excretion/ elimination
onset
time to elicit therapeutic response
duration
time drug concentration is high enough to be therapeutic
pharmacodynamics
MOA: what drug does to body
-modify rate or function of cell/ tissue
pharmacotherapeutics
aka therapeutics
monitoring for AE, therapeutics index, drug concentration, interactions, adverse drug events, (med errors; allergic reactions)
reasons why drugs are given
acute, maintenance, supplemental, palliative, supportive, prophylactic or emporic
enteral route
tablets, capsules, wafers, pills, syrup, emulsions, solutions, lozenges, rectal suppository, sublingual, buccal tablets
parenteral route
area in body:
intravenous, intramuscular, subcutaneous, intradermal intraarterial (artery), intrathecal (spine), intraarticular (joint)
drug form:
injectable, suspensions, emulsions, powders for reconstitution, solutions
topical route
area on body:
skin, eyes, ears, nose, lungs, rectum, vagina
drug form:
aerosols (inhaled), ointments, creams, paste, powder, solutions, foam, gels, patches (transdermal), rectal and vaginal suppositories
first- pass routes
oral, rectal (both 1st/ non) , hepatic arterial, portal venous
non-first-pass routes
aural (in the ear), buccal, inhaled, intraarterial, intramuscular, intranasal, intraocular, intravaginal, intravenous, subcutaneous, sublingual, transdermal, parenteral, topical
idiosyncratic reaction
an abnormal or unexpected response to a medication, other than an allergic rxn
first pass effect
- reduces the bioavailability of a drug to less than 100%
- drug must ‘first pass’ through oral, GI, stomach, liver before reaching effected site
