Exam 1 Review Flashcards
five components of the nursing process
- assessment
- nursing diagnosis
- planning
- implementation
- evaluation
rights related to safe medication
right patient
right drug
right dose
right form/route
right time
right indication
right documentation
right response
right to refuse
pharmaceutics
preparing and dispensing drugs
pharmacokinetics
study of drug absorption, distribution, metabolism, and excretion from the body
pharmacodynamics
effects of drug on the body
four aspects of pharmacokinetics
absorption
distribution
metabolism
excretion
difference between OTC, herbals, and dietary supplements
OTC - drugs that you can get w/o rx
herbals - products made from herbs
dietary supplements - product to supplement diet
methods of medication administration
eneteral, parenteral, and topical
compliance
implementation or fulfillment of prescriber’s prescribed course of treatment or therapeutic plan
medication error
any preventable adverse drug event involving inappropriate medication use by a pt or health care professional; may or may not cause pt harm
noncompliance
informed decision on the part of the pt to not adhere to or follow a therapeutic plan or suggestion
nursing process outcomes
objective, realistic, and measurable pt centered statements with time frames
agonist
drug that binds to and stimulates the activity of one or more receptors in the body
antagonist
binds to and inhibits the activity of one or more receptors in the body
chemical name
chemical composition of the drug
contraindication
any condition which renders a particular form of treatment improper or undesirable
drug classification
method of grouping drugs
generic vs trade name
generic is the nonproprietary name and trade is the proprietary name
medication error
preventable adverse drug event involving inappropriate medication use by a pt or healthcare professional
peak level
max concentration of drug in the body after administration
receptor
molecular substance on the cell that bind specific substances
therapeutic drug monitoring
monitoring drug levels to identify pt’s drug exposure and to allow dosage adjustments for maximum therapeutic effects
trough level
lowest concentration of a drug in the body after its peak
neonate classification (age range)
younger than 1 month of age
older adult classification (age range)
65+
pediatric classification (age range)
children 12 and under
black box warning
warning required by FDA to alert prescribers of serious adverse events seen with a given drug
controlled substance (categories)
C-I through C-V
Ethics
rules of conduct
HIPAA
protects health insurance coverage for workers, protects confidential pt information
Informed consent
written permission obtained from a pt consenting to a specific procedure
Narcotics
medically administered controlled substance (opioid)
OTC
drugs available to consumers w/o a prescription
Placebo
inactive substance that is not a drug but resembles one for research purposes
Adverse drug event
undesirable occurrence related to administration of or failure to administer a prescribed medication
Adverse drug reaction
unexpected, unintended, or excessive responses to medications given at therapeutic dosages
Idiosyncratic reaction
abnormal or unexpected response to a medication that is not an allergic reaction and is peculiar to an individual pt
Medical errors
any errors in pt care that cause or have the potential to cause harm
Medication errors
preventable adverse drug event
Medication reconciliation
procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care discovery
Affective domain
learning that modifies feelings, beliefs, values, and opinions; feeling domain
Cognitive domain
learning and storing of basic knowledge; thinking domain
Psychomotor domain
learning of a new procedure or sill; the doing domain
Complementary medicine
alternative medicine when used simultaneously w/ western medicine
Dietary supplement
product that contains an ingredient intended to supplement the diet
Herbal medicine
using herbs to heal
Herb
plant components like bark, roots, leaves, etc.
enteral
oral medications and suppositories
paraenteral
injectables; any administration other than GI
diseases and conditions that decrease metabolism
cardiovascular dysfunction, renal insufficiency, starvation, obstructive jaundice, and slow acetylator
conditions that increase metabolism
fast acetylator
drugs that increase metabolism
barbiturates, rifampin and phenytoin (P-450 inducers)
drugs that decrease metabolism
ketoconazole (P-450 inhibitor)
effect of eating leafy green vegetables
decreased anticoagulant effect from warfarin
effect of eating dairy
chemical binding of the drug leading to decreased effect and treatment failures
tetracycline, levofloxacin, ciprofloxacin, moxifloxacin (antibiotics)
effect of grapefruit juice
decreased metabolism leading to increased effects
amiodarone (antidysrhythmic), bus-irons (anti anxiety), carbamazepine (anti seizure), cyclosporine, tacrolimus (immunosuppressants), felodipine, nifedipine, nimodipin (calcium channel blockers), simvastatin, and atorvastatin (anti cholesterol drugs)
effects of aged cheese & wine
induces hypertensive crisis / monoamine oxidase inhibitors
premature infant
younger than 38 weeks of gestation
infant
1 month to 1 years old
Category A drug
studies indicate no risk to human fetus
Category B drug
studies indicate no risk to ANIMAL fetus
Category C drug
adverse effects reported in ANIMAL fetus
Category D drug
possible human fetus risk has been reported but potential benefit may warrant use in pregnant women
Category X drug
confirmed fetal risk & not to be used in pregnant women
Absorption differences in neonate & pediatric patients
-lower gastric pH until 1-2 years of age
-slowed gastric emptying b/c of slow or irregular peristalsis
-first-pass elimination is reduced b/c of immature liver and reduced microsomal enzymes
-intramuscular absorption is faster and irregular
Distribution differences in neonate & pediatric patiens
-higher body water content 70-80% in full-term infants, 85% in preme’s, and 64% in children 1-12
-lower fat content b/c higher water content
-decreased protein binding b/c of immature liver (less protein production)
-immature blood-brain barrier increases brain absorption
Metabolism differences in neonate & pediatric patiens
-decreased microsomal enzymes b/c immature liver
-older children may have increased metabolism and require higher dosages
Excretion differences in neonate & pediatric patiens
-kidney immaturity causes glomerular filtration rate and tubular secretion and resorption decreased
-perfusion to kidney may be decreased, resulting in reduced renal function, concentrating ability, and excretion of drugs
physiologic changes in adult patients (cardiovascular)
lower cardiac output = lower absorption and distribution
lower blood flow = lower absorption and distribution
physiologic changes in adult patients (GI)
increased pH = altered absorption
decreased peristalsis = delayed gastric emptying
physiologic changes in adult patients (hepatic/liver)
lower enzyme production = lower metabolism
lower blood flow = lowered metabolism
physiologic changes in adult patients (renal/kidney)
lower blood flow = lower excretion
lower function = lower excretion
lower glomerular filtration rate = lower excretion
pediatric dosage considerations for calculations
body surface area measured, always use weight in kilograms, always use cm not inches, use mg/kg for dosage calculations
BBW Class I
most serious recall when a product can cause serious adverse effects or death
BBW Class II
less severe recall that may result in temporary or medically reversible health effects
BBW Class III
least severe recall not likely to cause significant health problems
American Nurse Association
institutional policies and procedures; state and federal hospital licensing
Nursing ethics
autonomy, beneficence, confidentiality, justice, nonmaleficence, and veracity
autonomy
ability to act on one’s own; promoting pt’s decision making and supporting informed consent
beneficence
actively promoting good; nursing actions that determine how a pt is best served
justice
being fair or equal in one’s actions; nursing actions that ensure fairness in distributing resources for the care of patients and determining when to treat
nonmaleficence
do no harm
veracity
duty to tell the truth (placebos, investigational new drugs, and informed consent)
elements of liability in nursing
duty, breach of duty, causation, damage
duty
nurse is responsible for assessment, monitoring, and reporting of pt’s condition
breach of duty
nurse fails to follow their duty
causation
nurse fails to notice adverse effects that lead to pt harm
damage
the damage that results from a nurses breach of duty
C-I
high abuse potential, no medical use, and severe dependance, only dispensed with approved protocol
heroin, LSD, acid, etc.
C-II
high abuse potential, accepted medical use, severe dependency potential
only written rx & no refills, label warning
codeine, pentobarbital, morphine, cocaine, and stimulants
C-III
less abuse potential than II, accepted medical use, moderate dependance potential
written or oral rx, expires in 6 mo. w/ no more than 5 refills, label warning
C-II painkillers combined w other products
C-IV
less abuse potential than C-III, accepted medical use, limited dependance potential
same dispensing restrictions as C-III
phenobarbital, benzodiazepines, tramadol, etc.
C-V
less than C-IV, accepted medical use, limited dependance potential
written rx or otc
meds for cough, diarrhea, certain opioids, etc.
drugs commonly involved in severe medication errors
CNS drugs, anticoagulants, insulin, and chemotherapeutic drugs
errors can occur during…
any step of medication process
procuring, prescribing, transcribing, dispensing, administering, and monitoring
when a nurse is administering a drug, they must…
always check the medication order 3 times before giving the drug
how to handle verbal or telephone rx order?
repeat order to prescriber, spell drug name around, speak slowly and clearly, and list indication next to each order
