Final Blueprint Flashcards
what is the first step to Nursing Process?
Nursing Assessment-Obtain drug history
- lifestyle and beliefs, martial status, ADLs, etc.
- allergic rxns to OTC and prescription drugs/foods
- medical history, including all associated or chronic disorders
- all prescription and OTC drugs including herbal preps
- habits - dietary, exercise, recreational drug use, including alcohol
- sensory deficits, esp those affecting ability to self-adm
- socioeconomic status - age, ed level, occupation, health insurance coverage –Determine baseline measurements needed to monitor safety & efficacy of drug
what is the second step to the nursing process?
Nursing Diagnosis - NANDA
knowledge deficit related to drug therapy, as evidenced by clients:
1) statement of misconception
2) request for information
3) errors in following instructions
4) signs of cognitive impairment
-noncompliance related to drug therapy, as evidenced by acknowledgement of failure to follow regimen by ct
2) failure on objective tests
3) development of complications
4) exacerbation of symptoms
5) failure to improve or progress
6) failure to keep appts
–Examples of other drug-specific nursing diagnoses
1) high risk for injury R/T anticoagulant therapy
2) sexual dysfunction R/T antihypertensive medication
etc.
What is the third step of the nursing process?
Nursing Plan
2 major components - Outcome Criteria and nursing interventions
1. Outcome criteria - states a pt goal, or the desired pt behavior or response to be reached w/ nursing care. It should be measurable and objective, including an action verb and time frame.
2. Nursing interventions - helps pt achieve the goals of outcome criteria.
Ex. Instrust pt to take antibiotic 3 x day until all pills taken
- What is the fourth step to the nursing process?
- Nursing Implementation*
- Adm med as prescribed
2. Monitor ct for therapeutic effect
3. Evaluate serum drug level and results of relevant lab tests
4. Monitor ct for adverse effects, toxicity, and drug interactions, notify physician
5. Teach ct about med and importance of compliance
6. Monitor ct compliance by the following means: - physiologic measurements, such as serum or urine drug level
- judgment by attending physician or other health team member
c. ct self-report
d. pill counts
e. direct observation
what is the last step to the nursing process?
Nursing Evaluation
- Client obtains expected effects of prescribed drug
- Client avoids adverse effects and drug interactions
- Client demonstrates an understanding of his/her med as taught
- Client complies w/ the prescribed therapeutic regimen
what does ADPIE stand for?
Assessment Diagnosis Planning Implementation Evaluation
what are the Rights of Medication Administration?
Right drug Right dose Right patient Right time Right route Right chart or MAR Right to refuse (unless confused) Right to hold (nursing judgment Right reason Right assessment for adm & response to med
Schedule I drugs
drugs have a high abuse potential; no currently accepted medical use in the U.S.; pose unacceptable dangers; illegal
Ex: heroin, LSD, mescaline, mehtaqualone
Schedule II drugs
drugs have high abuse potential, but with currently acceptable therapeutic use. May lead to physical or psychological dependence or both. Written prescriptions required, no telephone renewals.
Ex: fentanyl, meperidine, morphine, codiene, oxycodone, methadone, cecobarbatal
Schedule III durgs
have a lower abuse potential than Schedule I or II. Current acceptable therapeutic use in US. Abuse may lead to moderate or low physical or psychological dependence or both. Prescriptions required to be rewritten after 6 months or 5 refills.
Ex: Drugs containing limited codiene or morphine, nonnarcotic derivatives of barbituric acid, paragoric, tylenol with codiene
Schedule IV drugs
drugs with less abuse potential than schedule III, acceptable therapeutic use in the US. Written or oral prescription required, with refills limited to 5.
Ex: fenobarbital, Valium, Ativan, Chloralhydrate
Schedule V drugs
drugs with lower abuse potential and with currently acceptable therapeutic use in the US.
Ex: cough syrup that contains codiene, lomotil (stops diarrhea), terpinhydrate (anti-tussive)
How does Surface area affect Drug Absorption?
a client with a resected intestine will have reduced absorption of orally administered drugs
How does blood flow affect Drug Absorption?
blood flow in intestine is increased after eating and decreased w/ exercise
How does pain and stress affect Drug Absorption?
these factors decrease absorption; the cause has just not been established
How does GI motility affect Drug Absorption?
high-fat or solid foods delay gastric emptying, retarding absorption or orally administered drugs; anticholinergics decrease intestinal motility, delaying absorption of orally administered drugs)
How does dosage form affect Drug Absorption?
sublingual tabs are absorbed more rapidly than compressed and sustained - release tabs; IM solutions are absorbed more rapidly than IM suspensions and emulsions
what are rapid rate dosage forms?
(seconds to mins): sublingual, IV, inhalation route
what are Intermediate rate dosage forms?
(1-2 hours): oral, Im, or SQ route
what are Slow rate dosage forms?
(hours to days): rectal, sustained release, topical systems
what is an example drug-drug interaction?
tetracycline and antacids
what is an example of a drug-food interaction?
tetacycline and milk, CCBs and grapefruit juice
- First-pass effect*
some drugs are partially metabolized in the liver or portal vein before passing into the circulatory system
what are examples of drugs that are susceptible to a first pass effect?
dopamine, imipramine, isoproterenol, lidocaine, morphine, nitroglycerin, propranolol (Inderal), reserpine, and warfarin (coumadin)
why is the first pass effect important?
First pass effect often explains why the recommended oral dose of an agent is far greater than the IV dose
Drug solubility
for a drug to be absorbed, its solubility (in lipids or water) must correspond to the characteristics of the absorption site.
Bioavailability
extent to which active ingredient is absorbed and transported to target tissue, variable w/ drug brand
Enterohepatic recycling
some drugs, such as digoxin and digitoxicin, travel intact through the biliary tract after initial absorption and are then reabsorbed into bloodstream through the intestine.
what is Drug half life?
time required for the total amount of a drug in the body to decrease by one-half, usually calculated in plasma. It is different for each drug. Half life will determine how frequently a drug must be given to maintain a therapeutic blood level.
Drug Excretion
the process by which drug metabolites are eliminated from the body (primarily through the kidneys
If a drug is not readminstered, most drugs are effectively eliminated after how many half life?
5
what would be given to reach steady state accumulation more rapidly?
a loading dose
Ex: Lanoxin - tx CHF, give large initial dose then 2-4hrs
Drug clearance
the rate at which drug is eliminated by the body. A drug with low clearance is removed from the body slowly. A drug with high clearance is removed rapidly and will require more frequent adm and higher doses.
Renal excretion
a process that takes place by glomerular filtration and/or tubular secretion.
what are the effects of aging on Drug Metabolism & Excretion?
- Metabolism - the liver’s efficiency in metabolizing drug declines with age; one factor is the decline in hepatic circulation
- Excretion - age-related decline in renal function is not always heralded by increased serum creatinine levels; the risk of nephrotoxicity (e.g., with aminoglycosides is greater in the elderly)
Peak
needs to be measured 30mins-2hrs after administration
Ordered after 3rd dose of med. Draw trough levels first (lowest level then give med, then draw peak). Usually
on IV dosages
Trough
measured 30mins right before the next dose
Cholinergic agents effect what system?
parasympathetic
Bethanechol (Urecholine)
stimulates smooth muscle of GI tract and urinary bladder. Used to tx urinary retention.
Pilocarpine (Adsorbacarpine, Akarpine, Isopto Carpine, Pilocar)
tx IOP
Edrophonium (Tensilon)
used to diagnose myasthenia gravis
Neostigmine (Prostigmin)
used to diagnose and tx myasthenia gravis, used to prevent and tx postop distention and urinary retention Antidote for neuromuscular blockers
what are the Adverse Effects Cholinergic agents?
Salivation Lacrimation Urination Diaphoresis Gi increase GI secretions Elimination (diarrhea)
what do you need to teach clients taking cholinergic agents?
- show client how to instill cholinergic agent into eye
- tell client that drug may affect visual acuity
- show client receiving anticholinesterase therapy how to assess and record changes in muscle strength
- help client on anticholinesterase therapy to develop a system for recording each dose and its effects
- Stress need to take drugs on time
when is Atropine contraindicated?
Glaucoma patients
Cholinergic Blocking Agents
Treats bradycardia. Pre-anesthetic to decrease secretions, blocks vagal effects of SD node, minimizes vagal reflexes
what are the 3D effect of Cholinergic Blocking Agents?
Drying, decreased GI motility, Dilated pupils
Epinephrine
adrenergic agent (sympathomimetics)
Treats shock, bradycardia, allergic rxns, anaphylactic shock, cardiac arrest, bronchodilator, asthma attacks, hemostasis-stops bleeding
Adverse effects: palpitations, cardiac arrhythmias, tachycardia
what do Beta blockers TX?
tx hypertension, angina, arrhythmias, migraine, idiopathic hypertrophic subaortic atenosia, mitral valve prolapse, glaucoma
what are the adverse effects of beta blockers?
fatigue (give in evening) hyperglycemia, hypoglycemia (blocks the tachycardia that associated w/ hypoglycemia
how do Neuromuscular Blockers work?
Relax skeletal muscles by disrupting nerve impulse transmission. Do not cross blood-brain barrier, so pt remains conscious and aware of pain
what are neuromuscular blockers used for?
relax muscles during surgery, reduce intensity of muscle spasms in electronically induced spasms, manage clients who are fighting or bucking mechanical ventillation, paralytic diaphragm
what are the adverse effects of Neuromuscular Blockers?
hypotension and bronchospasm, increased bronchial and salivary secretions.
what is the drugs of choice to tx malignant hyperthermic crisis?
dantrolene (dantrium)
