Module 1: Nursing Management of Drug Therapy Flashcards
Drug Indication
Drugs may be prescribed for more than one reason (i.e.):
1. Beta blockers — used to decrease HR, decrease BP, and/or treat migraines
- Aspirin — used for pain relief and/or prevention of platelet aggregation
Nursing Management of Drug Therapy: Assessment
Baseline:
- Pt’s condition prior to drug admin. — observations (vitals & system assessment) and labs
- Medical history — liver failure, renal disease, malabsorption syndrome
- Medication history — what does the pt take at home? What have they taken previously?
- Allergies — RXNs
Documentation: What are the orders?
Diet:
- Restrictions (NPO)
- IV access
Nursing Management of Drug Therapy: Planning
Some drugs cannot be given at the same time; must change the order of drug admin. (i.e. calcium antacids impair the absorption of other drugs)
THE FIVE RIGHTS:
1. Right pt — 2 identifiers (name, birthdate, or MRN)
- Right medication — Check med. (lower & uppercase lettering to differentiate look/sound-alike meds.; DDIs; Generic may not be the same as trade drug), and check expiration
- Right dose — Compare ordered dose with usual dose; Assess for metabolic (liver disease) or elimination issues (renal disease); Med. (i.e. dopamine) may be dose-weight based; Dose varies with age (especially the very young & old)
- Right route — Some meds. (i.e. morphine) are affected by first pass effect (a phenomenon of drug metabolism whereby the concentration of a drug, specifically when admin. orally, is greatly reduced before it reaches the systemic circulation)
- Right time — Note intervals; PRN meds.; Some meds. (i.e. HTN meds., diuretics) can be detrimental if admin. in the morning
Nursing Management: Intervention
Right documentation:
1. Document if admin. or not; if not admin - why?
- If not given, notify team and any adverse issues (i.e. BP med. held because BP <80/50; team notified, new vitals obtained)
Nursing Management: Evaluation
Reassess (intended effect):
1. Vitals
- Glucose — S/S of hypo/hyperglycemia
- Urine output
- Lung sounds
- Adverse effects — i.e. drop in BP, decreased RR, S/S of hypoglycemia
Pt Education
Pts and their families need to know:
1. Intended effects
- AEs
- Diet restrictions
- Interactions
- When to speak to their provider or pharmacist
Nurse-Pharmacist Collaboration
Collaborating with a pharmacist can:
1. Provide a correct dose for a pt based on new evidence
- Decrease pill burden by combining meds.
- Maintain generic vs. trade meds.
- Find more affordable drug options
- Help the nurse look for hidden AEs via lab data