Nursing Process, Pharmacological Principles & Antidiarrheals Flashcards
Nursing Process
A research-based organizational framework for professional nursing practice
Flexible, adaptable, and considered the major systematic framework for professional nursing practice
Ensures the delivery of thorough, individualized, and quality nursing care to patients
Requires critical thinking (clinical reasoning and clinical judgement)
Ongoing and constantly evolving process
5 Steps of the Nursing Process
Which includes goals and outcome criteria?
Which includes PT education?
ADPIE
P- Planning includes GOALS and Outcome criteria
Implementation- PT education
Assessment
List what you want to assess.
Data collection, review, and analysis
Medication profile:
Any and all drug use
Home or folk remedies;
natural heath products or homeopathic treatments
Alcohol, tobacco, caffeine intake
Current or past illicit drug use
Prescriptions and over-the-counter medications
Past or present health history and associated drug regimen
Family history; growth and developmental stage
Issues related to age and medication regimen
Define NANDA-I?
Purpose?
North American Nursing Diagnosis Association International (NANDA-I)
Purpose of NANDA-I is to increase the visibility of nursing’s contribution to the care of patients and to further develop, refine, and classify the information and phenomena related to nurses and professional nursing practice.
International Classification for Nursing Practice (ICNP)
Project of the International Council of Nurses
The ICNP is a framework that can be cross-mapped with other health care classification systems, creating multidisciplinary health vocabularies within information systems.
Cross-mapped with other health care classification systems such as NANDA
The Canadian Nurses Association (CNA) has endorsed the ICNP as the standard for collecting nursing data.
Disparity in opinion as to which approach is best
Nursing Diagnoses
Define and list the 3 step process.
Nursing diagnoses are used to communicate and share information about the patient and the patient’s experience.
Three-step process:
PART I: Human response to illness, injury, or significant change
PART II: Factors related to the response (“related to”)
PART III: Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”)
Common nursing diagnoses related to drug therapy develop from data associated with:
Deficient knowledge
Risk of injury
Nonadherence
Various disturbances, deficits, excesses, or impairments in bodily function
Planning
Identification of goals and outcome criteria
Define Goals and Outcome criteria?
Goals:
Objective, measurable, and realistic, with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria
Outcome criteria
Concrete descriptions of patient goals
Implementation
Implementation is guided by the preceding phases of the nursing process.
Initiation and completion of specific nursing actions as defined by nursing diagnoses, goals, and outcome criteria
Independent, collaborative, dependent
Statements of interventions include frequency, specific instructions, and any other pertinent information.
List the 10 rights of medication
MEDICATION/ DRUG
PT
DOSE
TIME
ROUTE
DOCUMENTATION
REASON
REFUSE
EVALUATION/ ASSESSMENT
PT EDUCATION
Time-Critical Scheduled Medications
Facility-defined medications:
Administer at exact time when necessary (e.g., rapid-acting insulin), otherwise within 30 minutes before or after scheduled time.
Early or delayed administration of maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm
Non–Time Critical Scheduled Medications
Daily, weekly, monthly medications: Administer within 2 hours before or after scheduled time.
Medications prescribed more frequently than daily but no greater than q4h: Administer within 1 hour before or after scheduled time.
Early or delayed administration within a specified range of either 1 or 2 hours should not cause harm
Medication Errors
Defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care provider, patient, or consumer”
INCIDENT REPORT
Evaluation
Systematic, ongoing, and dynamic part of the nursing process
Determining the status of the goals and outcomes of care
Monitoring the patient’s response to drug therapy
Therapeutic, expected, and toxic responses
Clear, concise documentation
THE PATIENT REPORTED THAT HIS MEDICATION AT 2100 WAS MISSED
WHAT WOULD YOU DO?
Check MAR
PT taking antiepileptic medications and has NPO orders. What would you do?
Call the Doctor to clarify instructions
PT is requesting pain medications. What would you do first?
First assess pt’s pain and pain level
Drug
Any chemical that affects the physiological processes of a living organism
Pharmacology
Broadest term for the study or science of drugs
Chemical name
Describes the drug’s chemical composition and molecular structure
Generic name
(nonproprietary, official name)
Name given to a drug approved by Health Canada
Trade name
(proprietary name)
The drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer).
Drug classification
3 ways to classify drugs?
Drugs are grouped together based on:
their similar properties
their structure
their therapeutic use
Example of names
Chemical: propionic acid
Generic: ibuprofen
Trade: Advil
Pharmacological Principles
Pharmaceutics
Pharmacokinetics
Pharmacodynamics
Pharmacogenomics (pharmacogenetics)
Pharmacotherapeutics
Pharmacognosy
Pharmacoeconomics
Toxicology
Pharmaceutics
The study of how various drug forms influence the way in which the drug affects the body
Optimal design
how the drug influence the body
Dissolution-dissolving of solid dosage forms and their absorption
Enteric coating
Thin filmed drugs (quick dissolve in buccal tissue)
Combining drugs
Time-release technology
Enteric coated
coats the drug- so that it dissolves in the intestines to protect stomach acid
Fastest form of oral drugs
liquid
slowest form of oral drugs
enteric
Enteric coated
DO NOT CRUSH/ will dissolve in stomach and disrupt the acid (so call pharmacy to send a liquid form of the drug)
Pharmacokinetics DEFINE
The study of what the body does to the drug
From the time drug is put into the body until the parent drug and metabolites have left the body
4 steps Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Remember: “A D M E” sounds like “add me”
Pharmacokinetics: Absorption
Includes (3)?
Bioavailability, first-pass effect, routes
Bioavailability
The extent of drug absorption
extent a drug becomes completely available to its destination/ enter circulation
First-pass effect
Reduces bioavailability to <100% (inactive metabolites)
Occurs in liver
Types of routes
Enteral route- GI tract
Sublingual and buccal routes
Parenteral route
Topical route
Transdermal route
Inhalation route
Types of parenteral routes (7)
intradermally,
subcutaneously,
intravenously,
intramuscularly,
intrathecally (spinal cord)
intra-articularly( joint),
intra-arterially
Define enteral route
4 routes
The drug is absorbed into the systemic circulation through the mucosa of the stomach, small intestine, or large intestine
Oral
Sublingual
Buccal
Rectal (can also be topical)
What 4 ROUTES bypass the first pass effect at the liver?
Sublingual and buccal
Parenteral
Topical route (except rectum)
Parenteral route (7)
Intravenous (fastest delivery into the blood circulation)
Intramuscular
Subcutaneous
Intradermal- mantu test
Intra-arterial
Intrathecal- spinal cord
Intra-articular- joint
Which type of topical route has a first effect?
Rectum because it is part of the GI tract
Types of topical route?
Skin (including transdermal patches)
Eyes
Ears
Nose
Lungs (inhalation)
Rectum- HAS FIRST PASS EFFECT (part of GI tract)
Vagina
Pharmacokinetics: Distribution
Transport of a drug by the bloodstream to the drug’s site of action
4 places of extensive blood supply:
Heart
Liver
Kidneys
Brain
MAIN SITE OF METABOLISM
Liver
Distribution:
Albumin?
The most common blood protein and carries the majority of protein-bound drug molecules.
If a given drug binds to albumin, it is?
Inactive
Active
drug that is not bound
The unbound portion of a drug is called?
and considered?
Active
is considered a “free” drug
Low albumin levels can contribute to?
drug toxicity because less drug will be inactive
inactive drugs: drug binds to albumin
What causes drug-drug interaction?
Competition between drugs for binding sites, with albumin
A possible solution for drugs competing for binding sites and causing drug-to-drug interactions?
Is to change administration times between these drugs.
Pharmacokinetics:
Metabolism is also referred to as?
Also referred to as biotransformation
Biochemical alteration of a drug
Metabolism is a biochemical alteration of a drug into (4)
An inactive metabolite,
A more soluble compound,
A more potent metabolite (as in the conversion of an inactive prodrug to its active form),
Or a less active metabolite
What is the most responsible for metabolism?
Other organs? 5
The liver
Others: skeletal muscle, kidneys, lungs, plasma, intestinal mucosa
Cytochrome P-450 enzymes
(Or simply P-450 enzymes), also known as microsomal enzymes
Lipophilic
(“fat loving”)
enzymes work mostly on these
Hydrophilic
(water-loving)
easier to metabolize
Substrates
targeted drugs for specific enzymes
Enzyme inhibitors
decrease or delay metabolism
Enzyme inducers
stimulate metabolism
Liver/ kidney disease can lead to
toxicity
Pharmacokinetics:
Excretion
Elimination of drugs from the body
Liver and bowel also play a role
Renal excretion – affected by kidney disease
Biliary excretion – affected by liver disease/ bowel disease
Primary organ of excretion?
Primary organ responsible is kidney
What other 2 organs play a role in excretion
Liver and bowel also play a role
What does kidney disease affect?
renal excretion
what does liver and bowel disease affect
biliary excretion
Pharmacokinetics
Half-life
Time required for half (50%) of a given drug to be removed from the body during elimination phase
The length of time required for the concentration of a particular substance (typically a drug) to decrease to half of its starting dose in the body.
Pharmacokinetics:
Steady state
define
how many half lives
Amount of drug removed via elimination = (equals) amount absorbed with each dose
Takes about 4-5 half lives of drug administration
Steady state means consistent blood levels and correlates with maximum therapeutic benefits
Onset of action
when it starts to have an effect
Peak effect
maximal therapeutic effect
Duration of action
how long it is effective
The length of time until the onset and peak of action and the duration of action play an important part in determining the
peak level and trough level of a drug
What happens if the peak blood is too high?
drug toxicity
Peak level
highest blood level of a drug
highest concentration of a drug in the blood
highest level of drug in the blood
Trough level
lowest blood level of a drug
the lowest concentration of a drug in the blood
Toxicity occurs if the
Peak blood level of the drug is too high
What is used to monitor peak/trough, adequate therapeutic effects, minimize drug toxicity
Therapeutic drug monitoring
Onset
When the drug elicits response
Peak
Max response
Duration
How long it is effective
Pharmacodynamics
(2)
The study of what the drug does to the body
The mechanism of drug actions in living tissues (how does it work)
Therapeutic effect
A positive effect on faulty physiology.
The goal of drug therapy.
Mechanism of action
Modified cell or tissue function
3 types of mechanism of action
Receptor interactions
Enzyme interactions
Nonselective interactions
Receptor interactions
drug and receptor binding
Enzyme interaction
drug and enzyme binding
Nonselective interactions
disrupt cell processes in various ways
disrupt cell membranes; some antibiotics
Organ used by the first pass effect
Liver
Difference between PO and IV dose as influenced by 1st pass effect?
PO dose will be always higher than IV dose due to the 1st pass effect