Week 2 Flashcards
The nursing process
ADPIE
- assessment
- diagnosis
- planning
- implementation
- evaluation
Ten Rights to Medication Administration
- Right Dose
- Right Route
- Right Time
- Right Individual
- Right Medications
- Right patient education
- Right “cure”/concept
- Right assessment
- Right refusal
- Right documentation
3 P’s of Medication administration
- Pick
- Pour
- Put away
Chemical name
Describes the drugs chemical composition and molecular structure
Generic Name (nonproprietary, official name)
Name given to a drug approved by health Canada
Brand/ Trade name
The drug has a registered trademark, use of the name is restricted by the drug’s patent owner (usually the manufacture)
Common nursing diagnoses related to pharmacology
- knowledge deficiency
- risk of injury
- non adherence
- various disturbances
- other concerns related to medications
Pharmaceutics
The science of preparing and dispensing drugs, including dosage and design
What is a drug
Anything that affects a living organism
DRUGS ONLY LEVERAGE EXISTING PHYSIOLOGY
Pharmacokinetics
How the body alters the drug
- Absorption
- Distribution
- metabolism
- excretion
Pharmacokinetics - absorption
- the movement of the drugs from the site of administration to circulation for distribution
- bioavailability = extent of absorption
First pass route
Oral route (drug is typically absorbed by the stomach, small or large intestine)
Non first pass routes (fully avoid or partially)
- sublingual and buccal routes
- rectal route
- parenteral routes
- topical routes
Enteral Route
The drug is absorbed into the systemic circulation through the oral mucosa or mucosa of the stomach, small intestine or large intestine
- oral (PO)
- sublingual (SL)
- buccal
- rectal (PR)
Parenteral routes
- intravenous (IV) (fastest due to direct delivery into the blood circulation)
- intramuscular (IM)
- subcutaneous (SC)
- intradermal (ID)
- intrathecal
- intra-articular
- intraosseous (IO)
- epidural
Topical Routes
- skin (including transdermal patches)
- eyes
- ears
- nose
- lungs (inhalation)
- vagina
Pharmacokinetics - distribution
Transport of a drug by the bloodstream to the drug’s site of action
Factors that affect this:
- blood volume
- blood flow
- transport proteins
- body mass composition
Pharmacokinetics - metabolism
The biochemical alteration of a drug into either: an inactive metabolite, a more soluble compound, a more potent metabolite, or a less active metabolite
- the liver the most common site of metabolism
- the liver breaks down the drug into metabolites via cytochrome P450 enzymes
Pharmacokinetics - excretion
Elimination of drugs from the body
- the primary organs responsible are the kidneys (renal excretion) via glomerular filtration, active tubular reabsorption, and active tubular secretion. The liver and bowel can also play an important role in excretion
Drug route designs
-Tablets or capsules (enteral)
- injections (parenteral)
- patches or ointment (topical)
Dosage/delivery design
- Enteric-coated tablets
- combination drugs
- time release medications
Half life (pharm)
Time required for serum drug levels to be reduced by 50% during elimination
Onset (pharm)
The time required to get a therapeutic response
Peak (pharm)
Time required for maximal therapeutic response (highest blood Level)
Duration (pharm)
Length of time that the drug concentration is sufficient
Trough (pharm)
Lowest blood level of a drug by
Toxicity (pharm)
Occurs if the peak blood level of the drug is too high and causing toxic effects
Pharmacodynamics
How the drug alters the body
how drugs exert their actions
- receptor interactions
-enzyme interactions
- non selective actions
Pharmacotherapeutics
Factors influencing drug effects
- drug interactions; synergistic effect, antagonistic incompatibility
- tolerance and dependence
- teratogenic effect
Types of drug therapy
- acute
- maintenance
- supplemental
- palliative
- supportive
- prophylactic
- empirical
Homeostasis
State of equilibrium in the internal environment of the body, naturally maintained by adaptive response that promote health and survival
Water content of the body for infants
70-80%
Water content of the body for adults
50-60%
Water content of the body in older adults
45-55%
Cations: positively charged ions
- sodium Na+ (ECF)
- potassium K+. (ICF)
-calcium Ca+
Magnesium Mg+
Anions: negatively charged
-Bicarbonate HCO3-
-Chloride Cl-
-Phosphate PO4-
Diffusion
- Simple PASSIVE, requires no energy
- movement or SOLUTES from an area of high concentration to one of low concentration
- movement stops when the concentrations are equal in both areas (homeostasis)
Facilitated Diffusion
- involves the use of a protein carrier in the cell membrane
- requires no energy
Active transport
- a process requiring energy in which the molecules move against the concentration gradient
- e. Sodium potassium pumps
Osmosis
- the movement of fluid between two comparments separated by a semipermeable membrane that ALLOWS THE MOVEMENT OF FLUID but not solute
- water moves through the membrane from an area of low solute concentration to an area of high solute concentration
- requires no outside energy
- measurement osmolality
- osmotic movement of fluids
Hydrostatic pressure
- the force within a fluid compartment
- blood PUSHING against the capillary wall
Oncotic pressure (osmotic pressure)
- pressure extorted by colloids (large molecules in solution)
- PULING force
Albumin (protein)
- albumin = water magnet
- albumin is large, unable to pass through the capillary membrane
- more albumin more PULL of fluid into the vessel
Causes of Hypoalbuminemia
- anorexia
- malnutrition
- starvation
- cirrhosis
- fad dieting
- poorly balanced vegetarian diets
Clinical manifestations of Albumin
- Edelman (from decreased ontonic/osmotic pressure)
- delayed healing
- anorexia
- fatigue
- anemia and muscle loss (r/t breakdown of body tissue to meet the body’s need for protein)
Acute drug therapy
Short term
Maintenance drug therapy
Ex. High cholesterol medication
Supplemental drug therapy
Ex. Insulin for a diabetic
Palliative drug therapy
Ex. Highly focused on say prom management but can also have curitive effect
Supportive drug therapy
Ex. Vitamins
Prophalactic drug therapy
Ex. Vaccines
Empirical drug therapy
Ex. Strong suspicion of infection
Isotonic IV fluids
- theoretically, no net fluid shift between compartments
- lactated ringers (RL)
- 0.9% NaCl (normal saline)
- plasmalyte
Think: ISO-PERFECT
Hypotonic IV fluids
- more fluid than solutes
- water moved from ECF to ICF by osmosis
- 1/2 (0.45%) NaCl
Think HIPPOS SWELL CELLS
Hypertonic IV fluids
- more solutes than fluid
- initially expands and raises the osmolality of ECF
- 3% NaCl
Think: HYPERACTIVITY MAKES YOU SKINNY
Fluid Volume Deficit (Hypovolemia)
- abnormal loss of normal body fluids (diarrhea, fistula drainage, hemorrhage) inadequate intake
Treatment
- replace water and electrolytes with balanced IV solutions
Fluid Volume Excess (hypervolemia)
- excessive intake of fluids, abnormal retention of fluids (ex. Heart failure)
Treatment: remove fluid without changing electrolyte composition or osmolality of ECF
Electrolytes: Sodium (NA+)
- remember, water follows salt
- you mist consider fluid volume status when you consider sodium
Plays a major role in
- ECF volume and concentration
- generation and transmission of nerve impulses
NORMAL RANGE: 135-145 MMOL/L
Sensible loss
it makes sense, it is measurable, objective
- urine
- sweat
- stool
- wounds
Insensible loss
Hard to measure or control
- loss of humidity from the respiratory tract
Intracellular fluid (ICF)
Fluid within the cell
- makes up a large portion of out body
Extracellular fluids (ECF)
- intravascular fluid (plasma, liquid portion of blood)
- interstitial fluid (fluid surrounding cells)
Transcellular fluids
Fluid that is not changed very often
- spinal fluid
-
Mechanisms controlling fluid and electrolyte movement
- diffusion
- facilitated diffusion
- active transport
- osmosis
- hydrostatic pressure
- oncotic/ osmotic pressure
Hyponatremia
Causes
- sodium loss and/or water gain
- renal or GI loss of sodium
- syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- overuse of diuretics
Clinical manifestations
- confusion
-nausea
- vomiting
- seizures
- coma
Management
- fluid restriction
- fluids replacement with sodium containing solution
- is CNS manifestations, consider small amount of hypertonic saline solution (3% NaCl)
KIDNEYS REABSORB Na+ AND RETAIN H2O
Hypernatremia
Causes
- sodium gain and/or water loss
- decreased ADH (vasopressin)
- significant fluid loss (insensible/sensible)
- excessive sodium intake, hyperglycaemia
-inadequate renal excretion of sodium
Clinical Manifestations
- thirst
-agitation, restlessness
- seizures, coma
- impaired LOC
Management
- treat underlying cause
- consider diuretics
KIDNEYS EXCRETE EXCESS Na+ IN URINE
PRIMARY PROTECTION IS THE SENSATION OF THIRST FROM THE HYPOTHALAMUS
Electrolytes: Potassium K+
- major ICF cation
- Na/ K pump helps to maintain this tight range
- transmission and conduction of nerve and muscle impulses; resting membrane potential
- maintenance of cardiac rhythm
- storage of glucose in the liver and muscle
Excretion loss
- kidney
- stool
- sweat
Normal Range
- 3.5-5.0 MMOL/L
Sources of K+
- fruits and vegetables
- salt substitutes
- potassium supplements (PO, IV)
Hypokalemia: low serum potassium level
Causes
- renal or GI loss
- magnesium deficiency
- metabolic alkalosis
Manifestations
- cardiac arrhythmia
- skeletal muscle weakness
- respiratory muscle weakness
- muscle cramps
- decreased gastrointestinal mobility
- impaired regulation of arteriolar blood flow
Management
- K+ supplements orally or Iv (slow infusion)
Hyperkalemia: high serum potassium level
Causes
- impaired renal excretion of K+
- shift of K+ from ICF to ECF (ex. Crush injury, sepsis)
- excessive intake of K+
Manifestations
- cardiac
-MSK
- CNS
- GI
Management
- ECG monitoring
- Dialysis
- discontinue K+ intake
Increase elimination of K+ (diuretics, Kayexalate)
- increase fluid intake
- force K+ from ECF to ICF by IV insulin or sodium bicarbonate
- reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV
