Wk 1 Nursing Process, Basic and Legal Concepts Flashcards
The Nursing Process Steps
ADPIE
ASSESSMENT (only RN can do) DIAGNOSIS PLAN IMPLEMENTATION EVALUATION
THE NURSING PROCESS
ASSESSMENT?
ASSESSMENT
- HISTORY
- PHYSICAL
THE NURSING PROCESS
DIAGNOSIS?
DIAGNOSIS
- PRIMARY MEDICAL PROBLEM
- SECONDARY MEDICAL PROBLEM
- SOCIAL, PSYCHOLOGICAL, EDUCATIONAL, ENVIRONMENTAL, SAFETY, NUTRITIONAL PROBLEMS
THE NURSING PROCESS
PLAN?
PLAN
- THERAPEUTIC GOAL
- MEDICATION KNOWLEDGE
- SPECIAL NEEDS EQUIPMENT
- TEACHING NEEDS
THE NURSING PROCESS
IMPLEMENTATION?
nine rights
IMPLEMENTATION
- RIGHT DRUG (verify 3x)
- RIGHT DOSE
- RIGHT PATIENT (2 identifiers, DOB/Name)
- RIGHT ROUTE (Several, proper conc. depends on route)
- RIGHT TIME (best chance for absorption, least chance for side effects)
- RIGHT DOCUMENTATION
- RIGHT REASON
- RIGHT RESPONSE (monitor and record)
- RIGHT REFUSE (record why pt refused, notify provider, education to pt)
THE NURSING PROCESS
EVALUATE?
EVALUATE
- THERAPUTIC EFFECTS
- ADVERSE EFFECTS
- ALLERGIES
3 COMMON RESPONSE TO MEDS
Therapeutic/Desired Effect
Expected Side Effects/Side Effect
Adverse Effect
Drug Regulation: Levels of Authority
FEDERAL LAWS - GOVERNMENT
- SAFE AND EFFECTIVE MEDS
- CONTROLLED SUBSTANCE ACT (DEA) controlled how drugs are given
- USFDA approval for all new drugs
STATE LAWS AND REGULATIONS RULES - BOARD OF NURSING
- PRESCRIBE AND DISPENSE approves who can prescribe and administer
- NURSE PRACTICE ACTS for each state
INDIVIDUAL AGENCY/HOSPITAL RULES - WHERE YOU ARE PRACTICING
-AGENCY POLICIES AND PROCEDURES
3 CATEGORIZES OF DRUGS
Defined by the Federal Government
- CONTROLLED SUBSTANCES
- PRESCRIBED MEDICATIONS
- OVER THE COUNTER (OTC)
Controlled Substance Schedules-
5 Categories
MOST REGULATED
Schedule I
- High potential for abuse
- No accepted medical use in US.
- Heroin
Schedule II
- Hydromorphone (Dilaudid)
- Methylphenidate (Ritalin)
Schedule III
-Tylneol #3
Schedule IV
-Benzodiazepines, some diet drugs
Schedule V
- Low potential for abuse
- Cough preparations with small amounts of codeine
Controlled Substances in workplace
possession?
maintenance?
Possession of Controlled Substances -Administering med to pt -Replacing unit stocked to floor -The nurse get prescribed med Maintenance of Controlled Substances -locked -Counted every 8 hours -documentation
3 Possible Effect of Long Term Use
- TOLERANCE= drug related metabolism problem that causes the same amount of drug to have less effect over time then a higher dose is needed to have same effect.
- DEPENDENCE= at state in which the body shows withdrawal symptoms when the drug is stopped or a reversing agent is given. Changes in the body either physical or psychological.
- ADDICTION= psychological and physical dependence in which there is a desperate need to have and use a drug for a non medical reason. The addicted person has a limited ability to control the drug craving or use.
Types of Drug Orders (4)
-Standing
-Stat or Emergency
-Single
-As needed or “PRN” Ex. constipation or pain med
KNOW SAFE DOSAGE RANGES
High-Alert Drugs
high risk of harm when associated with a drug error
What does PINCH stand for?
P is for POTASSIUM AND OTHER ELECTROLYTES
I is for INSULIN
N is for NARCOTICS AND OTHER SEDATIVES
C is for CHEMOTHERAPEUTIC DRUGS
H is for HEPARIN AND OTHER ANTICOAGULANTS
What does Black Box Designation mean?
A special designation by the FDA that the drug is a higher-than-normal risk for causing serious and even life-threatening problems in addition to its positive benefits for some people
Types of Drug Names
Trade or Brand name
Generic name
Chemical
Trade Name or Brand Name (capitalized)
- Manufacturer’s name
- Tylenol
- if trade name with line through it no longer covered by trademark but is now generic
Generic Name (not capitalized)
- Used by all regardless of manufacturer
- acetaminophen
- hard to pronounce, prescribers don’t use often
- generic is most common in all countries
Chemical
- Chemical composition of med
- N-Acetyl-para-aminophenol (rarely used)
Types of Drug Responses
Chemical reactions that change physiologic activity of body (3)
Agonist- Drugs that work by activating or unlocking cell receptors causing the same actions as the body’s own chemicals (produce action similar to our body)
Antagonist- Drugs that attach at a drug receptor site but do not activate or unlock the receptor. Remains inactive. Ex Narcan, reverse drug OD
Partial Agonist- Drugs that attach to the receptor site but produce only partial effect rather than a full effect (Agonist)
What type of action occurs when the drug attaches to a site but produces only a small chemical response?
Partial Agonist- Drugs that attach to the receptor site but produce only partial effect rather than a full effect (Agonist)
What happens when an antagonist drug attaches to a receptor site?
Antagonist- Drugs that attach at a drug receptor site but do not activate or unlock the receptor
Pharmacokinetics
Pharmacon (drug, poison) + Kinetics (motion)
4 basic processes for drug utilization
Absorption- Drugs enter the body and pass into circulation to reach the part of the body it needs to affect through the processes of diffusion, osmosis, and filtration. Influences that effect absorption: solubility, route, blood flow.
Distribution- Movement of a drug in the body to reach it’s site of action by way of the blood and lymph system
Metabolism- once the drug is absorbed and distributed in the body the body transforms or alters the drug into active or inactive chemicals. Liver 1st pass= inactivates. Med is broken down and used in chemical reactions- Biotransformation
Excretion or Elimination (kidneys) - All inactive chemicals, and chemical bi-products and waste (often to referred to as metabolites) finally break down through metabolism and are removed from the body through of processes of excretion.
Half-Life- The time is takes the body to metabolize and excrete 50% of the drug from the body. Short 1/2 life= take drug more often. Long 1/2 life= may take med 1x/day
7 Common Responses to Meds
Desired/Therapeutic Effect Side Effect Adverse Effect or reaction Idiosyncratic Response Paradoxical Reaction Allergic (hypersensitivity) Response Anaphylactic Reaction
How do drug side effects differ from adverse effects?
Side effects- mild and annoying
Adverse effects- more severe
What is the term used to describe a drug reaction opposite to that expected?
Opposite reaction- a type of idiosyncratic response is called a paradoxical response
How does an allergic reaction differ from an anaphylactic reaction?
Allergic- hives, rash, itching
Anaphylactic- life threatening
Common Drug Interactions
Additive Effect
Antagonistic Effect
Displacement
Additive Effect = 2 drugs given together, work as a team.
ex: calcium w/ vit D
Antagonistic Effect = 1 drug interferes with the action of another ex: narcan
Displacement = One drug replaces another at the drug receptor site, decreasing the effect of the first drug
ex: displace effects of a sedative
Common Drug Interactions
Incompatibility
Interference
Synergistic Effect
Incompatibility = Drugs mixed together produces a chemical reaction. (do not mix well)
Interference = Second drug causes the rapid excretion of another decreasing the effect of the first one
Synergistic Effect = 2 drugs given together have a greater effect than if they were given separately. Example- Tylenol is given with codeine for added pain relief
Patient Variables: Affect on Drug Action
Body Weight Age Illness- liver/kidney problems Food, alcohol, drugs Pregnancy and breastfeeding- risk vs benefit Genetics Cumulative Effects- increased side effects Psychological Dependence
FDA Pregnancy Risk Categories A B C D X
A - No demonstrated risk to human fetus
B- No demonstrated risk to fetus in animals but data is lacking for humans
C- Teratogenic effects in animals; no data for humans
D- Evidence of human fetal risk but benefits may outweigh the risk for pregnant women
X- Demonstrated risk to fetus. The use of the product is contraindicated in pregnant women
Types of Drug orders
STANDING
Standing= indicates the drug is to be given until discontinued or for a certain amount of doses. Hospital or institutional policy usually dictates that most standing orders expire after a certain number of days. A renewal order must be written by a prescriber before the drug may be continued.
Types of Drug orders
EMERGENCY OR STAT
Emergency or STAT= one time order to be given immediately
Types of Drug orders
SINGLE
Single= a one time order, given at a specified time
Types of Drug orders
AS NEEDED OR PRN
As needed or PRN= is an order for a drug to be given as needed based on nurse’s judgement of safety and patients need
Define Absorption
Drugs enter the body and pass into circulation to reach the part of the body it needs to affect through the processes of diffusion, osmosis, and filtration.
Define Adverse effect/reaction
Severe symptoms or problems that can cause great harm
Define Agonist
Drugs that work by activiating or unlocking cell receptors causing the same actions as the body’s own chemicals.
Define allergy
An antigen-antibody response that can cause hives, rashes, itching, or swelling
Define Anaphylactic reaction
A serve life threatening form of an allergic reaction
Define antagonist
Drugs that attach at a drug receptor site but do not activate or unlock the receptor
Define Brand name
CAPITALIZED- The proprietary name that a manufacturer gives to a specific drug. AKA trade name
Define Desired action
The drug does what it supposed to do
Define Distribution
Movement of a drug in the body to reach it’s site of action by way of the blood and lymph system
Define First-pass effect
drugs move very quickly from the stomach or SI to the liver. drugs are inactivated in the liver before being distributed to other parts of the body.
that is why some drugs are given sublingual or IV or it would be inactive and pt. wouldn’t receive the amount of drug they require.
Define Idiosyncratic response
Responses to a drug that are peculiar and unpredicated
Define nephrotoxic
Adverse drug effects that can result in kidney damage
Define pharmacodynamics
The effects of a drug on a body function (what a drug does to the body)
Define pharmacokinetics
The metabolism of a drug within the body (what the body does to a drug)
Define pharmacotherapeurtics
The use of drugs in the treatment of disease
Define side effect
Mild but annoying responses to the drug. Nausea and headache are common and usual side effects to many drugs
Define generic name
NOT CAPITALIZED- The most common drug name used the manufacturer in all countries. AKA non proprietary name.
Define half life
The time is takes the body to metabolize and excrete 50% of the drug from the body
Define synergistic effect
The effect of two drugs taken at the same time is greater than the sum of the effects of each drug given alone
Define trade name
CAPITALIZED- The propriety name that a manufacturer gives a specific drug. AKA brand name.
Types of excretion and elimination FECES URINE BREATHING EVAPORATION OTHER
Feces- fibrous or insoluble waste usually passed through GI tract as feces.
Urine- chemicals that may be made of water-soluble are dissolved and filtered out as they pass through kidney and are lost in urine
Breathing- some chemicals are exhaled from the lungs through breathing
Evaporation- lost through evaporation through the skin during sweating
Other- very small amounts of drug escape in tears, saliva, tears and breast milk
Common Responses to Meds
DESIRED/ THERAPEUTIC EFFECT
The expected response of a drug and the therapeutic goals is reached. IE- fentanyl patch relieves pain.
Common Responses to Meds
SIDE EFFECTS
Mild but annoying responses to the drug. Nausea and headache are common and usual side effects to many drugs. May not nec. change the med (stomach pain due to ASA)
Common Responses to Meds
ADVERSE EFFECT OR REACTION
Severe symptoms or problems that can cause great harm. Ex GI bleed from ASA. May develop SS. Let provider know, may change or stop med.
Common Responses to Meds
IDIOSYNCRATIC RESPONSE
Responses to a drug that are peculiar and unpredictable. IE- genetic or hormonal variation of that individual.
Common Responses to Meds
PARADOXICAL REACTION
patients reaction may be just the opposite reaction than what is expected. IE- benadryl is a sedation but will cause excitement and awareness.
Common Responses to Meds
ALLERGIC (HYPERSENSITIVITY) RESPONSE
An antigen-antibody response that can cause hives, rashes, itching, or swelling
Common Responses to Meds
ANAPHYLACTICE REACTION
A serve life threatening form of an allergic reaction. IE- swelling of lips, tongue, throat or trachea. Most common in pediatrics and geriatrics
Categories of drugs (Defined by Fed gov)
Controlled Substances
Drugs that are highly regulated because they are commonly abused. AKA “scheduled drugs” Narotics, opiods, sedatives or tranquilizers (can move from 1 class to another Ex. opiods)
Categories of drugs (Defined by Fed gov)
Prescription Medications
Category of drugs regulated by federal legislation because they are dangerous and their use must be controlled; may be purchased only when prescribed. antibiotics etc.
Medicare controls price to be charged
Categories of drugs (Defined by Fed gov)
Over the counter
Category of drugs identified by federal legislation as having low risk to patient and may be purchased without a prescription. Ex tylenol. Herbal meds- not tested for safety and effectiveness and can interact with meds
