Wk 1 TLO Nursing process Flashcards
Explain how the nursing process is used in Pharmacology
ADPIE. See page 2 in book
Describe the nursing process as it relates to teaching and safely giving meds
Implementation= 9 rights
Medication knowledge
Nurses give medications under 3 levels of authority; give an example of each level (federal, state, agency).
Federal- Safe & effective
Controlled Substance Act (DEA) US FDA
State- Prescribe & dispense
Nurse Practice Acts
Agency- Agency policies/procedures
Identify the 3 categories of meds in the US according to Federal Legislation. Explain how controlled prescription meds and OTC meds differ.
Controlled Substances-
Prescription Medications-
Over-the-counter (OTC)-
Define:
a. Physical Dependence
b. Psychological Dependence
c. Tolerance
a. Physical Dependence - the actual physical symptoms that occur with drug withdrawal. ex. shaking, increased hr, pain, confusion, seizure
b. Psychological Dependence - feeling of anxiety, stress or tension when a patient does not have medication
c. Tolerance- drug related metabolism problem that causes same amount of drug to have less effect over time. Higher dose is needed to have same effect
Identify the 5 med schedules or classifications of controlled substances (United States) and give an example of a med in each category. Identify which schedule has the highest potential for abuse
I- High potential for abuse
No accepted medical use in US.
Heroin
II- Hydromorphone (Dilaudid)
Methylphenidate (Ritalin)
III- Tylneol #3
IV- Benzodiazepines, some diet drugs
V- Low potential for abuse
Cough preparations with small amounts of codeine.
Discuss the process how controlled substances are accounted for on a hospital unit.
Locked in pyxis, sign off by another nurse, 2 nurse witness narcotic waste, counted ever time med is removed
List what you would do if you make a med error.
Go straight to manager or team leader
Compare the difference between generic meds and brand (trade) names meds. Describe how the nurse can recognize a trade name med. Give an example of both names for 1 med.
generic meds- Not capitalized. acetaminophen
brand (trade) names meds- Capitalized. Tylenol
Explain the following ways meds respond at receptor sites:
a. Agonist
b. Antagonist
a. Agonist - drug fits receptor site, strong response
b. Antagonist - drug fits receptor site, remain inactive
Describe the following basic med processes:
a. Absorption
i. Discuss what factors increase or decrease the speed of absorption.
b. Distribution
c. Metabolism
d. Excretion – including half life
a. Absorption- i. Discuss what factors increase or decrease the speed of absorption. - solubility, route, blood flow. Diffusion, osmosis, filtration
b. Distribution - blood/lymph, movement of drug in body
c. Metabolism - liver, 1st pass= inactivates. med is broken down and used in chemical reactions, Biotransformation
d. Excretion – Kidneys- ways in which chemicals and chemical by-products are removed
e. Half-life- time to metabolize and excrete 50% of drug. Shorter 1/2 life= take drug more often
Longer 1/2 life= may take med 1x/day
Identify in what organ meds are primarily metabolized
Primarily metabolized in the liver
Identify what organs excrete meds from the body.
Excreted- kidneys
List 6 patient variables that may affect med action and dose of med needed
Body weight Age Genetics Illness- liver/kidney problem Psychological Dependence Cumulative effect- increased side effect
Discuss why infants and the elderly require different doses of a med
Infants - Body weight, high metabolism, small muscle mass, high body water, no GI acid, liver is immature (increased risk of OD/toxic), immature kidneys
Elderly - polypharmacology, slower metabolism, chronic conditions, kidney failure, adverse drug response, sedatives, diuretics/dehydration, electrolyte levels, reduction of GI acids, decline body water and lean body mass, reduction of liver function, lower excreting rate.
Describe each of the nine rights of administration as essential components of safe med administration.
RIGHT.... patient time route dosage med documentation reason reaction refuse
Describe the legal, regulatory, and ethical responsibilities of a nurse for med administration.
Legal-
Regulatory-
Ethical-
Route from fastest to slowest
IV/inhalation intramuscular Subcut syrups, elixirs, liquids suspension powders capsules tablets coated tables enter-coated tablets timed-release capsules
Define
Diffusion
Osmosis
Filtration
Diffusion- substances (gas, liquid or solid) move from region of high concentration to low concentration
Osmosis- flow is primarily from the thicker or more concentrated solution to the thinner or less concentrated
Filtration - substance through a filter or through a material that prevents passage of certain molecules
Explain special consideration for the pregnant and lactating woman relative to taking medication
Risk vs benefits, teratogenic potential ie: cause malformation or damage to the embryo or fetus, age of fetus, organ dev 14-56 days major abnormalities, 57-term growth/mental dev, minor structure changes. Immature BBB/liver. Nicotine, pot, cocaine, heroin, angel dust, illicit drugs pass through milk. Watch baby for sleepiness or restlessness.
Describe how the sympathetic and parasympathetic nervous system affects the respiratory system
Sympathetic - fight or flight
Dilates bronchi
Decreases secretions
Parasympathetic - calming and conserving
Constricts bronchi
Increases secretions
Describe the legal, regulatory and ethical responsibilities of a nurse for med administration
Legal- drug diversion (suspect/report)
Regulatory- fed/state/agency or regulations/policy
Ethical- drug diversion (suspect/report)
Describe high alert meds and errors associated with them
too high/low/no dose, packaged/stored/administered differently. “PINCH”
Define black box warning
drug has higher than normal risk for causing serious or life threatening problems in addition to its positive benefits for patients
