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.
