Transcript 2-1 Prescription (Legend) Drugs

Nursing Consideration in Pharmacology
Legal, Ethical, and Cultural
Mosby items and derived items © 2006 by Mosby, Inc.
Slide 1
Unlabeled Use of Drugs
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HCPs may give drugs for an indication other
than what was approved by the FDA. While
drug is in approval process, the HCPs may
give it anyway.
These decisions are based on successful
clinical trials published in professional
journals and have been “blessed” by the
physician’s professional organization.
Technically could be sued and prosecuted if
something went wrong.
Copyright © 2006, 2001 by Mosby, Inc.
Slide 2
Legal Issues for Nurses
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Medication order must be valid/safe
Prescriber and nurse must be licensed
Nurses cannot dispense—only pharmacists
Nurse must know purpose, actions, effects,
and major side effects and toxic effects of
drug and the teaching required to enable
client or caregiver to safely and accurately
self-administer drug
Nurses must keep up with continuing
education R/T meds and skills
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Slide 3
Legal Responsibilities of Nurses
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Monitor for SEs and report them
Correctly calculate drug dosages
Never pre-pour, pre-chart, give others meds, or falsify
Question prescriber if necessary
Follow policies regarding verbal and phone orders
Be familiar with practice guidelines by NCBON,
federal regulations, and employer
Abide by drug control laws—inside/outside of work
Be responsible for those people you supervise
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Slide 4
Follow Standards of Care
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Institute of Safe Medicine Practices
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Joint Commission on Accreditation of Health
Care Organizations
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National Patient Safety Goals
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Slide 5
Legal : Interdisciplinary
Communication
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Prescriber
Pharmacist
Nurse to nurse
Student to nurse
Chain of command
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For nurse
For student
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Slide 6
Legal : Documentation
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Verbal MD orders
MAR
Narcotics
Nurse’s notes
Admission hx
D/C instructions
Variance reports
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Slide 7
Document Defensively
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Record promptly—especially prns, stats, onetimes
Record effectiveness of prns
Record refusals and reason and reporting of
the refusal
Record adverse responses and the reporting
of them
Record fluid intake taken if pt is on I&O
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Slide 8
Ethical Guidelines
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Do no harm (nonmaleficence)
Do good (beneficence)
Let patients decide for themselves after
giving full information (autonomy)
Be truthful (veracity)
Treat all the same (justice)
Be faithful to practice and patients (fidelity)
Possess integrity and accountability
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Slide 9
Legal/Ethical Considerations in the
Drug Approval Process
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Informed consent for clinical trials—subject
must be competent, consent must be
voluntary, without coercion, and be fully
informed of procedure, benefits, risks. Must
be written in subject’s language, signed,
dated and witnessed.
History of informed consent :
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Nuremburg Code of 1947
Declaration of Helsinki of 1964
FDA Modernization Act of 1997
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Slide 10
Legal/Ethical Considerations
for Nurses
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Fine line sometimes between violating own principles
and providing nonjudgmental nursing care.
Forcing meds—only children and legally certified
mentally incompetent. Forcing on competent adults
is assault and battery.
Use of placebos
Chemical restraints
Threatening to withhold medications to get patient to
comply with other things
Unlabeled use of drugs
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Slide 11
Cultural Considerations
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Ethnopharmacology—Broad field of study
which involves looking at the genetic
influence on pharmacokinetics and drug
response that may occur from inherited
metabolic defects or deficiencies.
May be used to customize drug therapy for
each ethnic group.
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Slide 12
Common Drug Groups With Unique
Pharmacogenetic Responses
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Analgesics—narcotic and non-narcotic
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Cardiovascular medications
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Central nervous system agents—
sedative/hypnotics, anxiolytics,
antidepressants, ETOH, tranquilizers
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Slide 13
Examples of Genetic Differences
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African Americans—ACEIs and B-blockers
may be less effective in lowering blood
pressure
Chinese—poor metabolizers of Codeine;
more sensitive to antidepressants and
tranquilizers
Hispanics—more sensitive to antidepressants
Native Americans—less tolerant to ETOH
Caucasians—more sensitive to tranquilizers
and more SEs to ETOH
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Slide 14
Cultural Influences on
Medication Therapy
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Biocultural response to meds
Nutrition and dietary habits
Religious beliefs
Sick role
Pain responses
Attitudes about illness & treatment
Attitude toward HCPs
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Slide 15
Cultural Influences cont’d
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Cultural diversity affects compliance
Most cultures self-treat or seek alternative
methods before seeking Western medicine so
ask what person has tried before
To gain some insight, ask, “How do you keep
well?”, “What do you believe made you
sick?”, or “Do you have any concerns about
medication that could affect your care while in
the hospital?”
Copyright © 2006, 2001 by Mosby, Inc.
Slide 16
Specific Cultures: Hispanics
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Origins in Cuba, Mexico, Puerto Rico, Central
and South America, and Spain
Sense of fatalism and that health is good
luck, reward, or blessing
Strong belief in prayer, magic, hot and cold
balance, and wearing religious objects
Folk healer is called “curandero” who
practices cleansing and healing rituals,
prescribes herbal teas based on dreams,
prescribes hot and cold therapy, and
performs massage
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Slide 17
Hispanics cont’d
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Believe causes of illness include:
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Imbalance in four aspects of body—blood,
phlegm, yellow bile, and black bile
Supernatural forces—malevolent spirits, bad luck,
witchcraft, ”mal ojo”
Strong emotional states—”susto”, embarrassment,
envy, anger, fear, excessive worry
Family turmoil, immoral or unethical behavior
Bad air, bad food, germs, getting too hot or cold,
poverty
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Slide 18
Asian Americans and Pacific Islanders
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Origins include China, Japan, Korea,
Vietnam, Hawaii, Phillipines
See body as gift from ancestors and must
take care of it—illness prevention is a major
focus
Believe in balance which is maintained by the
supernatural forces of Yin and Yang
Traditional methods of Chinese healing:
holistic medicine, acupuncture, moxibustion,
meditation, and herbal remedies
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Slide 19
Asians cont’d
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Believe illness and disasters are caused by
imbalance of Yin and Yang.
Yin is female and negative and represents
darkness, coldness and emptiness. Also
represents solid organs and forces inside
body
Yang is male and + and represents light,
warmth, and fullness. Represents the hollow
organs and forces outside body
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Slide 20
Asians cont’d
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Dx is by appearance, history, smell of person,
appearance of tongue, and palpation of
superficial and deep pulses.
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Balance must be restored with herbs, and
accupuncture or moxibustion along yin and
yang points (meridians).
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Slide 21
Native Americans
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Illness is imbalance between body and universe
because of ill spirits, not following traditional beliefs, or
a disruption in nature. Need to trace back cause of
illness to an action or lack of action by client, which may
be known or unknown.
Recovery is based on diagnosing problem and
reestablishing harmony or balance with nature
Prevention is practiced thru wearing charms, dancing
rituals, sweat bath purification, and protection from
temperature extremes.
Each tribe (more than 200) has specific ideas and
practices related to health and illness
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Slide 22
Native Americans cont’d
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Medicine man decides tx after conferring with
family
Dx is made by using divination with chanting
rituals, medicinal herbs, or stargazing and
asking star spirit for guidance. Color of star
determines dx and px
Tx includes rituals, heat, exercise, massage,
dietary changes, and herbs. Herbs are colorcoded and odors and shapes are important.
Plants exposed to eastern sunlight are best.
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Slide 23
African Americans
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Origins in Africa and West Indies
Health means that body, mind, and spirit are
in harmony
Illness is disharmony, either from natural
causes or divine punishment, or as a result of
the activity of demons and evil spirits
Survival is to restore harmony and balance by
removing evil spirits
Healing is considered a divine gift
Western medicine sometimes perceived as
degrading, humiliating, and racist
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Slide 24
African Americans cont’d
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Healer or “root man” can prescribe a regimen
of herbs or rituals and practices to be done by
sick person. Should be done before seeing a
physician
Healer must be stronger than person who
sent the “hex”
Home remedies include herbs, prayer, laying
on of hands, wearing charms or amulets that
protect against evil spirits, herbal teas, hot
baths, and hot compresses.
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Slide 25
European Americans and
Caucasians
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Most ascribe to biomedical theory.
1st self tx by home remedies or OTC meds then MD
Religious rituals or ceremonies may be carried out in
addition to Western medicine, such as Hail Marys,
rosaries, laying on of hands, prayer, wearing crosses
or other symbols, or use of herbs
Examples of home remedies include salt water
gargles, honey and whiskey for coughs, Vicks for
congestion, chicken soup, baking soda, wet tobacco
for stings, raw potatoes for warts, and alcohol,
mercurochrome, or merthiolate for cuts.
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Slide 26
CAM Therapy
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Complementary medicine is used together
with conventional medicine
Alternative medicine is used in place of
conventional medicine
CAM is abbreviation for complementaryalternative medicine
A wide variety of herbs, flowers, leaves, teas,
poultices, powders, prayers, chants,
procedures, and even animal parts are used
by different cultures to treat “illness.”
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Slide 27
Commonly Used Herbs
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Aloe: burns
Black Cohosh, Dong quai: menopause
Chamomile, peppermint, ginger: GI problems
Cranberry: UTI
Echinacea and Goldenseal: immunity
Garlic: hypercholesteremia
Ginkgo: memory enhancement, circulation
Ginseng: energy
Copyright © 2006, 2001 by Mosby, Inc.
Slide 28
Commonly Used Herbs cont’d
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Glucosamine / chondroitin: osteoarthritis
Green tea: antioxidant
Feverfew: migraines
Hawthorn: HTN
Milk thistle—liver and GB problems
Saw palmetto: prostate health
St. John’s Wort: depression
Valerian and Kava: insomnia
Copyright © 2006, 2001 by Mosby, Inc.
Slide 29
Client Education
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Efficacy from one dose to another cannot be
guaranteed.
Many interfere with blood clotting and insulin
activity.
Should not be used by pregnant or
breastfeeding or on children w/o MD advice.
Lifestyle changes may be equally effective as
“a pill can fix everything” mentality
Copyright © 2006, 2001 by Mosby, Inc.
Slide 30
Education cont’d
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Use single-agent products for better
evaluation.
Read package labels and warnings
Takes longer to work
Treat herbs like other meds—do not exceed
recommended dosage
Don’t stop regular med w/o MD advice
Keep in original container and store in cool,
dry, dark place
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Slide 31