Transcript Introduction to pharmacology

INTRODUCTION TO PHARMACOLOGY
OVERVIEW OF COURSE SCHEDULE
•
•
Lectures
•
September 5
•
September 26
•
October 17
•
November 7
•
November 21
•
December 5 (No lecture)
Quizzes and Assignments (refer to syllabus and Quia)
•
Given every lecture
• It is not as bad as it looks…
•
•
Assignments due at beginning of every class
Exams
•
October 17 – Midterm
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December 5 – Comprehensive Final
PHARMACOLOGY
• What is it?
• Nursing Responsibility
• Horror Story: Overdose on Chemotherapy Drug…
• Always THINK!
• i.e. ibuprofen or acetaminophen to a cancer patient?
• i.e. furosemide to a hypokalemic patient?
• When in doubt, look it up
• NEVER assume or take someone else’s word
DRUG NAMES
• chemical name
• generic Name
• Used in all countries by all manufacturers
• oFFICial Name
• Used in the US Pharmacopeia National Formulary
• Trade Name
• Note how medication names are written.
• FYI
• Chemical Diagram of furosemide
• Seen in medication inserts
•
FYI
• Names on the medication bottle
MEDICATION DEVELOPMENT
Pre FDA Phase
• Research
• In – Vitro
Testing
(artificial
environment)
• Animal Testing
FDA Involvement
• Investigational
New Drug
Status
Clinical Testing
• Phase 1 :
• Volunteers
• Phase 2:
• Patients
• Phase 3
• Medical
Research
Centers
MEDICATION DEVELOPMENT
FDA
Involvement
• IND after
phases
• Advisory
Panel
FDA Approval
or Disapproval
• If approved,
continued
surveillance
Post marketing
Surveillance
• Continued
with
MedWatch,
ISMP or
MERP
• Exclusive
Marketing
Rights
ADDITIONAL FDA PROGRAMS
• Orphan Program
• Assists in development of specialty medications
• Rare Disorders
• i.e. Tourette’s, Ovarian Cancer
• Significantly decreased profit margin
• Pharmaceutical Companies receive assistance
• Accelerated Programs
• Decrease approval times
• Public Threat
• i.e. HIV / Aids
• Rare Cancer Diagnosis
• Waiting for final approval not necessary
WHY ARE THERE SO MANY LAWSUITS?
•
FYI
• Why can people sue pharmaceutical companies that label the warnings?
• i.e. The Pending Class Action Suit against Bayer for YAZ
• Levine v. Wyeth
• 2009
• Phenergan
• US Supreme Court Ruling
• Federal vs. State Laws
• Tort Suits
• Medical Device Amendments of 1976
• Reigle v. Medtronic
• 2008
PHARMACOKINETIC PHASE
• Absorption
• Gastrointestinal Tract
• Moves into body fluids
• Influencing Factors
• Route
• Solubility
PHARMACOKINETIC PHASE
•
First – Pass Effect
Drug absorbed
by small
intestine
Liver
Metabolizes
Remaining
drug is not
sufficient for
therapeutic
effect
PHARMACOKINETIC PHASE
• Distribution
• Systematic Circulation
• Distributed to various body tissues
• Target Sites
• Specific receptors in body
PHARMACOKINETIC PHASE
• Influencing Factors
• Protein Binding
• Blood Flow
• Solubility
• Lipid Soluble
• Water Soluble
PHARMACOKINETIC PHASE
• Quick Distribution
• Areas of large supply
• Heart
• Liver
• Kidneys
• Slow Distribution
• Skin
• Muscle
PHARMACOKINETIC PHASE
• Metabolism and Excretion
• Metabolism
• Body changes drug to a more/less active form for excretion
• Excretion
• Elimination of drug from body
• Special Considerations
• Renal disease
• Dosage reduction and monitoring required
• Geriatrics
• Diminished renal function
PHARMACOKINETIC PHASE
•
Half – life
• Time required to eliminate 50% of medication
• Inversely proportionate with frequency of administration
Half Life
Frequency of
Administration
Half Life
Frequency of
Administration
PHARMACOKINETIC PHASE
•
Half – Life (cont.)
• Difficulty with excretion
• Increase in half life
• Increase risk of toxicity
PHARMACOKINETIC PHASE
•
Onset, Peak and Duration
• Onset
• Time between administration and therapeutic effect
• Peak
• Absorption Rate = Elimination Rate
• Duration
• Amount of time for therapeutic effect
PHARMACODYNAMICS PHASE
• Pharmacodynamics
• Study of drug mechanisms and changes in the body
• Primary Effect
• Desired
• Secondary Effect
• Desired or undesirable
• Drugs exert action with two mechanisms
• Alteration in cellular form
• Alteration in cellular environment
ALTERATION IN CELLULAR
ENVIRONMENT
• Physical Changes
• Osmotic Pressures
• Lubrication
• Absorption
• Conditions to surface of cell membrane
• Examples
• Mannitol
• Sunscreen
• Activated Charcoal
• Docusate
ALTERATION IN CELLULAR
ENVIRONMENT
• Chemical Changes
• Inactivation of cellular functions
• Alterations in chemical components of body fluid
• pH level changes
• Examples
• Antacids
• Antibiotics
• Antineoplastics (anti-cancer)
RECEPTOR – MEDIATED DRUG ACTION
• Interaction with receptor
• Cell function alters
• Drug molecule joins with receptor on cell surface
• Agonist
• Binds and stimulates receptor
• Antagonist
• Binds, but does not stimulate receptor
• Prevents drug response
• Competitive and noncompetitive
MEDICATION USE AND PREGNANCY
•
Administered during the first trimester
• Teratogenic Effects
•
Most drugs
• Contraindicated
• Benefits vs. risk
•
Nursing Education for patients
• Medications and herbal supplements only AFTER consultation with MD/NP
• Risks of smoking and ETOH use
• LBW
• Premature Birth
• FAS
• Addictive Drugs
• Newborn addiction / withdrawal
DRUG REACTIONS
•
Allergic Reaction
• AKA Hypersensitivity
• Usually after more than one dose
• Body views drug as antigen
• S/S
• Itching
• Rash
• Hives
• Swelling
DRUG REACTIONS
•
Anaphylaxis
• Life Threatening
• Respiratory Compromise
• Hypotension
• Angioedema
• Anaphylactic Shock
• Nursing Interventions
• IV
• Epinephrine
• Solumedrol
• Antihistamines (FYI – Ranitidine IV (H2 Histamine Blocker)
• Respiratory Support
• Beta-agonist (i.e. Albuterol)
• Intubation
DRUG REACTIONS
•
Drug Idiosyncrasy
• Unusual and abnormal reaction
• Caused by genetic Deficiency
•
Drug Tolerance
• Decreased response
• Increased dosages needed
• i.e. Narcotics
DRUG REACTIONS
• Cumulative Drug Effect
• Unable to metabolize and excrete medication prior to next dose
• i.e. Liver and Renal Disease
• Decrease dose to prevent toxic reaction
• Toxic Reactions
• Blood concentration levels exceed therapeutic levels
• Too high a dose (remember horror story…)
• Cumulative Effect
DRUG REACTIONS
• Toxic Reactions (cont.)
• Reverse toxicity
• Antidote
• Examples
• warfarin
• Vitamin K
• acetaminophen
• Mucomyst
• heparin
• protamine sulfate
• Monitor drugs with low safety margin
PHARMACOGENETIC REACTIONS
• Pharmacogenetic Disorder
• Abnormal response to medication
• Genetic traits
• Example
• G6PD Deficiency
• Drugs causes hemolysis
• Aspirin
• sulfonamides
• chloramphenicol
DRUG INTERACTIONS
Medications
Supplements
ETOH
Diet
DRUG INTERACTIONS : ADDITIVE
1
2
1
DRUG INTERACTIONS : SYNERGISTIC
1
4
1
DRUG INTERACTIONS; ANTAGONIST
1
1
1
DRUG-FOOD INTERACTIONS
• Food may impair or enhance its absorption
• Drug taken on empty stomach vs. given with meals
• Drug–food mixture: Drugs combine with a drug forming an
insoluble food
• i.e. tetracycline administered with dairy products
FACTORS INFLUENCING DRUG
RESPONSE
• Age
• Weight
• Gender
• Disease
• Route of administration
NURSING IMPLICATIONS
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•
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Consult appropriate references and hospital pharmacist
Observe patients
Report
Use judgment
Accurately observe and evaluate circumstances
Record
HERBAL THERAPY AND DIETARY
SUPPLEMENTS
• Herbal therapy
• Type of complementary/alternative therapy - using
plants or herbs
• Explain that ‘natural’ is not necessarily safe
• Nutritional or dietary supplements
• Substances not regulated as drugs by FDA; effective
for promoting health
NATIONAL CENTER FOR COMPLEMENTARY AND
ALTERNATIVE MEDICINE (NCCAM)
• Scientific research
• Trains CAM (complimentary / alternative medicine)
scientists
• disseminates information gleaned from conducted
research
• Develops programs
• Encourages scientists to investigate CAM
treatments that show promise
BREAK
THE SIX RIGHTS
Patient
Medication
Route
Dose
Time
Documentation
PATIENT RIGHTS
• Right to refuse
• Patient without capacity?
• Right to know what they are getting and why
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• General principles of drug administration
• Factual knowledge of each drug given
• Reasons for use
• general action
• common adverse reactions
• special precautions in administration
• normal dose ranges
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• Check current and approved references for all
drug information
• Consider before administering a drug:
• Patient’s allergy history
• previous adverse reactions
• patient comments
• change in patient condition
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• The medication order
• Must have MD/NP Order
• Exceptions: Code Drugs
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• Guidelines for preparing a drug for
administration
• Check health care provider’s written orders
and compare label of the drug with MAR
• Wash hands and do not let hands touch
capsules or tablets
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• Guidelines for preparing a drug for administration
(cont’d)
• Never remove a drug from: An unlabeled
container; a package with an illegible label
• Never crush tablets or open capsules or
administer a drug prepared by someone else
• Alert: Drugs with similar names
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• Guidelines for preparing a drug for
administration (cont’d)
• Return drugs requiring special storage to the
storage area immediately after they are
prepared for administration
• Unit dose: Remove wrappings when the drug
reaches the patient; chart immediately after
administering the drug
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• Each time a drug is prepared and
administered: Follow the 6 rights
• Precautions taken by the nurse: Confirm any
questionable orders; verify calculations with
another nurse; listen to the patient;
concentrate on only one task at a time
• Most common occurrence of errors: Insulin
and heparin
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• Drug Errors - patient receives:
• The wrong dose
• The wrong drug
• An incorrect dosage of the drug
• A drug by the wrong route
• A drug given at the incorrect time
• If error occurs, report immediately
• Wrong pill or NSS given without order: Still an error
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• National Patient Safety Goals
-Accrediting body for hospitals: JCAHO
-Approve National Patient Safety Goals
yearly
• Institute for Safe Medication Practices
-Medication Errors Reporting Program
CONSIDERATIONS IN DRUG
ADMINISTRATIONS
• Drug dispensing system
• Computerized Dispensing System
• Unit Dose System
• Bar Code Scanner
ORAL ROUTE (PO)
• Most frequent route of drug administration
• Oral Drug Forms: Tablets; capsules; liquids
• Sustained-release drugs
• Nursing responsibilities: Verify the drug;
identify the patient; assess; keep water readily
available; instruct; never leave a drug at the
patient’s bedside to be taken later
PARENTERAL ROUTE
• Parenteral drug administration routes:
Subcutaneous (SC); intramuscular (IM);
intravenous (IV); intradermal route;
intralesional; intra-arterial; intracardiac;
intra-articular
• Nursing responsibilities: Wear gloves;
use standard precautions; cleanse skin
PARENTERAL ROUTE
• Administration of drugs by subcutaneous route:
Places the drug into the tissues between the skin
and the muscle
• Nursing responsibilities:
• Volume of injection: Single/multiple sites
• SC injection sites: Upper arms; upper
abdomen; upper back
• Needle length and angle of insertion:
Obese/thin patients
PARENTERAL ROUTE
• Administration of drugs by intramuscular
route: Administration into a muscle
• Nursing responsibilities: 22-gauge needle
• Volume of injection: Single/multiple sites
• Injection sites, needle length and angle of
insertion: Deltoid muscle; ventrogluteal or
dorsogluteal sites; vastus lateralis
• Z-Track technique: Prevents backflow of drug
into the SC tissue
PARENTERAL ROUTE
• Drug administration- intravenous route: Directly
into blood; needle inserted into a vein
• Methods of administration: Slow; rapid;
piggyback infusions; existing IV line; using
intermittent venous access device; added to an IV
solution; venipuncture
• Intravenous infusion controllers, pumps:
Detectors, alarms alert the nurse
• Possible problems: Air in line; occlusion; low
battery; completion of infusion; inability to
deliver preset rate
PARENTERAL ROUTE
• Administration of drugs by intravenous
route (cont’d)
• Nursing responsibilities:
• Record type of IV fluid and drug
added to the IV solution after start of
infusion; check infusion rate and
inspect needle site
• Swelling around the needle:
Extravasation or infiltration
PARENTERAL ROUTE
• Drug administration- intradermal route:
Sensitivity tests - Tuberculin; skin allergy
• Nursing responsibilities:
• Injection sites: Inner part of forearm;
upper back; hairless; avoid areas near
moles, scars, or pigmented skin
• 1-mL syringe; 25- to 27-gauge needle;
1⁄4 to 5⁄8 inch
• Needle insertion: 15-degree angle; do
not aspirate syringe or massage the area
PARENTERAL ROUTE
• Other parenteral routes of drug
administration: Intracardial; intralesional;
intra-arterial; intra-articular
• Nursing responsibilities:
• Prepare drug for administration; Ask
primary care provider
• Venous access ports: For chemotherapy or
long-term therapy
ADMINISTRATION OF DRUGS THROUGH THE
SKIN AND MUCOUS MEMBRANES
• Application to the skin and mucous
membranes
• Several routes
• Topical
• Transdermal
• Inhaled through the membranes of the
upper respiratory tract
ADMINISTRATION OF DRUGS THROUGH THE
SKIN AND MUCOUS MEMBRANES
• Administration of drugs by the topical route
• Act on the skin; not absorbed through the
skin
• Nursing responsibilities:
• Follow special instructions: Drug action
may depend on correct administration of
the drug
ADMINISTRATION OF DRUGS THROUGH THE
SKIN AND MUCOUS MEMBRANES
• Administration of drugs by the transdermal
route
• Readily absorbed from the skin
• Drug dosages: Implanted in a small patchtype bandage
• Drug system maintains: Constant blood
concentration; reduces the possibility of
toxicity
ADMINISTRATION OF DRUGS THROUGH THE
SKIN AND MUCOUS MEMBRANES
• Administration of drugs by the transdermal
route (cont’d)
• Nursing responsibilities:
• Wear gloves; apply patch on clean, dry,
nonhairy areas of intact skin; apply next
dose to new site: Remove old patch
• Commonly used sites: Chest, flank, and
upper arm
ADMINISTRATION OF DRUGS
THROUGH THE SKIN AND MUCOUS
MEMBRANES (CONT’D)
• Administration of drugs through inhalation
• Drug droplets, vapor, or gas: Through
mucous membranes of the respiratory tract
• Use face mask, nebulizer, or positivepressure breathing machine
• Nursing responsibilities:
• Provide proper instructions
NURSING RESPONSIBILITIES AFTER
DRUG ADMINISTRATION
• Record: Administration of the drug; IV flow
rate, site used for parenteral administration;
problems with administration; vital signs
taken immediately before administration
• Evaluate and record: Patient’s response to the
drug
• Observe and record: Adverse reactions and
frequency
ADMINISTRATION OF DRUGS IN THE
HOME
• Home setting caregivers: Patient or family
members
• Ensure: Patient or caregiver understands the
treatment regimen
• Home care checklist: For administering drugs
safely in the home
MULTIPLE CHECK SYSTEM
• Order entry, barcoding, and technologic
checks
• Best method: manual redundancy system and
the “5 rights and 3 checks” method.
BREAK
THE FIVE PHASES OF THE NURSING
PROCESS: ASSESSMENT
• Assessment: Collecting objective and subjective
data
• Objective data:
• Facts obtained by means of a physical
assessment, physical examination
• Subjective data:
• Facts supplied by patient or patient’s
family
THE FIVE PHASES OF THE NURSING
PROCESS: ASSESSMENT
• Initial assessment:
• Objective and subjective data collected when
patient is first seen in a hospital, outpatient
clinic, health care provider’s office, or other
type of health care facility
• Objective data:
• Obtained during initial assessment through
activities, such as examining skin,
obtaining vital signs, palpating a lesion,
auscultating lungs
THE FIVE PHASES OF THE NURSING
PROCESS: ASSESSMENT
• Initial assessment (cont’d):
• Subjective data:
• Acquired during initial assessment by
obtaining information from patient, such
as family history of disease, allergy
history, occupational history, a description
of current illness or chief complaint,
medical history, and drug history
THE FIVE PHASES OF THE NURSING
PROCESS: ASSESSMENT
• Ongoing assessment:
• Made at time of each patient contact
and may include the collection of
objective data, subjective data, or both
• Objective data:
• Blood pressure; pulse; respiratory
rate; temperature; weight;
examination of the skin;
examination of an intravenous
infusion site; auscultation of the
THE FIVE PHASES OF THE NURSING
PROCESS: ASSESSMENT
• Ongoing assessment (cont’d):
• Subjective data:
• Any statements made by the patient
about relief or non-relief of pain or
other symptoms after administration
of a drug
THE FIVE PHASES OF THE NURSING
PROCESS:
NURSING DIAGNOSIS
• Nursing diagnosis:
• Description of patient’s problems and their
probable or actual related causes based on
subjective, objective data in database
• Provide framework for selection of nursing
interventions to achieve expected outcomes
• North American Nursing Diagnosis Association
(NANDA): Formed to standardize the
THE FIVE PHASES OF THE NURSING
PROCESS:
NURSING DIAGNOSIS
• Frequently used nursing diagnoses related to
administration of drugs:
• Effective therapeutic regimen management
• Ineffective therapeutic regimen management
• Deficient knowledge
• Noncompliance
• Anxiety
THE FIVE PHASES OF THE NURSING
PROCESS: PLANNING
• Nurse develops expected outcomes after
nursing diagnoses are formulated
• Expected outcome: Describes maximum
level of wellness that is reasonably
attainable for patient
• Expected patient outcomes related to drug
administration:
• patient will effectively manage the
therapeutic regimen
THE FIVE PHASES OF THE NURSING
PROCESS: PLANNING
• Expected patient outcomes related to drug
administration (cont’d):
• patient will understand the drug regimen
• patient will comply with the drug
regimen
THE FIVE PHASES OF THE NURSING
PROCESS: PLANNING
• Nurse: Select appropriate interventions on
basis of expected outcomes to develop plan of
action or patient care plan
• Planning phase: Describes the steps for
carrying out nursing activities or
interventions that are specific and that will
meet the expected outcomes
• Expected outcomes serve as basis for
evaluating the effectiveness of nursing
interventions
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation:
• Carrying out of a plan of action, is natural
outgrowth of assessment, planning phases
of nursing process
• Refers to preparation, administration of one
or more drugs to specific patient when
related to administration of drugs
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Effective therapeutic regimen management:
• Nursing diagnosis: Takes into
consideration that patient is willing to
regulate, integrate into daily living the
treatment regimen
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Effective therapeutic regimen management
(cont’d):
• Patient willing, able to manage treatment
regimen: He or she may simply need
information concerning drug; method of
administration; what type of reactions to
expect; what to report to primary health
care provider
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Effective therapeutic regimen management
(cont’d):
• Patient willing to take responsibility: Need
to develop teaching plan that gives patient
information needed to properly manage
therapeutic regimen
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Ineffective therapeutic regimen management:
• NANDA definition: Pattern of regulating
and integrating into daily living program for
treatment of illness and sequelae of illness
that is unsatisfactory for meeting specific
health goals
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Ineffective therapeutic regimen management
(cont’d):
• Patient who is not managing the drug
regimen correctly: Nurse must ensure that
patient understands drug regimen
• Discuss drug regimen with patient,
including reason drug is to be taken, times,
amount, adverse reactions to expect,
reactions that should be reported
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Deficient knowledge:
• Absence or deficiency of cognitive
information to a specific subject
• Determine: What information patient is
lacking and then plan a teaching session
that directly pertains to specific area of
need
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Noncompliance:
• Behavior of patient or caregiver that fails to
coincide with therapeutic plan agreed on by
patient and health care provider
• Lack of information about the drug, the
reason the drug is prescribed, or the
expected or therapeutic results; also result of
anxiety or bothersome side effects
THE FIVE PHASES OF THE NURSING
PROCESS: IMPLEMENTATION
• Implementation (cont’d):
• Anxiety:
• Vague uneasiness or apprehension that
manifests itself in varying degrees from
expressions of concern regarding drug
regimen to total lack of compliance with
the drug regimen; decreases with
understanding of therapeutic regimen
• Critical for nurse: Allow time for a
thorough explanation and to answer all
questions and concerns in language patient
can understand
THE FIVE PHASES OF THE NURSING PROCESS:
EVALUATION
• Decision-making process that involves
determining effectiveness of nursing
interventions in meeting expected outcomes
• Used to determine if the patient or family
member understands the drug regimen
• Evaluate patient’s response to therapy: Check
patient’s blood pressure every hour, inquire
whether pain has been relieved, or monitor
pulse every 15 minutes
THE FIVE PHASES OF THE NURSING
PROCESS: EVALUATION
• Evaluate patient’s or family’s understanding
of drug regimen noting if one or both appear
to understand the material that has been
presented
The Teaching/Learning Process
• Teaching: An interactive process that
promotes learning
• Learning: Acquiring new knowledge or skills
• Motivate patient
• Encourage patient participation
The Three Domains Of Learning
• Cognitive Domain (intellectual activities:
thought, recall, decision making, drawing
conclusions, using previous experiences)
• Affective Domain (attitudes, feelings, beliefs,
opinions of the patient and caregiver)
• Psychomotor Domain (learning physical
skills or tasks)
Adult Learning
• Demonstrate technique
• Supervise the practice
• Help patient get ready
• Allow patient to perform the task
The Nursing Process as a
Framework for Patient Teaching
• Identify patient health needs
• Devise a plan of care
• Initiate the plan
• Evaluate effectiveness of plan
The Nursing Process as a Framework
for Patient Teaching (cont'd)
• Assessment
• Gather data
• Develop an effective teaching plan
• Assess individual’s learning ability
• Determine purpose of assessment
The Nursing Process as a
Framework for Patient Teaching
(cont'd)
• Nursing Diagnoses
• Effective Individual Therapeutic Regimen
Management
• Ineffective Therapeutic Regimen
Management
• Deficient Knowledge
The Nursing Process as a
Framework for Patient Teaching
(cont'd)
• Planning
• Actual development: Use strategies
• Develop individualized teaching plan
• Select relevant information
The Nursing Process as a
Framework for Patient Teaching
(cont'd)
• Implementation
• Actual performance: Interventions
identified in teaching plan
• Put the plan into action
• Begin teaching
The Nursing Process as a
Framework for Patient Teaching
(cont'd)
• Evaluation
• Evaluate patient’s knowledge of
materials presented
• Factual material: Ask patient to
list/repeat information presented
DOCUMENTATION
•
Document Pain level with every pain med administration
• ALWAYS follow up after pain medication is given
• 60 minutes PO
• 30 minutes IM
• 15 minutes IV
• Times can vary by facility
•
NEVER document you gave a medication until you ACTUALLY DO
•
Always document that a patient refused a medication and why, if applicable
•
Document if medications are late and why
•
Never document for another nurse giving medications
• Exception – emergency situations (Codes, STEMI, etc)
•
Always remember: CYA
NCLEX
•
What type of name is each of the drugs?
• Tylenol
• furosemide
• clonIDINE
• aspirin
• Ethyl 4 – (8-chloro-5, 6-dihydro-11 H-benzo [5,6]….
• Nitro-Dur
• nitroglycerine
• olmesartan medoxomil hydrochlorthiazide (benicar)
NCLEX
•
What are the following abbreviations?
• PO
• QHS
• TID
• BID
• QOD
• QD
•
Which of the previous abbreviations are not allowed by JCAHO?
CASE STUDY
•
Sarah Smith is a 50-year-old Caucasian woman who is admitted to the hospital for
treatment of an asthma exacerbation. She is currently a 1-pack/day smoker.
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•
Discussion:
•
•
1.
The physician has ordered Mrs. Smith to have a transdermal nicotine patch
while she is in the hospital. What is the nurse’s responsibility when administering a
transdermal patch to a client?
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•
2.
What should the nurse do before administering any medications to Mrs. Smith?
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•
3.
The physician has ordered Mrs. Smith a Proventil HFA inhaler to use 2 puffs
every 2 hours as needed for shortness of breath and wheezing. How would the nurse
instruct Mrs. Smith to use the inhaler?
CASE STUDY
•
Maria Sanchez is a 75-year-old Hispanic woman. She speaks very little English. She
lives with her daughter and her family. Her past medical history includes
hypertension, hyperlipidemia, and status post cerebrovascular accident with rightsided hemiparesis. Mrs. Sanchez has just been diagnosed with diabetes. She has been
referred to you, the nurse, as the clinic-certified diabetes educator for glucometer
teaching and diabetes education.
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Discussion:
•
•
1.
Which learning domains should the nurse pay particular attention to when
developing a teaching plan for Mrs. Sanchez?
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•
2.
What barriers or obstacles does the nurse face in educating Mrs. Sanchez about
her glucometer and her disease state?
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•
3.
What can the nurse do to overcome the barriers and successfully educate Mrs.
Sanchez about her glucometer and her disease state?
CASE STUDY
•
Stanley Smith is a 70-year-old African American man. He has multiple medical
conditions including hypertension, type 2 diabetes, and dyslipidemia. His current
medications include aspirin 81 mg daily, Hyzaar 100/25 mg daily, Zocor 20 mg daily,
and Glucophage XR 500 mg twice daily. He was admitted to the hospital today for
treatment of community-acquired pneumonia. He is 70 inches tall and weighs 195
pounds.
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•
Discussion:
•
•
1.
What factors does Mr. Smith have that might alter drug response?
•
•
2.
Mr. Smith is given azithromycin 500 mg for 1 dose and then azithromycin 250
mg daily for the next 5 days and ceftriaxone 1 gram IV twice daily. After beginning
the IV administration of ceftriaxone Mr. Smith’s heart rate increases to 110 bpm, his
blood pressure is 90/60 mm Hg, and he complains of difficulty breathing and itching.
The nurse notices Mr. Smith has urticaria and angioedema and is sweating profusely.
What should the nurse do?
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3.
What medications might the nurse need to administer to a client experiencing
anaphylactic shock?