Transcript Chapter 16 Cholinesterase Inhibitors

Chapter 2
Application of Pharmacology in
Nursing Practice
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Why Should a Student Nurse
Learn About Drugs?
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Motivation for studying Pharmacology
Essential for nursing practice
Worthwhile investment
Much more required than the Six Rights
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Right drug, patient, dose, route, time,
documentation
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Evolution of Nursing
Responsibilities Regarding Drugs
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Correct administration, without additional
interventions, cannot ensure that treatment
will result in the therapeutic objective.
Proper delivery is only the beginning of a
nurse’s responsibility.
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Evolution of Nursing
Responsibilities Regarding Drugs
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Nurses + physicians + pharmacists
participate in a system of checks and
balances designed to promote beneficial
effects and to minimize harm.
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Evolution of Nursing
Responsibilities Regarding Drugs
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The nurse must know
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What medications are appropriate for the patient
What drugs are contraindicated for the patient
The probable consequences of the interaction
between drug and patient
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Evolution of Nursing
Responsibilities Regarding Drugs
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The nurse’s role as advocate
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Follows the patient’s status most closely
Detect mistakes made by pharmacists and
prescribers
First member of the health care team to observe
and evaluate drug responses and intervene if
required
Must know the response that a medication is likely
to elicit
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Evolution of Nursing
Responsibilities Regarding Drugs
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The nurse’s role as advocate
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Last line of defense for the patient
Ethically and legally unacceptable to administer a
drug that is harmful to the patient—even though
the medication has been prescribed by a licensed
prescriber and dispensed by a licensed
pharmacist
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Application of Pharmacology in
Patient Care
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Two major areas in which pharmacologic
knowledge can be applied:
1. Patient care
2. Patient education
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Application of Pharmacology in
Patient Care
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Preadministration assessment
Dosage and administration
Evaluating and promoting therapeutic effects
Minimizing adverse effects
Minimizing adverse interactions
Making PRN decisions
Managing toxicity
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Preadministration Assessment
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Collecting baseline data
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Needed to evaluate therapeutic responses and
adverse effects
Identifying high-risk patients
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Liver and kidney impairment
Genetic factors
Drug allergies
Pregnancy
Elderly and pediatric
Tools: patient history, physical examination, and
laboratory results
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Dosage and Administration
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Certain drugs have more than one indication.
Dosage may differ depending on which
indication the drug is used for.
Many drugs can be administered by more
than one route.
Dosage may differ depending on the route
selected.
Certain IV agents can cause severe local
injury if IV extravasates.
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Dosage and Administration
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Read the medication order carefully.
Verify the identity of the patient.
Read the medication label carefully.
Verify dosage calculations.
Implement any special handling the drug may
require.
Don’t administer any drug if you don’t
understand the reason for its use.
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Evaluating and Promoting
Therapeutic Effects
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Evaluating therapeutic responses:
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One of the most important aspects of drug therapy
Must know the rationale for treatment and the
nature and time course of the intended response
Cannot effectively evaluate a drug with multiple
applications if the intended use is not known
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Evaluating and Promoting
Therapeutic Effects
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Promoting patient adherence
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Also known as compliance or concordance
Extent to which a patient’s behavior coincides with
medical advice
Implementing nondrug measures
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Drug therapy can often be enhanced by nondrug
measures.
Biofeedback, emotional support, weight reduction,
smoking cessation, sodium restriction, etc.
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Minimizing Adverse Effects
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All drugs have the potential to produce
undesired effects.
Always know the following:
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The major adverse effects the drug can produce
The time when these reactions are likely to occur
Early signs that an adverse reaction is developing
Interventions that can minimize discomfort and
harm
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Minimizing Adverse Interactions
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Take a thorough drug history.
Advise the patient to avoid OTC drugs that
can interact with the prescribed medication.
Monitor for adverse interactions known to
occur.
Be alert for as-yet unknown interactions.
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Making PRN Decisions
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PRN: pro re nata, meaning “as needed”
Nurse has discretion regarding how much
drug to give and when to give it.
Know the reason for drug use.
Be able to assess the patient’s medication
needs.
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Managing Toxicity
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Early identification makes early intervention
possible.
Know the early signs of toxicity.
Know the procedure for toxicity management.
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Application of Pharmacology in
Patient Education
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Drug name and therapeutic category
Dosage size
Dosing schedule
Route and technique of administration
Expected therapeutic response and when it
should develop
Nondrug measures to enhance therapeutic
responses
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Application of Pharmacology in
Patient Education
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Duration of treatment
Method of drug storage
Symptoms of major adverse effects and
measures to minimize discomfort and harm
Major adverse drug-drug and drug-food
interactions
Whom to contact in the event of therapeutic
failure, severe adverse reactions, or severe
adverse interactions
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Teaching Dosage and
Administration
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Give patient the following information:
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Name of drug
Dosage and schedule of administration
Technique of administration
Duration of drug use
Storage of drug
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Application of Pharmacology in
Patient Education
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Promoting therapeutic effects
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Nature and time course of expected beneficial
effects
Recognizing treatment failure, allow for timely
alternative therapy implementation
Minimizing adverse effects
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Insulin overdose
Anticancer and infection
Some side effects are benign but disturbing,
especially if unknown to the patient.
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Minimizing Adverse Interactions
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Educate patient about hazardous drug-drug
and drug-food interactions.
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Example: phenelzine and amphetamines or figs
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Application of the Nursing
Process in Drug Therapy
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Application of the nursing process conceptual
framework in drug therapy
Use of a modified nursing process format to
summarize nursing implications in this text
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Review of the Nursing Process
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Assessment
Analysis: nursing diagnoses
Planning
Implementation (intervention)
Evaluation
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Applying the Nursing Process in
Drug Therapy
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Preadministration assessment
Analysis and nursing diagnoses
Planning
Implementation
Evaluation
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Preadministration Assessment
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Collection of baseline data to evaluate
therapeutic effects
Collection of baseline data to evaluate
adverse effects
Identification of high-risk patients
Assessment of the patient’s capacity for
self-care
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Analysis and Nursing Diagnoses
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Three objectives:
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Judge the appropriateness of the prescribed
regimen.
Identify potential health problems that
the drug might cause.
Determine the patient’s capacity for
self-care.
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Planning
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Defining goals
Setting priorities
Identifying specific interventions
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Drug administration
Interventions to enhance therapeutic effects
Interventions to minimize adverse effects
Patient education
Establishing objective criteria for evaluation
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Implementation
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Drug administration
Patient education
Interventions to promote therapeutic effects
Interventions to minimize adverse effects
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Evaluation
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Therapeutic responses
Adverse drug reactions and interactions
Adherence to the prescribed regimen
Satisfaction with treatment
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Modified Nursing Process Format to Summarize
Nursing Implications (see Table 2-2)
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Preadministration assessment
Implementation: administration
Implementation: measures to enhance
therapeutic effects
Ongoing evaluation and interventions
Patient education
What about diagnosis and planning?
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