Pharmacology10/5/09

Bring study guide to class everyday and do the chapters.Pg 187, go over termsWill have to do a calculation testNext qtr will give meds, not this qtr

Bring all books to class

Can bring calculators to class, but not for test

Test dates:Exam 1: 10/26 – wk 1, 2, 3 on syllabus (ch. 1-8; 10-14, 16; 17-20 – labs 1-3; 4-6; 7-9)Exam 2: 11/16 – wk 4, 5, 6 (ch. 21-25, 27 & 28; 29-34; 35-36 – labs 10-12; 20)Exam 3: 12/7 – wk 7, 8, 9, 10 (ch 37-44; 45-49; 51-53; 56, 58-59 – labs 21)Final: 12/7 – cumulative

Pop quizzes thru out qtr

Team B

Do a one page paper on bowel movement: be creative, looking for content, what it is, why it is, where it is and why it is

10/17 women health summit, Jefferson clinic not mandatory, but will get points for attending

CLINICALS: SATURDAY 6:45-1:00PM, ANGELA WILLIAMS

Need 85% to pass the dosage calculation test

Tomorrows class time will be posted on ms. Mitchell’s door.

Next Monday, ch 1-8,

PHARMACOLOGY NOTES

10/12/09

Mynursinglab.comCourse id: CRSCDSH-600869

RR count one full minute if individual is having breathing problems, or you have some concerns- Otherwise count 30 secs X 2 = RR

Pulse rate count one full minute if client is having some problems or you have some concerns- Otherwise count 15 secs X 4 = pulse rate

CHAPTER 1

The purpose of pharmacology in this qtr is to intertwine this with the nursing process. We will use nursing diagnosis relating to medicine.

5 steps to nursing process: assessment, diagnosis, planning, implementation and evaluation.

Pg 7, box 1-1 as an example of the nursing care plan as it relates to drug therapy.

Assessment: subjective data is how the medication is making the patient feel. What the patient tells you about how the medicine is workingObjective data would be how much medicine taken and how for example.

Nursing diagnosis: deficient knowledge r/t ineffective education level as evidenced by inability to perform a return demonstration, (this needs to focus on medicine)

Planning: look on MAR (medicine administration record) to get a list of medication for your patient, it could also be in the chart on by the medicine.

- Compare the information (MAR) to what the dr. ordered- Six steps

o Name of patiento Date orderedo Name of medicationo Dosage, including size, frequency, and no. of doseso Routeo Signature of the dr.

Diagnosis: NANDA (North America Nursing Diagnosis Association) coordinates the nursing diagnosis box 1-3S3 phases/steps to nursing diagnosis

- Problem: whats going on with patient- Causes: related to – R/T (r/t)

o Etiology: the cause of a diseaseo Example, injury of LLE 2ndary to a fall

- AEB (as evidenced by): for exampleo cast

o rednesso tender to touch

Planning: objective and measurable, goal and what you want the patient to do: for example- The patient will have decreased pain within 72 hrs AEB- Pg 10 – patient-oriented outcome criteria must apply to any medications the patient will

receive. For example, the outcome criteria for a 43-year old male with diabetes mellitus might be focused on the administration of insulin and general aspects of insulin therapy.

Implementation: is what the nurse will do (the intervention by the nurse) to help meet the goal of the patient

- There should be an implementation for each planning objective- You need to understand 5 rights: route, time, drug, dose, patient

Evaluation:

THE NURSING PROCESS AND DRUG THERAPY

BOX 1-1 sample nursing care plan r/t drug therapy and the nursing process

Assessment: a comprehensive medication profile- Check the medication order for the six elements:

o Nameo Date name of medicationo Dosageo Routeo Signature of md

Nursing Diagnosis: - development of nursing dx- 3 parts

o Human responseo Identifies factorso

Planning:- Prioritize the nursing diagnosis and specific goals and outcome criteria, including time

frame for their achievement- Goals are objective, measurable

Implementation- Actions by the nurse- Also called intervention- Use the “Five Rights” of medication administration

o Drugo Doseo Patiento Routeo Time

- Preventing medication errors (pg 11 right dose)

Evaluation- Charting don’t’s pg 12

o Don’t record staffing problems (don’t mention them in a patient’s chart but instead talk with the nurse manager).

o Don’t record a peer’s conflicts, such as charting possible disputes between a patient and a nurse

o Don’t mention incident reports in charting because they are confidential and are filed separately and not in the patient’s chart. The facts of an incident may be documented, but don’t mention the terms (e.g., that it was an error).

o Don’t use the following terms: “by mistake”, “by accident,” “accidentally,” “unintentional,” or “miscalculated”

o Don’t chart other patients’ names because this is a violation of confidentialityo Don’t chart anything but factso Don’t chart casual conversations with peers, physicians, or other members of the

health care teamo Don’t use abbreviations as a general rule of thumb. Some agencies or facilities

may still use a list of approved abbreviations, but overall they are discouragedo Don’t use negative language because it may come back to haunt you

Chapter 2

Pharmacalogic principles- Parenteral route – IV, main one that will give the fastest action- Bioavailable: a measure of the extent of drug absorption for a given drug and route (from

0% to 100%)- Sublingual and buccal- SQ, intradermal, intramuscular- Distribution- Excretion- Half-life: the time required for half of an administered dose of drug to be eliminated by

the body (aka elimination half-life)- Onset, peak duration: onset-the time required for a drug to elicit a therapeutic response

after dosing. Peak – the time required for a drug to reach its maximum therapeutic response in the body. Duration – the length of time the concentration of a drug in the blood or tissues is sufficient to elicit a therapeutic response.

- Enzyme interactions- Adverse effects: aka side effects – any undesirable bodily effects that are a direct

response to one or more drugs.- Tolerance and dependence: found in opioids, pharmacotherapeutic- Synergist effects: one drug helps the other one become more effective- Incompatibility: the quality of two parenteral drugs or solutions that leads to a reaction

resulting in the chemical deterioration of at least one of the drugs when the two substances are mixed

- Allergic reactions: an immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication: a type of ADE.

- 4 main sources of drugs

Distribution: 3 proteins that bind to drug- Albumin- Corticosteroids- Glycoprotein

Drugs that are water soluble and highly protein bond are more strongly bond to proteins in the blood

Metabolism: some patients will absorb more faster than others,- Excretion needs to be taken into consideration

PharmacokineticsEnzyme interactions:

- Antagonist

CHAPTER 3

Life Span- Fetal gestational age determines the potential for harmful drugs effects to the fetus- Greatest risk is the first trimester of pregnancy- The FDA classifies drugs according to their safety for use during pregnancy- Category D (table 3-1): possible fetal risk in humans reported- Pediatric patient are small and have immature organs – susceptible to many drug

interactions- Formula involving age, wt,. and body surface area (BSA) are used- BSA most accurate of these dosage formula- Milligrams per kilograms of body weight to calculate pediatric dosage

o This is used most ofteno Calculate body weight by height and BSA

Elderly- Decline in organ function – cardiovascular, gi, liver, renal- Drugs is more likely to result in adverse effects and toxicity- Polypharmacy- Increase in hospital rates for treatment of adverse drug effects- Table 3-3 physiologic changes- Meds: sedatives and hypnotics have common complication (confusion)- Thiazide diuretics – electrolyte imbalance

CHAPTER 4

Table 4-2C-II severe physical and psychologic

Informed consent: involves the careful explanation to the human test patient or research subject of the purpose of the study in which he or she is being asked to participate, the procedures to be used, the possible benefits and the risks involved.

FDA: approval process of medication4 phases:

1. Phase 1: Studies involve small numbers of volunteers who have the disease or ailment that the drug designed to diagnose or treat.

3. Placebos – studies involve larger numbers of patients who are followed by medical research centers and other types of health care facilities.

a. They use placebos

Ethical practice: ethical nursing practice is based on fundamental principles such as beneficence, autonomy, justice, veracity, and confidentiality.

Box 4-1 & box 4-2 pg 52

Check out pg 53 cultural implications box

CHAPTER 5 MEDICATION ERRORS

Medication errors can be prevented if we use the 5 rights.

Common medication errors: allergic reactions and idiosyncratic reaction (usually unpredictable)

Nursing measures to prevent medication errors:1. Allergies – check if they have allergies with food2. Do not try to decipher md’s handwriting3. Use leading zeros (0.35)4. Don’t use trailing zeros (10.0)5. Listen to and honor any concerns expressed by the patient

CHAPTER 6

Developmental stages box 6-1Know adolescence – identity versus role confusion. Adolescent integrates many roles into self-identity through imitation of role models and peer pressure.

CHAPTER 7

Rhabdomyolysis: breakdown of the muscle tissue. Is said to be caused by taking a lot of herbal products.

Pg 79 dietary supplements, and especially herbal medicines, are often perceived as being natural and therefore harmless.

CHAPTER 8

Alcoholism is the main abused substancePg 91 disulfiram

- know how it works - it helps the patient to stop drinkingo if they take this drug and have alcohol, it can caused them to have a severe

reaction

nicotine is another common drug- use the nicotine gum – the rapid chewing release in the gum has a reaction in the body,

that will help.

CHAPTER 9

MAR (medication administration record)

Liquid medications are often used for pediatric patients- sometimes you have to draw it up in a syringe and put it in the side of the patients mouth

NG or G TUBE- sit the patient up in a semi-fowlers position (45 degree angle), fowler position is a 90

degree

rectal drugs- never break a suppository- use a lubricant- make sure u insert the suppository on the wall of the colon, not on the stool- lay patient on left side

break ampules away from you

filter needles are used with an ampule, use them to draw up medicine.

- Multi-dose vials should be marked with the date and time of opening and the discard date- If the vial has been previously opened and used, wipe the top of the vial vigorously with

an alcohol swab- Air must first bwe injected into a vial before fluid can be withdrawn. The amount of air

injected into a vial should equal the amount of fluid that needs to be withdrawn.- When an - If a needle has been used to remove medication froma vial, always change the needle

before administering the dose

Injection overview- 5ml or more of drug, do not give in the deltoid muscle

z-track method

intradermal injections – 3-4 fingers - Do not aspirate

Insulin syringe- Double check syringe and unit using

Ventrogluteal site – is the preferred site for intramuscular injections- Avoid the sciatic nerve

Deltoid site – used for giving immunizations, except for infants

IV Medication – read pg 116- Make sure you flush before and after- Make sure you have a good site, good blood return

Piggyback system

Pharmacology11/30/09

Chapter 44 NSAID (nonsteroidal anti-inflammatory drugs) pg 677

Most common-motrin (ibuprofen) Adverse cardiovascular issues, because they are more prone to pulmonary edema

Antirheumatic drugs, 684 Commonly prescribed Pay attention to anti-gout drugs

Gout: excessive production of uric acid Allopurinol (Zyloprim) 684

Indicated for patience with gout Therapeutic effect: Decrease in uric acid

688, when teaching a patient who is taking colchicines for the treatment of gout, what instructions is appropriate Report to dr. increase pain, blood in urine, increase fatigue

This drug can cause renal issues

Chapter 45 697, muromonab-CD3 (orthoclone OKT3)

Reversal of graft rejection Contraindicated for patients who experience fluid overload

In preparation for the exam, which factor should the nurse consider before giving this exam

Need to know fluid volume status 699, with immunesuppression drugs, nursing implementations

Take with food Use oral form to prevent infection Can cause yeast, easily Teaching:

Hygiene Avoid grapefruit juices

Do not put in Styrofoam container after drug is mixed. Which of the following should be included in preoperative teaching plan:

Before the surgery will be administer orally 695, azathioprine (imuran)

Adverse affects: Hematologic: Leukopenia, thromboycytopenia, (blood) Hepatic: hepatoxicity is common adverse effect (liver)

Which is an expected adverse effect of imuran therapy: Leukopenia

695, interactions Cyclosporine, tacrolimus, and sirolimus: Diltiazem, nicardipine, verapamil, fluconazole,

itraconazole, clarithromycin, allopurinol, metoclopramid, amphotericin B, cimetidine, and ketoconazole.

azathioprine should not be given with allopurinol. Cyclosporine: st. johns wort, cat’s claw, echninacea Which drugs may increase the actions of clyclosporine:

Allopurinol

Chapter 46 709, haemophilus influenza Type b (Hib)

Given by injection Conditions that may predispose an individual to HIb infection are septicemia, pneumonia,

cellulitis, arthritis, osteomyelitis, periarditis, sickle cell anemia, an immunodeficiency syndrom, or Hodgkin’s disease.

Two patients arrive in clinic, one a young boy with sickle cell, the other is an old man with Hodgkins disease. The nurse notices that both patients require the same vaccine. What vaccine is it? Haemophilus influenza Type b (Hib)

Side effects: 707 Serum sickness:

Autism Rash, shock, edema, urticaria, arthritis; adenopathy, fever, flushing, itching, cough, dyspnea, cyanosis, vomiting

45yr old man has had a series of immunizing drugs. Has developed edema of the face tongue and throat Serum sickness

709, 711-712, a housekeeper stuck with contaminated needle. The expects that which drug would be used for passive immunity to hepatitis b infection: Hepatitis b-recombinant

This is used because the she has already been stuck Use hepatitis B immunoglobulin before they have been stuck

710, pneumococcal vaccine, polyvalent (Pneumovax 23) Bacterial capsular antigenic extract vaccine Adult/child>2yr: SC: 0.5ml x1 Streptococcus pneumoniae

A 72 yr old patient receive a pneumococcal vaccine. Which statement is true? Given subcutaneous injection

Chapter 47 720, characteristics of neoplastic drugs (table 47-1)

Malignant matastizes to other tissue, benign does not Sarcoma: malignant tumors that arise primarily form connective tissues One patient has cancer of the bone, one has cancer of ….

Sarcoma 731, methotrexate (trexall)

Used for the treatment of solid tumors such as breast, head and neck, and lung cancers and for the management of acute lymphocytic leukemia and nonHodgkin’s lymphomas.

Rescue dosing of its antidote drug leucovorin Patient experiencing bone marrow suppression. What is used for this patient?

Rescue doses 741, implementations

Most toxic medications of antineoplastic Manage stomatitis or excessive oral mucosa dryness and irritation Nausea and vomiting occur commonly with antineoplastic. Premedicate with emetics 30-

60 minutes before treatment Diarrhea is also a common adverse effect Address nutritional concerns, the meals and snacks consumed over a 24 hr period should

be monitored to determine if nutritional intake is adequate Establishing a therapeutic relationship with the patient that begins with trust and empathy

When administering chemo for treatment of cancer, which intervention is best for treating preventing chemotherapy induced nausea and vomiting? Premedicate with emetics 30-60 minutes before treatment

726, antineoplastic drugs Use in combination A patient is receiving a combination of drugs for breast cancer. Which statement best

describes the rationale for combination therapy? Hair loss will be minimized

Using drugs with different mechanism of action will maximize the side effects of drugs