1
Q
objective data
A
what you can see or measure
2
Q
subjective data
A
what patient/family has to tell you
3
Q
what is included in medication history
A
- prescription meds
- otc meds
- herbal preparations
- vitamins
- home remedies
- alcohol/tobacco
- caffeine
- street drugs
4
Q
nursing diagnosis
A
analyze data gathered –> make conclusion (special wording)
5
Q
planning
A
identiication of a goal to be met
planning what interventions will be done
6
Q
planning wording and requirement
A
“the patient will” not “the nurse will”
must be objective, measurable, and realistic
7
Q
three types of implementation
A
1) teaching/education
2) action
3) further assessment
8
Q
evaluation
A
how did it work out?
9
Q
eight rights of med admin
A
- right drug
- right time
- right dose
- right route and form
- right patient
- right documentation
- right reason
- right response
10
Q
one more right of med admin
A
right to refuse (and presented in the right manner)
11
Q
do’s and don’ts of charting med errors
A
- chart facts
- don’t chart about staffing problems or conflicts
- don’t mention incident report
- don’t use “accident”, “mistake”, or “miscalculation”
- document pt response, maybe a set of vitals
12
Q
generic name
A
long chemical name (one for each med)
13
Q
trade name
A
catchy drug company name (each med may have several)
14
Q
medication classifications
A
groupings of medications with similar uses or actions
15
Q
pharmacoeconomics
A
study of the economic factors influencing the cost of medication therapy
e.g. cost-benefit analysis
16
Q
pharmacodynamics
A
how the medication works and affects the body on the chemical level
17
Q
pharmacotherapeutics
A
understanding of medication actions for treatment and prevention of disease
18
Q
pharmacokinetics actions
A
1) absorption
2) distribution
3) metabolism
4) excretion
19
Q
absorption
A
getting the medication inside the body into the blood
20
Q
absorption routes
A
enteral (PO)
parenteral injections (SQ/SC and IM)
intravenous (IV)
topical
21
Q
enteral (PO) route bioavailability…
A
subjected to the “first-pass effect” of passing through the liver before getting through the blood, thus it starts to break down medications, limiting bioavailability
22
Q
PO pros
A
- easy and cheap
- takes 30 min to work
- pills, tablets, capsules, liquids
23
Q
PO cons
A
- not all meds can be given this way
- interference: acid/food in stomach, small intestine disease, poor bloodflow to stomach/intestine
24
Q
PO variations
A
- enteric coated
- sublingual
- rectal suppositories
25
enteric coated
coat meds that are destroyed by acid so they do not dissolve until they reach the alkaline pH of intestine.
DO NOT CRUSH
26
sublingual
placed under tongue
absorbed into venous system to bypass liver
e.g. nitroglycerin
DO NOT CHEW OR SWALLOW
27
rectal suppositories
- some used for local effect e.g. constipation
- often used when oral meds cannot be given
- absorbed uncertainly as stool interferes
- bypasses liver
28
SQ/SC and IM are absorbed by...
absorbed by diffusion into capillaries; bloodflow is important.
avoid the first-pass effect
29
SQ/SC goes into the... (& time to absorb)
goes into the fat (20-30 min to begin)
30
IM
goes into the muscle (10-15 min to begin)
31
pros of SQ/SC/IM
- quick
| - easy to learn
32
cons of SQ/SC/IM
- can damage tissue
- cannot control precisely
- can be affected by body temp
33
IV pros
- fastest method (immediate)
- complete absorption
- no barriers
- can be used for very irritating meds
- 100% bioavailable
34
IV cons
- very expensive (equipment and skills)
| - can't "take it back" if mistakes are made
35
topical methods
skin: creams/lotions, transdermal patches
eyes: drops and ointments
ears: drops
nose: drops/sprays
lungs: inhalers (very quick; mostly for direct action on lungs)
36
topical pros
- can have excellent local effects
| - bypasses liver
37
topical cons
- doesn't work quickly or predictably for systemic effects
38
pediatric absorption variations (PO, topical, IM)
- stomach has less acid until 3 yo
- peristalsis is irregular and slow
- topical absorption is faster due to thick skin
- IM absorption is faster and irregular
39
geriatric absorption variations
- less HCl acid in stomach
- slowed GI emptying
- less blood flow to GI tract due to decreased cardiac output
- villi flattening = less absorptive area
40
distribution
getting the medication from blood to the cells, where it can be used. begins to be eliminated by liver or kidney
41
what is key in distribution
blood flow!
more meds go to areas where there is more blood: heart, liver, brain, kidney
less medication goes to areas such as fat or bone
42
blood brain barrier
system of special capillaries w limited entry to the brain.
pro: keeps harmful substances out
con: keeps helpful substances out
43
medications must be ____ to get past the BBB
fat soluble or have their own transport system
44
fat soluble medications are better distributed because ...
they don't bind to proteins
45
water soluble medications are less well distributed because ...
proteins take them out of the body
46
pediatric variations in distribution
1. greater total body water
2. less fat content
3. decreased protein binding due to immature liver to make proteins
4. immature BBB
47
geriatric variations in distribution
1. more fat and less water
| 2. less proteins produced by the liver
48
metabolism AKA biotransformation
transformation of medications into something that can be excreted/inactive
49
main organ of metabolism
liver
50
metabolism is affected by (3 things)
- age (young immature liver or old worn out liver)
- malnutrition (liver doesn't have enzymes needed
- route (contact with liver)
51
pediatric variations in metabolism
1. immature liver does not make many of the enzymes needed to detoxify meds (slower metabolism)
2. older children may need higher dose bc liver is working so well
52
geriatric variations in metabolism
1. decreased enzyme production by liver
| 2. decreased liver blood flow
53
excretion
removal of the medication from the body
54
main organ of excretion
kidney
55
most medications are excreted in the
urine
56
other routes of excretion
- bowel
- sweat
- saliva
- breast milk
- expired air
57
pediatric variations in excretion
- kidneys are immature, so filtration is slower
| - less blood flow to kidneys
58
geriatric variations in elimination
- decreased number of functioning nephrons
| - less blood flow to kidneys
59
medicating pregnant women 1st trimester
- most harmful to fetus
- limited blood flow to fetus
- relatively safe
60
medicating pregnant women: 3rd trimester
- medication transfer to fetus is most likely due to excellent blood flow
- fetus is more resilient now
61
pregnancy safety categories
pregnancy
lactation
females and males of reproductive potential
62
breastfeeding women
low dosage crosses into breast milk; must eval risks and benefits
63
pediatric categories
neonate/newborn: <1 mo
infant: 1 mo - 1 yr
child: 1 - 12 yrs
adult: > 12 yrs (depending on weight)
64
body surface area formula for children
body surface area/1.73 * adult dose = child dose
65
why is body surface area calculation better than weight alone
1) better estimate of maturity and metabolic rate
| 2) dosage based on weight alone assumes child is just a "little adult" physiologically
66
physiologic changes with advanced age affecting geriatric medication (cardiac, GI, hepatic, renal)
cardiac: decreased cardiac output, decreased bloodflow
GI: decreased acid, decreased peristalsis
Hepatic: decreased enzyme production
Renal: decreased blood flow
67
polypharmacy
multiple medications taken at once for a variety of problems
| (prescription and OTC); more meds = more interaction
68
goal in polypharmacy
eliminate unneeded drugs, decreasing interaction
69
onset
time to start working
70
peak
time when working best
71
duration
length of time drug has high enough concentration to be therapeutic
72
half life
time for half of the med to be eliminated
73
goals of medication therapy
1. maintain therapeutic index/level of med in blood
2. avoid too little or too much med for pt
3. do what it is supposed to do
74
interactions/mechanisms of action
- receptor interaction
- enzyme interaction
- nonspecific interaction
75
receptor interaction
binds to a receptor site, which causes or blocks an action
76
enzyme interaction
binds with an enzyme, which may act with or block that enzyme
77
nonspecific interaction
alters a cell wall or disrupts a normal process
78
reasons for treatment with meds
- acute needs
- maintenance needs
- supplemental needs
- palliative needs
- prophylactic needs
79
monitoring needs
important because the more meds a pt has in his/her system the higher chance of interactions
80
adverse medication effect/side effect
unwanted effects produced by therapeutic levels of a drug
usually predictable
81
toxic effects/poisoning
| AKA overdose
avoidable sfx because dose was too high
| fx are usually exaggerated effect of desired action
82
additive effects
2 meds with similar actions given together; often can get by with smaller dose of each
83
synergistic effects
two meds given together makes the effect greater than if alone
84
antagonistic effects
two meds given together work against each other so effect is less than expected
85
incompatibility
two meds given react chemically to deteriorate the medications (may cause cloudiness, precipitate, or change in colour
86
allergic reaction
a reaction that triggers a person's immune system; triggers histamine and inflammation.
NRSG 213
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