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What are the 6 rights?
- right drug
- right patient
- right dose
- right route
- right time
- right documentation - "if its not written its not done"
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5 steps in the nursing process
- assessment
- diagnosis
- planning
- intervention
- evaluation
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assessment includes
- identify the reading level and cognitive abilities of the client
- identifying potential problems in medical and drug histories such as previous reactions and allergies
- monitoring lab tests for therapeautic or adverse reactions
- physical examination of the patient
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analysis and nursing diagnoses
- define actual or potential health problems
- ex: knowledge deficit, new drug regimen
- potential for bleeding
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planning is
- the goals for the patient
- They have to be measurable ex. in time or units
- ex: client verbalizes the correct times to take medications prior to discharge.
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What is needed and not needed for educating a client?
A physicians order is not needed to educate but documentation is required.
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interventitions include
monitoring labs that are affected by a medication, and how often they will be checked
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most medication errors occur when
they are administered.
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4 types of pharmacology nursing interventions are
- drug administration
- patient education
- interventions to promote therapeutic effects
- interventions to minimize side effects or adverse effects
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examples of drug interventions on a care plan include:
give pain medications as ordered and assess the clients response after 30 minutes.
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evaluation is
- how well did your care plan work?
- did the client understand your teaching?
- was the medication effective? ex reassess the patients pain level.
- does the client need further help to self administer medication? ex insulin
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Drugs have what 3 names:
- a pharmokinetic name
- a generic name
- trade or brand name
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pharmacokinetics is
how drugs are transported, abdsorbed, utilized, and excreted based upon their chemical and physiological properties.
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absorption is
the movement of the drug from its original site of administration into blood and cells
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rate of absorption determines
how soon the drug will take affect
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factors that affect absorption include
- the route of administration. ex. intramuscular and oral are slower than IV.
- lipo soluable vs non soluable. lipids pass through the cell membrane faster and makes the drugs work faster.
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availability is
how much of the drug when dissolved is readily available for absorption.ex. aspirin is broken down by the acids in the stomach to make it readily available but the alkalinity of blood does not absorb
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availability affects the
rate of absorption
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distribution = metabolism which is
how the drug is distributed and metabolized in the body
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insulin is
distributed directly by the cells as it is absorbed by them.
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most drugs are metabolized by
the liver by the P450 enzyme system
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factors affecting drug distribution/metabolism are:
- accelerated excretion by the kidneys. ex: coffee is a diuretic and causes rapid excretion of meds.
- age: the very young (less than one) and the very old have lower metabolism and poor excretion and can become toxic on smaller amounts
- drug inactivation (first pass effect) when the drug gets to the liver and metabolizes so fast that the drug is inactivated in the first dose.
- P450 enzyme competition by other meds, binding the CYP families which make some drugs unable to meabolize. They are in competition with other binding sites that are taken by other drugs.
- fluid volume and vascular resistance
- nutritional status of the patient- certain proteins and vitamins are needed for absorption of certain meds.
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90% of meds are excreted through the
kidneys
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factors affecting excretion include:
- renal function and ability to excrete and reabsorb K+, H+ and HCO3
- breast feeding - alot of drugs are passed to the infant this route.
- bile production - bowel/GI excretion
- sweat and saliva amounts
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T1/2 ( the half life of a drug) is
the time it takes for 50% o the drug in the body to be used. Literally in hours when the drug has spent half its life.
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T1/2 is used to determine
timed of dosage
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Which populations can be affected drugs with a long half life
infants and elderly due to lower metabolism and rates of excretion. These drugs can be toxic.
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If a client becomes toxic it takes how many half lives for the drug to be eliminated over time
4 half lives
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Chemotherapy peaks in _____ days. and lasts in the body for _____ days which means is T1/2 is ____ days. Which affects:
peaks at 21 days, lasts in the body 28 days, T1/2 is 14 days and it affects the kidneys and cardiac output.
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the therapeutic index is
a comparison of the drugs usual therapeutic dose (ratio) to the drugs lethal dose
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A safer drug has a _________ index
high therapeutic
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a low therapeutic index is
a drug with a closer relationship with the therapeutic dose and the lethal dose.
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name a nursing diagnosis which indicates a need for patient education
knowledge deficit
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What should a nurse educate a client on his medication
side effects, take it daily, dont take a second dose if missed ask them to repeat it to you.
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what is the difference between a generic and name brand drug?
They have different binders which some people can be allergic to
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