Pharm unit 1

a process tht helps you gain information about a patient,the patient's problem, and anyhthing that may effect the choice of drug given to a patient

listening with a setthoscope

a record

a conclusion aabout the patients problems; the physician will decide the medical diagnosis, the nurse will decide the nursing diagosis.

is the process of looking at what happens once a care plan is implamented ((requires a nurse to watch for a patients response to drugs, noteing both the expected, and unexpected findings))

following the care planand giving the medication accurately to a patient

a close observation

a plan developed over the years that and coordinates a nurses actavities. its five major parts are assessment, diagnosis, planning, evaluation. (adpie)

• any observed and/or measureable information obtained from documentation that patients may bring with them, such as electrodiagrams,  x-rays, of information that can be directly observed during aphysical examination
• or obtained during a laboritory test, and diagnostic procedures.

is feeling, or touching

is detecting differences in vibrations through skin

are the six points to check when administering a drug. these include five pints to check before administering medication. (the righ drug, the right time, the righ dose, the right patient, the right rout.) and one more point to check rite after administeration; (the right documentation)

infromattion supplied by the patient family, it may be felt or known only by the patient, and not detectanble to anyone else.

when a drug produces the intened reaction and the theraputic goal is met.

• ADPIE is the acronym used for the nursing process; the five logical steps in the nursing plan.
• 1 Assessment - interview, get history, and physical exam from the patient./
• 2 Diagnosis you, as a nurse make a nursing diagnosis by finding the problems a patient has.
• 3 Planning - you set the thereputic goals with your patient, gain, share knowleges of you patients medications with the patient; get special needs equipment for your patient,and teach your patient at their learning levels.
• 4 Implementation you make sure you have the right drug, the right time, the righ tdose right patient , right rough and right documentation.
• 5 Evaluation: Document the patients theraputic effects, adverse effects, and allergies to the medications

• Chech the right drug label at least 3 times:
• 1 - before taking the drug from the unit dose cart or shelf
• 2 - before preparing or measureing the prescribed dose of medication.
• 3 - before putting the medication back on the shelf or just before opening the medication at the time you give it to the patient.

check the right time by paying close attention to special dietary restrictions; one-time-only, as needed (“pnr”) or “stat” on medications.

Check to make sure the dose is correct. Pay close attention to doseespecially with infants, children, older adults, and obese people

Make sure you have the right patient by looking at their identification bracelets, and ask them their name and date of birth.

Make sure you give the medication the route the       physician ordered the medication to be given.

For right documentation note how and when you gave the drug

Chart the drug given, the dose, and the time the drug       was actually given (not the time it was supposed to be given).

NEVER!

• The right drug
• the Drug must be varified 3 times:
• 1.      Before taking the drug from the unit dose cart or shelf
• 2.      Before preparing the prescribed dose
• 3.      Before replacing the medication on the shelf or before administering it to the patient

• (1) any part of theorder is incorrect or unclear,
• (2) the patient’s condition would be made worseby the medication,
• (3) the physician may not have had all the informationneeded about the patient when drug therapy was planned, 
• (4) there has been achange in the patient’s condition and a question has arisen about whether themedication should be given

the process of looking atwhat happens when the care plan is implemented. Evaluation requires the nurseto watch for the patient’s response to a drug, noting both expected andunexpected findings.

 are seen when the drug does what it was supposed to do. If you understand why the medication is being given, you will be able to decide whether or not that goal is being met.

 are seen when patients do not respond to their medications in the way they should or develop new signs or symptoms.

• Generic Names – same in all countries and is not capitalized
• Trade names have the r symbol. They are catchy and capitalized
• Sound alike drugs, drugs whos names look, and/or sound alike EX. Novolog and Novolin

a patient follows a prescribed plan of care

when a patient doesn’t follow a prescribed planof care.

the ability to read, write, and speak English,do math and solve problems at the level necessary to function on the job and insociety.

 the ability to understand and use information that is important in keeping them healthy

 a person with a low literacy level is often at a higher risk for disease and disability. They may die of disease than someone with higher literacy.

• Teaching should be offered systematically to decrease stress for the patient.
• Teaching should be done in a timely way and in a quiet unhurried setting so the patient has a chance to ask questions
• Offer 3 major pieces of information in the order they need to be remembered.

• Teaching should be offered systematically to decrease stress for the patient.
• Teaching should be done in a timely way and in a quiet unhurried setting so the patient has a chance to ask questions.
• Offer 3 major pieces of information in the order they need to be remembered

• Verbal Education:
• direct teaching with the nurse telling the patient information, and then giving the patient a chance to ask questions
• Written information
• this can incluse, special lables for perscription bottles, materials inserted in the drug packet, booklets that accompany the booklet
• Audiovisual resources: slide tape programs, videocasettes, and CD-ROMs
• Nurse and patient use on the internet

• So the Pt. understands why they are taking the medications, So that the Pt. continues to take the medication, and so the patient knows the risks and the allergic reaction of the medication.
•  THE NURSE MAY BE HELD LEGALLY RESPONSIBLE FOR FAILURE TO TEACH THE PATIENT THIS INFORMATION.

a.       EVALUATION OF LEARNINGb.      Throughout the teaching process it is important for the nurse to summarize, repeat, and keep in simple.  Check for understanding as the teaching continues by having the patient repeat back the important points.  It is important not to create fear or stress when quizzing patients on information that has been discussed.  Not in the patient's record what has been taught.  This not should list the important topics covered, state what material was given to the patient, and provide your view of the patient's level of understanding.  And list anything that has made you believe that the patient is willing to carry out the treatment plan.

a category of drugs that are most heavily regulated by US federal legislation because of their high potential for abuse. includes major pain killers (narcotics) and some sedatives, or tranquilizers.

a category of drugs created by the US govvernment, because they are dangerous, and their use must be controled. maybe purchased only when prescribed by an othorized perscriber. Examples are antibiotics and oral birth control.

acategory of drugs identified by federal legislation as having low risk to patients and may be purchased without a perscription

Built-in safety features to reduce risk of infection and other hazards in health care institutions

refers to a physiologic need for medication to relieve shaking, pain, or other symptoms

refers to  anxiety, stress, or tension that is felt if the patient does not have the medication. one type of dependance often leads to another, both types of dependance are often found together in the same individual.

a list of nimbered patinent problems as an index to the chart.

a nurses responsability for dilivering meds appropriately, ethicaly, and to the best of her ability.

a nursrs responsability for good judgement, and actions while carrying out professional duties

controlled substances that are highly regulated because they commmonly abused

• High potential for abuse,  (no currently accepted medical use) lack of acceptable safety for use under medical supervision.
• EX. hashish, heroin, lysergic acid diethylamide (LSD), marajuana, peyote, 2,5-diemethylmidemethenphedamine (STP)

• High potential for abuse, may lead to savier psychologic or physical dependance.
• EX. amphedamines, meperidine, methadone, methaqulone, morphine, pentobarbitol, oxycodone, (percocet), secobarbitol.

• Potential for abuse that may lead to moderate to low physical dependance, and psychological dependance.
• EX glutethimide, asprin with codine, (Emprine with Codine), asprin with bubitol and caffine (Fiorinol), methaprylone, paregoric, acetaminiphine with codine,

• Abuse potential may lead to limited physical or psychological dependance
• EX. lorazapam  (Ativan), Diazapam (Valium)

• Abuse potential may lead to limited physical or psychological dependance
• EX. diphenoxlate, with trophine sulphate, (lomotil) ,guaifenesin with codine sulfate antitussives

Even though perscription drugs do not requre a perscripton for purchase, a physitians order is nessisary before thy can be given at the hospital. --- even OTC meds carried in by the patients themselves can only be taken with a physicians order.

a.       If a dose is ordered that is smaller than that provided (so that some medication must be discarded), or if the medication is accidentally dropped, contaminated, spilled, or otherwise made unusable and unreturnable, two nurses must sign the inventory report and describe the situation. The medication given should be noted in the patient’s chart, and there should also be a follow-up note about the patient’s response to the medication.   

as desired

capsule

compound

day or give

dilute

divide

dose

drain

elixer

extract

minim

per rectum

take

mark

mark or write on the lable

one half

tablet

three times a day

tincture

ointment

dram

ounce

it is hunted down, all nurses with a key have to be questoined, all pt charts have to be searched, if it cant be reconsiled, it has to notified to administration, and pharmacy BIG errors cet a call to the cops

a.       When it's discovered that an error has been made, the nurse should immediately check the patient. (Giving to much insulin?)  If the error poses a risk to the patient's condition... the physician should be notified promptly, and orders from the physician should be followed.  Continue watching the patient's condition through measuring vs., drawing blood for tests, etc...The nurse should also notify charge nurse, record in the pt's chart exactly what happened and fill out incident report. Half of the adverse medical events occurring each year are because of medical errors that could be prevented.

• -Standing order- Indicates that the drug is to be administered until discontinued or for a certain number of doses. Hospital policy dictates that most standing orders expire after a certain number of days.  A renewal order must by written by the physician before the drug may be continued.
• Stat order- One time order to be given immediately
•  Single order -one time order to be given at specified time.PRN order -Given as needed based on nurse's judgment of safety and pt need

 involves the way a drug enters the body and passes into the body fluids and tissues

two drugs are given together and the combined effect of the drugs is equal to either that of the most active drug or the sum of the effects of the individual drugs

   or adverse effects, usually imply more severe symptoms or problems that develop because of the drug

 some drugs attach at the receptor site and activate the receptor, producing an action similar to that of the body’s own chemicals

– sensitivity caused by antibody response to a drug

      – occasionally, the allergic reaction is so severe that the patient has trouble breathing, and rarely the heart may stop

a.       – described as, if one drug interferes with the action of another drug

a.     – Products that chemically identical

a.       – Medication that have to be broken down into smaller usable parts, primarily in the liver, through a series of complex chemical reactions until they become chemically inactive

a.       – are often the most difficult to remember, because they include the chemicals that make up the drug.

the expected response of the medication

– at times, one drug may replace another at a receptor site, increasing the effect of the first drug

a.       - refers to the ways that drugs move by means of circulating body fluids to their sites of action in the body

a.      – when one drug changes the action of another drug

a.       Enteral – directly into the gastrointestinal tract through oral, nasogastric tube, or rectal administration

a.       –All inactive chemicals chemical by-products are waste finally break down through metabolism and are removed from the body

a.       – when most of a medication goes very quickly to the liver, a lot of medication is inactivated and can’t be distributed to other parts of the body

a.       – most common drug name. this is the name the drug manufacturer uses a drug and it is the same in all countries

a.        – the time it takes the body to remove 50%

a.       – damage to the liver by a drug

a.       – an increase reaction to the drug

a.    – strange, unique, or unpredicted response

a.       – occurs when drugs do not mix well chemically

a.       – is seen when one drug promotes the rapid excretion of another drug, thus reducing its activity

a.    – the name that is given by the Food and Drug Administration.

a.       ) – directly into dermal, subcutaneous, or intramuscular tissue, epidurally into the cerebrospinal fluid, or into the bloodstream through intravenous injections

a.       (route) – through topical

 what the drug does to the body

a.       – what the body does to the drug

a.   – drugs most commonly forms a chemical bond at a specific site in the body

a.        – or brand name. this name is often followed by the symbol R, which indicates that the name is registered to a specific drug maker or owner and no one else can use it

• i.      Other drugs attach at the receptor site.                                                           
•   ii.      no new chemical reaction                                                        
•   iii.      prevent activation of the receptor, stopping other reactions from occurring