BSN - 2C PHARMA (2nd yr).pdf

GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA PHARMACOLOGY 1. SIX SOUR...

GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA PHARMACOLOGY 1. SIX SOURCES OF DRUGS Plant Sources (digitalis, opium) - oldest form, the study of the biological effect of drugs on 2. Animal Sources (Insulin,vaccines) living organism 3. Mineral Sources (Iron, NaCl) The study of medicine 4. Microbiological Sources Derive from two Greek word: 5. Semi Synthetic/Synthetic - ecstasy and ○ Pharmakon - medicine 6. Recombinant DNA Technology ○ Logos - study Prescription history likely began when humans first used The written direction for the preparation and plants to relieve symptoms of disease administration of a drug 300 B.C NAME OF DRUGS the Babylonians recorded the earliest surviving Generic Name "prescriptions" on clay tablets is assigned by the United States Adopted 2700 B.C Names (USAN) Council and is used the Chinese recorded the Pen Tsao (Great throughout the drug's lifetime. Herbal), a 40-volume compendium of plant Example: amoxicillin, paracetamol remedies Brand/Trade name 1500 B.C Sometimes called "Brand Name" Egyptians archived their remedies on a is the name given by the drug manufacturer document known as the Eber's Papurus and identifies it as property of that company. 1800 Chemical Name the start of modern pharmacology is assigned using standard nomenclature 20th Century established by the International Union of Pure Pharmacologists no longer rely on slow and Applied Chemistry (IUPAC). process of isolating active agents from scarce a drug has only one chemical name, which is natural sources sometimes helpful in predicting a substance Could synthesize drugs in the laboratory physical and chemical properties it became possible to understand how drugs Example: produced their effects, down to their molecular Lithium carbonate - for bipolar, acute manic mechanism of action. & depression Materia Medica Calcium gluconate - to increase blood study of herbal remedies persisted until the calcium early 20th century Sodium chloride - also called as normal Pharmacologia Sen Manuductio ad Materiam saline Medicum First recorded reference to the word Official Name pharmacology by SAMUEL DALE 1693 is the name of the drug as it appears in the Friedrich Serturner official reference, the USP/NF; generally the first isolated morphine from opium in 1805 same as the generic name. injected himself & his 3 friends with a huge TWO METHODS OF DISPENSING DRUGS dose & suffered morphine intoxication for 1. Prescription a written order from a person with the legal several days afterward authority to write such a prescription ADVANTAGES OF A PRESCRIPTION First pharmacology dept in US - 1890 @ University of Michigan founded by John The nurse has the opportunity to examine the Jacob Abel considered as the Father of patient & determine a specific diagnosis American Pharmacology Practitioners can minimize therapy by ordering First Dept of Pharmacology - est in Estonia the proper drug for the patient's condition & by 1847 conveying the amount & frequency of the drug to be dispensed. 1 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA The healthcare provider has an opportunity to Blocks heart calcium Calcium channel blockers teach the patient the proper use of the drug channels and the side-effects to expect. 2. Over the Counter (OTC) Blocks hormonal activity Angiotensin-converting enzyme inhibitor Does not require a healthcare provider's order Patients may treat themselves safely if they Blocks physiological Adrenergic antagonist follow instructions included with the medication reactions to stress If the patient's does not follow instructions, the Dilates peripheral blood Vasodilator OTC can have adverse effects vessels Preferred by people, no need an appointment with the doctor thus saving time and money OTC reacts with foods, herbal products, other PHARMACOTHERAPEUTICS Drug Action drugs and other OTC drugs 1. Pharmaceutic Self-medication/tx is sometimes ineffectual 2. Pharmacodynamics and the potential for harm may increase if the 3. Pharmacokinetics disease is allowed to progress PHARMACOTHERAPEUTICS Sources of Drug Information is the application of drugs to treat, prevent and 1. Drug Labels diagnose disease. 2. Package Inserts Therapeutics is the branch of medicine 3. Reference Books concerned with the prevention of disease and 4. Journals treatment of suffering 5. Internet Information Substances applied for therapeutic purposes 2 Classification of Drugs Therapeutic Classification fall into one of the following 3 general based on their therapeutic usefulness in categories: treating particular diseases. ○ Drugs or medications what a particular drug does clinically ○ Biologics Focus: Cardiovascular Function ○ Complementary and alternative medicine (CAM) therapies Usefulness Drug Classification Pharmaceutic first phase of drug action wherein drugs should Influence blood clotting Anticoagulant be in a solution form Lower blood cholesterol Antihyperlipidemic 2 phases: 1. Disintegration Lower blood pressure Antihypertensive breakdown of an oral drug into smaller Restore normal cardiac Antidysrhythmic particles rhythm 2. Dissolution (drugs in liquid form are already in solution) Treat angina Antianginal the rate of dissolution is the time it takes the drug to disintegrate and Pharmacologic Classification dissolve to become available for the refers to the way a drug works at the body to absorb it. molecular, tissue, and body system levels Pharmacokinetics addresses a drug's mechanism of action Pharma - medicine Focusing on Therapeutic Application: Kinetics - movement or action Pharmacotherapy for Hypertension the study of drug movement throughout the Mechanism of Action Drug Classification body (MOA) describe how the body deals with medication Four Categories (ADME) Lower plasma volume Diuretic 1. Absorption 2. Distribution 2 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA 3. Metabolism Drug's properties - lipid solubility, ionization, 4. Excretion protein binding abilities Absorption Individual patient's characteristics - cell is a process involving the movement of a membrane permeability, tissue perfusion, substance from its site of administration, special barriers across body membranes, to circulating fluids. Metabolism Drugs may be absorbed across the skin and also known as biotransformation associated mucous membranes, or they may is the process of chemically converting a drug move across membranes that line the to a form that is usually more easily removed gastrointestinal (Gl) or respiratory tract from the body (a less active form). is the primary pharmacokinetic factor Liver - is the primary site of drug metabolism determining the length of time it takes a drug so changes in hepatic metabolism can to produce its effect significantly affect drug action. Depends on the: Biotransformation may be altered if a person is Drug formulation/route of administration/dose very young, is older, or has an unhealthy liver. Size of the drug molecules Nurses must be alert to the accumulation of its lipid solubility the active drug in these clients and to its degree of ionization subsequent toxicity. interactions with food or other medications Most metabolism in the liver is accomplished The Passage of Drugs through Plasma Membranes by the hepatic microsomal enzyme system 1. Active Transport (P450 System). Requires carrier such as an enzyme or protein the primary actions of the hepatic microsomal This is movement of a chemical against a enzymes are to inactivate drugs and concentration or electrochemical gradient accelerate their excretion Energy required for active absorption Excretion 2. Passive Transport (diffusion) Process how drugs are removed from the This is movement of a chemical from an area body of higher concentration to an area of lower Kidney - the main route of drug excretion concentration Other route: respiratory system, GIT, skin facilitated diffusion - relies on a carrier The rate at which medications are excreted protein to move the drug from an area of determines the concentration of the drugs in higher concentration to an area of lower the bloodstream and tissues. concentration. Half-life Passive transport does not require energy to The amount of time required for 50% of the move drugs across the membrane. drug to be eliminated from the body Bioavailability Factors that Affects Drug Excretion percentage of administered drug available for Liver or Kidney impairment activity. Blood flow For orally administered drugs, bioavailability is Degree of ionization affected by absorption and first-pass Lipid solubility metabolism. Drug-protein complexes Distribution Metabolic activity involves the transport of drugs throughout the Acidity or Alkalinity body Respiratory, Glandular or Biliary activity the transportation of a drug from its site of Factors Affecting the Body’s Response to Drugs absorption to its site of action Weight The simplest factor determining distribution is Age the amount of blood flow to body tissues. Gender Depends on: 3 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA Physiological factors - diurnal rhythm, Graded dose-response relationship electrolyte balance, acid-base balance, describes how the therapeutic response to a hydration drug changes as the medication dose is Pathological factor - disease, hepatic increased dysfunction, renal dysfunction, gastrointestinal Phase 1: when medicine is given, bacteria is groggy dysfunction, vascular disorders, low blood Phase 2: bacteria will be asleep due to increase of pressure dose Genetic factors Phase 3: Plateau - end of treatment therapy/bacteria Immunological factors - allergy will be killed Psychological factors - placebo effect, health 1-10.000 mg - therapeutic effect belicts. compliance over 10.000 mg - toxic effect Environmental factors - temperature, light, Potency noise the dose of medication required to produce a Drug tolerance particular response Cumulation effects tapang ng medicine Interactions (nirequired lang na dosage para maging mas Pharmacodynamics potent ang medicine pag kinompare sa ibang is the mechanism of drug action and the gamot) relationships between drug concentration and Efficacy responses in the body. the magnitude of maximal response to a drug Pharmaco - medicine bisa ng medicine Dynamics - change Drug-receptor interaction Drugs usually work in one of four ways: When a drug binds to a receptor, several 1. To replace or act as substitutes for missing therapeutic consequences can result chemicals. relationship of drug and receptor site 2. To increase or stimulate certain cellular receptor theory - mechanism by which drugs activities. targeting its target sites 3. To depress or slow cellular activities: Agonist 4. To interfere with the functioning of foreign Drugs that activate receptors and produce a cells, such as invading microorganisms or desired response neoplasms. (Drugs that act in this way are Mimics the effect; activator called chemotherapeutic agents.) ex: insulin (lowers blood sugar) Therapeutic Index Antagonist relationship between the therapeutic dose of Drugs that prevent receptor activation and a drug (ED50) and the toxic dose of a drug block a response (TD50). inhibitor / blocker ED50 is the dose of a drug that produces a ex: atropine sulfate - increases heart rate therapeutic response in 50% of the population; which were given to person experiencing TD50 is the dose of a drug that produces a bradycardia Partial Agonist toxic response in 50% of the population. drugs that elicit only moderate activity when Expressed mathematically as LD50 ÷ ED50, is binding to receptors a value representing the margin of safety of a also prevent receptor activation by other drug drugs. the higher the TI, the safer Onset of Action the greater the difference of 2 doses, the is the time it takes for a drug to reach the higher the TI minimum effective concentration (MEC) after to determine the safety of certain medication administration 4 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA Peak of Action DRUG STANDARDS AND LEGISLATION occurs when it reaches its highest Food and Drug Administration concentration in the blood was officially established in 1988 as an agency Duration of Action of the U.S. Department of Health and Human is the length of time the drug exerts a Services O is responsible for protecting the therapeutic effect public health by ensuring the safety, efficacy, Loading Dose and security of human and veterinary drugs, use of a higher dose than that which is usually biological products, and medical devices; and used for treatment to allow the drug to reach by ensuring the safety of.our nation's food the critical concentration sooner supply, cosmetics, and products that emit given once radiation. maintaining dose - after loading dose ensures that drugs and medical devices are SIDE EFFECT safe and effective secondary side effect of drug therapy Responsible in the review and approval Adverse Reaction process for a particular drug are unintentional, unexpected reactions to The Drug Approval Process drug therapy that occur at normal drug Phase 1. Preclinical Investigation dosages. Phase 2. Clinical Investigation Drug Toxicity Phase 3. Review of the New Drug Application (NDA) occurs when drug levels exceed the Phase 4. Postmarketing surveillance therapeutic range Branches of Food and Drug Administration Center for Drug Evaluation and Research (CDER) Tolerance Exercises control over whether prescription refers to a decreased responsiveness to a drugs and OTC drugs may be used for therapy drug over the course of therapy Center for Food Safety and Applied Nutrition Tachyphylaxis (CFSAN) Refers to an acute, rapid decrease in Oversees administration of herbal products response to a drug; it may occur after the first and dietary supplements dose or after several doses Center for Biologics Evaluation and Research Placebo effect (CBER) is a drug response not attributed to the regulates the use of biologics including chemical properties of the drug serums, vaccines, and blood products Mechanism of Drug Action Stimulation National Center for Complementary and The enhancement of the level of activity of Alternative Medicine (NCCAM) specialized cells was established for scientific research and Depression information about CAM therapies The reduction of activity of specialized cells Controlled Substance Replacement drug whose use is restricted The replacement of essential body compounds Some drugs are frequently abused or have a Irritation high potential for addiction. Drugs that often cause toxic effect on the In hospitals, controlled substances are kept in specialized cell a locked drawer, cupboard, medication cart, or Cytotoxic computer-controlled dispensing system. selectively kill invading parasites or cancers Agencies may have special inventory forms for Antimicrobial recording the use of controlled substances. prevent, inhibit, or kill infectious organisms Most health care agencies maintain a list of Modification of Immune Status high-alert medications, including controlled modify, enhance, or depress the immune substances, which require the verification of system two registered nurses. 5 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA Included on the record are the controlled Name (generic and trade) and drug substances wasted during preparation classification. In most agencies, counts of controlled Intended or proposed use. substances are taken at the end of each shift. Effects on the body. Addiction refers to the overwhelming feeling Contraindications. that drives someone to use a drug repeatedly. Special considerations (e.g., how age, weight, Dependence is a related term, often defined body fat distribution, and individual as a physiological or psychological need for a pathophysiological states affect substance. pharmacotherapeutic response). SCHEDULE DRUGS - drugs that have a Side effects. significant potential for abuse are placed into 5 Why the medication has been prescribed for categories called schedules this particular patient How the medication is supplied oy the pharmacy. How the medication is to be administered, including dosage ranges What nursing process considerations related to the medication apply to this patient Compliance taking a medication in the manner prescribed by the health care provider, or in the case of OTC drugs, following the instructions on the label. Drug Order and Time Schedules Teratogen STAT order is a substance that has the potential to cause refers to any medication that is needed a defect in an unborn child during pregnancy immediately and is to be given only once ASAP order (as soon as possible) should be available for administration to the patient within 30 minutes of the written order Single order is for a drug that is to be given only once, and at a specific time, such as a preoperative order. Prn order (Latin: pro re nata) is administered as required by the patient's condition Routine order are usually carried out within 2 hours of the Principles of Drug Administration time the order is written by the health care Responsibilities of Nurse provider 1. Medication Knowledge and Understanding Standing order 2. The 10 Rights of Drug Administration is written in advance of a situation that is to be 3. Patients Compliance and Successful carried out under specific circumstances. Pharmacotherapy System of Measurement 4. Drug Order and Time Schedules 3 Systems of Measurement used in Pharmacology 5. System of Measurement 1. Metric System Medication Knowledge and Understanding 2. Apothecary What drug is ordered. 3. Household 6 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA ROUTE OF ADMINISTRATION document the reason when possible 1. Enteral - orally, NGT concerns or complaints the patient verbalized 2. Topical - cream, ointment, suppository must also be included 3. Parenteral - IV, IM, ID MEDICATION ERROR GUIDELINES BEFORE DRUG ADMINISTRATION any preventable event that may cause or lead Verify the medication order and check for to inappropriate medication use or patient allergy history on the chart. harm while the medication is in the control of Wash your hands and apply gloves, if the health care professional, patient, or indicated. consumer. (NCCP MERP) Use aseptic technique when preparing and FACTORS CONTRIBUTING TO MEDICATION administering parenteral medications. ERRORS (By Health care Practitioner) Aseptic technique means using practices and Omitting one of the rights of drug procedures to prevent contamination from administration pathogens Failing to perform an agency system check. Identify the patient by asking the person to Failing to account for patient variables such as state his or her full name (or by asking the age, body size, and impairment in renal or parent or guardian), checking the identification hepatic function. band, and comparing this information with the Giving medications based on verbal orders or MAR or scanner and computer. A second item phone orders, which may be misinterpreted or of personal identification, such as asking the go undocumented. birth date, is also required by most health care Giving medications based on an incomplete agencies. order or an illegible order when the nurse is Ask the patient about known allergies. unsure of the correct drug, dosage, or Inform the patient of the name of the drug, the administration method. expected actions, common adverse effects, Practicing under stressful work conditions and how it will be administered. FACTORS CONTRIBUTING TO MEDICATION Position the patient for the appropriate route of ERRORS (By Patient) Taking drugs prescribed by several administration. practitioners without informing each of their For enteral drugs, assist the patient to a sitting health care providers about all prescribed position. medications. If the drug is prepackaged (unit dose), remove Getting their prescriptions filled at more than it from the packaging at the bedside. one pharmacy. Unless specifically instructed to do so in the Not filling or refilling their prescriptions. orders, do not leave drugs at the bedside. Taking medications incorrectly. Document the medication administration and Taking medications that may have been left any pertinent patient responses on the MAR. over from a previous illness or prescribed for After Drug Administration 1. The nurse must correctly document that meds something else. was given. Documentation must only happen REPORTING AND DOCUMENTING MEDICATION ERROR AFTER the medications has been given and Documeting not before or when they are prepared. Facilities should have policies 2. Must include: Factual manner drug name Avoid blaming and making judgement dosage Includes nursing interventions done time administered Includes individual who were notified of error any assessment Should also be written on MAR nurses' signature Reporting 3. If medications is omitted or refused: An "Incident Report" or "Occurrence must be recorded on the appropriate form Report" within the medical record 7 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA Specific details of the error should be recorded 3. Transcellular - known as the third space, in a factual and objective manner contains mucus and gastrointestinal (GI), Not included in patient's medical record cerebrospinal, pericardial, synovial, and ocular STRATEGIES FOR REDUCING MEDICATION fluids ERRORS ELECTROLYTES Composition of Body Fluid The nurse can reduce medication errors by 1. Intracellular Fluid (ICF) adhering to the four steps of the nursing K (+) cation process Mg (2+) Keeping up to date on pharmacotherapeutic Phosphate (2-) anion knowing common error types Sulfate (2-) NURSING PROCESS 2. Extracellular Fluid (ECF) 1. Assessment Na (+) 2. Nursing Diagnosis CI (-) 3. Planning НСО3 (-) 4. Intervention Ca (+) 5. Evaluation MOVEMENT OF BODY FLUIDS AND Computing Dosages of Medication ELECTROLYTES 1. OSMOSIS - movement of water across a semipermeable membrane from areas of low solute concentration to those of high solute concentration 2. DIFFUSION - movement of molecules from an area of high concentration to one of low D = (i.e., dose ordered by primary care provider) concentration H = (i.e, dose on label of bottle, vial, ampule) 3. HYDROSTATIC PRESSURE - the force within V= (i.e., form in which the drug comes, such as tablet a fluid compartment or liquid) 4. OSMOLALITY - describes the concentration Maintenance of Homeostasis of fluids Homeostasis 5. ACTIVE TRANSPORT - requires metabolic Delicate balance of fluids, electrolytes, acid, activity and expenditure of energy to move a and bases within the body despite a constantly substance across a cell membrane changing external environment. Osmolality 60% of average healthy adult's weight is water Refers to the number of particles dissolved in (fluid the serum, primarily sodium, urea (BUN), and Age, Sex, and Body fat affect total body water glucose Electrolytes - charge ions capable of Normal Range: 275 - 295 mOsm/Kg conducting electricity, are present in all body Sodium - greatest determinant of the fluids and compartment. osmolality of plasma or the ECF Distribution of Body Fluids (2 Major Potassium - the primary determinant of the Compartments) osmolality of the ICF 1. Intracellular Fluid (ICF) 3 Types of Fluid Concentration Based on the 2/3 of the total body fluid, found within the cells Osmolality of Body Fluids of the body 1. Iso-osmolar fluid - has the same weight 2. Extracellular Fluid (ECF) proportion of particles (e.g., sodium, glucose) Found outside the cell that account about 1/3 and water. of the total body fluid 2. Hypo-osmolar fluid - contains fewer particles 3 subcompartment: than water. 1. Interstitial - bathes and surrounds the tissue 3. Hyper-osmolar fluid - contains more particles cells than water. 2. Intravascular - contains the plasma and blood vessels 8 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA TONICITY ○ NSS (0.9% NaCl) Osmotic pressure exerted by the IVF on the ○ D5W semipermeable cell wall membrane 2. Hypotonic Used primarily as a measurement of the Exert less osmotic pressure than ECF; fluid concentration of IV solution compared with the goes into the cells osmolality of the body fluids CELL SWELL Fluid REPLACEMENT USES: 2,300-2,900 ml/day - recommended water ○ DKA intake for a healthy adult ○ Increased total fluid Kidney - major organ regulating fluid loss ○ Gastric fluid loss 1,200-1,500 ml/day - urine produce by EXAMPLES: kidney/day ○ 0.45% NaCl Fluid Loss ○ 0.33% Na C 1. Insensible Water Loss - continuous and 3. Hypertonic occurs daily through the skin and lungs without Exert greater osmotic pressure than ECF; fluid awareness and is not measurable goes out of cell 2. Sensible Water Loss - occurs through the; CELL SHRINK lungs/respiration (500 mL/day) USES: perspiration/skin (500–600 mL/day) ○ Severe, Na the GI tract/feces (200 mL/day) and is ○ Overload of fluid measurable. ○ Cerebral edema Consideration before IVF Administration ○ Ketosis 1. Purpose EXAMPLES: 2. Patient requirements ○ 3% NaC; D10W 3. Patient's weight, caloric needs, body surface area Name of IV Color Type 4. Illness and surgery 5. Ongoing assessment and monitoring PNSS Green Isotonic IVF (IV solutions) Plain LRS Blue Isotonic 3 General Classifications 1. Crystalloids D5LRS Pink Hypertonic 2. Colloids 3. Blood and Blood Products D5Water Red Isotonic CRYSTALLOIDS are solutions that contain fluids and D10Water Blue Green Hypertonic electrolytes and freely cross capillary walls Used as: D5 0.3 NaCI Sky Blue Hypertonic a short term maintenance fluid Treat dehydration and electrolytes imbalances 3 Major Classifications 1. Isotonic Same osmolality as ECF or plasma Does not change the shape of the cell USES: ○ Burns/Blood loss ○ Anaphylaxis/sepsis ○ Dehydration EXAMPLES: ○ LR (Lactated Ringer) 9 I Kyla De Torres  GOLDEN GATE COLLEGES COLLEGE OF NURSING BATCH 2024 PHARMACOLOGY (1ST SEM) MA’AM LENY VERAÑA COLLOIDS Unit used in measurement of I&O is milliliter Are solutions that contain protein or other (ml) large molecular substances like carbohydrates Thirst mechanism and lipid that increase the osmolarity without most important physiological regulator of dissolving in the solution fluid intake Known as PLASMA VOLUME EXPANDER Kidney INDICATION: Hypovolemic shock primary regulators of fluid output Example: Measuring fluid intake entails recording each item of 1. Dextran fluid consumed or administered, all of the following are 2. Albumin recorded: Blood and BLOOD PRDUCTS oral fluids (water, juice, milk, soup) Blood products include: liquid fluids at room temperature (icecream, ○ PRBC gelatin) ○ Plasma tube feedings including the water for flushing Nursing Considerations: parenteral fluids ○ Complete thorough patient blood products assessment BEFORE, DURING and IV medications AFTER administration Measurement of fluid output includes: ○ Verify with 2 nurses urinary output ○ Maximum Rate of an Infusion 4 vomitus hours/unit liquid feces ○ Begin at slow rate 25-50ml for first 15 tube drainage minutes wound and fistula drainage ○ VS every 15 minutes after starting the transfusion Measurement of I&O are totaled at the end of ○ Stop transfusion if s/sx of transfusion the shift and documented in the patient's chart reaction occur Determine if intake and output are Dilutions and Solutions Solution: mixture of substances made by proportional. When there is significant dissolving solids in liquids or liquids in liquids discrepancy between I&O, report to the Solvent: solution capable of dissolving other primary care provider. substances Solute: substance that is dissolved in liquid Dilution: reduction of a concentration of a substance. Diluent: agent that dilutes The concentration of the substance is the amount of solute dissolved in the solvent. Concentrations are expressed as volume per volume (v/v), weight per volume (w/v), or weight per weight (w/w). Fluid Intake and Output Computation Intake and output (I&O) measurement and recording is usually done to monitor a client's fluid and electrolytes balance during a 24-hour period Intake and output is done for patients with increase risk for fluid and electrolytes imbalance (e.g., heart failure, kidney failure) 10 I Kyla De Torres