Objectives TEST 1.docx

Pharmacology TEST 1 Objectives Chapters 1,2,3,4,5,7 Chapter 1: Make sure you know how to convert ML to teaspoon (no formulas allowed) 5 mL = 1 tsp Nursing Diagnosis – is the same as a human needs statement. • Part 1—“Altered safety needs, risk for injury” is the statement of the human response of...

Pharmacology TEST 1 Objectives Chapters 1,2,3,4,5,7 Chapter 1: Make sure you know how to convert ML to teaspoon (no formulas allowed) 5 mL = 1 tsp Nursing Diagnosis – is the same as a human needs statement. • Part 1—“Altered safety needs, risk for injury” is the statement of the human response of the patient to illness, injury, medications, or significant change. This can be an actual response, an increased risk, or an opportunity to improve the patient’s health status. • Part 2—“Related to lack of experience with medication regimen and second-grade reading level as an adult.” This portion of the statement identifies factors related to the response; it often includes multiple factors with some degree of connection between them. The human need statement does not necessarily claim that there is a cause-and-effect link between these factors and the response, only that there is a connection. • Part 3—“As evidenced by inability to perform a return demonstration and inability to state adverse effects to report to the prescriber.” This statement lists clues, cues, evidence, and/or data that support the nurse’s claim that the human need statement is accurate. The Nursing Process -A research-supported organizational framework for professional nursing practice -Ensures the delivery of thorough, individualized, and quality nursing care to patients -Requires critical thinking -Ongoing and constantly evolving process Interpersonal Education Collaboration (IPEC) was Formed in 2009 with the Objective to Develop core competencies for interprofessional collaborative practice. Interprofessional education occurs when students from two or more professions learn from and with each other. The goal is to Improve health outcomes. Five Steps of the Nursing Process Step 1: Assessment - Objective Data & Subjective Data Objective data includes information available through the senses, such as what is seen, felt, heard, and smelled. Among the sources of data are the medical record, laboratory test results, reports of diagnostic procedures, physical assessment, and examination findings. Examples of specific data are age, height, weight, allergies, medication profile, and health history. Subjective data includes all spoken information shared by the patient, such as complaints, problems, or stated needs (e.g., patient complains of “dizziness, headache, vomiting, and feeling hot for 10 days”). ASSESSMENT INCLUDES: Data collection, review, and analysis Medication profile All drug use Prescriptions Over-the-counter medications Vitamins, herbs, and supplements Compliance and adherence Step 2: Diagnosis / Human Need Statements Once the assessment phase has been completed, the nurse analyzes objective and subjective data about the patient and the drug and formulates statements of human need fulfillment/alteration. The following is an example of a human need statement: “Altered safety needs, risk for injury, related to medication-induced sedation as evidenced by decreased sensorium, dizziness, confusion. . . .” This statement of human need can be broken into three parts, as follows: • Part 1—“Altered safety needs, risk for injury” is the statement of the human response of the patient to illness, injury, medications, or significant change. This can be an actual response, an increased risk, or an opportunity to improve the patient’s health status. • Part 2—“Related to lack of experience with medication regimen and second-grade reading level as an adult.” This portion of the statement identifies factors related to the response; it often includes multiple factors with some degree of connection between them. The human need statement does not necessarily claim that there is a cause-and-effect link between these factors and the response, only that there is a connection. • Part 3—“As evidenced by inability to perform a return demonstration and inability to state adverse effects to report to the prescriber.” This statement lists clues, cues, evidence, and/or data that support the nurse’s claim that the human need statement is accurate. Human need statements are prioritized in order of criticality based on patient needs or problems. The ABCs of care (airway, breathing, and circulation) are often used as a basis for prioritization. Prioritizing always begins with the most important, significant, or critical need of the patient. Human need statements that involve actual responses are always ranked above statements that involve only risks. Step 3: Planning: Outcome Identification The planning phase includes the identification of outcomes that are patient oriented and provide time frames. Outcomes are objective, realistic, and measurable patient-centered statements with time frames. Step 4: Implementation In the implementation phase, the nurse intervenes on behalf of the patient to address specific patient problems and needs. This is done through independent nursing actions; collaborative activities such as physical therapy, occupational therapy, and music therapy; and implementation of medical orders. Family, significant others, and caregivers assist in carrying out this phase of the nursing care plan. Specific interventions that relate to particular drugs (e.g., giving a particular cardiac drug only after monitoring the patient’s pulse and blood pressure), nonpharmacologic interventions that enhance the therapeutic effects of medications, and patient education are major components of the implementation phase. See the previous text discussion of the nursing process for more information on nursing interventions. Step 5: Evaluation Evaluation is the part of the nursing process that includes monitoring whether patient outcomes, as related to the human need statements, are met. Monitoring includes observing for therapeutic effects of drug treatment, as well as for adverse effects and toxicity. Many indicators are used to monitor these aspects of drug therapy, as well as the results of appropriately related nonpharmacologic interventions. If the outcomes are met, the nursing care plan may or may not be revised to include new human need statements; such changes are made only if appropriate. If outcomes are not met, revisions are made to the entire nursing care plan with further evaluation. EVALUATION INCLUDES: Ongoing part of the nursing process Determining the status of the goals and outcomes of care Monitoring the patient’s response to drug therapy Expected and unexpected responses Clear, concise documentation The “Rights” of Medication Right drug Right dose Right time Right route Right patient Right Right reason or indication Right response Right to refuse Medication Errors Any preventable event that may cause or lead to inappropriate medication use or patient harm Patient-related events System-related events Adverse drug event- Any undesirable occurrence related to administration of or failure to administer a prescribed medication. Adverse drug reactions- Unexpected, unintended, or excessive responses to medications given at therapeutic dosages (as opposed to overdose); one type of adverse drug event. Allergic reaction- An immunologic reaction resulting from an unusual sensitivity of a patient to a certain medication; a type of adverse drug event and a subtype of adverse drug reactions. Idiosyncratic reaction- Any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient. Medical errors- A broad term used to refer to any errors at any point in patient care that cause or have the potential to cause patient harm. Medication errors- Any preventable adverse drug events involving inappropriate medication use by a patient or health care professional; they may or may not cause the patient harm. Medication reconciliation- A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. Chapter 2 Drug Classification: Drugs are grouped together based on similar properties Drugs are grouped together based on their similar properties. This is known as a drug classification. Drugs can be classified by their structure (e.g., beta-adrenergic blockers) or by their therapeutic use (e.g., antibiotics, antihypertensives, antidepressants). Within the broad classification, each class may have subclasses; for example, penicillins are a subclass within the group of antibiotics, and beta-adrenergic blockers are a subclass within the group of antihypertensives. Prototypical drugs are the first drug in a class of drugs and are noted as key drugs throughout this textbook. Prototypical drugs: first drug in a class of drugs Pharmacologic Principles Pharmaceutics- The study of how various drug forms influence the way in which the drug affects the body. Pharmacokinetics –Pharmacokinetics: Is the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Pharmacokinetics includes: Absorption, Distribution, Metabolism, and Excretion. -Absorption: is the movement of a drug from its site of administration into the bloodstream for distribution to the tissues. -Distribution: Refers to the transport of a drug by the bloodstream to its site of action. (Keep in mind: drugs are distributed first to those areas with extensive blood supply. Areas of rapid distribution include the heart, liver, kidneys, and brain. Areas of slower distribution include muscle, skin, and fat -Metabolism: The organ most responsible for the metabolism of drugs is the liver. Other metabolic tissues include skeletal muscle, kidneys, lungs, plasma, and intestinal mucosa -Excretion: Excretion is the elimination of drugs from the body. The primary organ responsible for this elimination is the kidney. Pharmacodynamics- The study of what the drug does to the body Mechanism of Action: Drugs can produce actions (therapeutic effects) in several ways. Drugs can exert their actions in three basic ways: through receptors, enzymes, and nonselective interactions. Drug-receptor relationships: Drug-receptor interaction is the joining of the drug molecule with a reactive site on the surface of a cell or tissue. Most commonly, this site is a protein structure within the cell membrane. Receptor Interactions- A receptor can be defined as a reactive site on the surface or inside of a cell. If the mechanism of action of a drug involves a receptor interaction, then the molecular structure of the drug is critical. Drug-receptor interaction is the joining of the drug molecule with a reactive site on the surface of a cell or tissue. Most commonly, this site is a protein structure within the cell membrane. Once a drug binds to and interacts with the receptor, a pharmacologic response is produced. The degree to which a drug attaches to and binds with a receptor is called its affinity. The drug with the best “fit” and strongest affinity for the receptor will elicit the greatest response. A drug becomes bound to the receptor through the formation of chemical bonds between the receptor on the cell and the active site on the drug molecule. Drugs interact with receptors in different ways either to elicit or to block a physiologic response. Enzyme Interactions- Enzymes are the substances that catalyze nearly every biochemical reaction in a cell. Drugs can produce effects by interacting with these enzyme systems. For a drug to alter a physiologic response in this way, it may either inhibit (more common) or enhance (less common) the action of a specific enzyme. This process is called selective interaction. Drug-enzyme interaction occurs when the drug chemically binds to an enzyme molecule in such a way that it alters (inhibits or enhances) the enzyme’s interaction with its normal target molecules in the body. Nonselective Interactions- Drugs with nonspecific mechanisms of action do not interact with receptors or enzymes. Instead, their main targets are cell membranes and various cellular processes such as metabolic activities. These drugs can either physically interfere with or chemically alter cellular structures or processes. Some cancer drugs and antibiotics have this mechanism of action. By incorporating themselves into the normal metabolic process, they cause a defect in the final product or state. This defect may be an improperly formed cell wall that results in cell death through cell lysis, or it may be the lack of a necessary energy substrate, which leads to cell starvation and death. Pharmacogenomics Pharmacotherapeutics-The clinical use of drugs to prevent and treat diseases. Defines principles of drug actions—the cellular processes that change in response to the presence of drug molecules. Drugs are organized into pharmacologic classes. Pharmacognosy- The source of all early drugs was nature, and the study of these natural drug sources (plants and animals) is called pharmacognosy. Pharmacogenomics- Study of the economic factors influencing the cost of drug therapy. Example: is performing a cost-benefit analysis of one antibiotic versus another when competing drugs are considered for inclusion in a hospital formulary. Such studies typically examine treatment outcomes data (e.g., how many patients recovered and how soon) in relation to the comparative total costs of treatment with the drugs in question. Toxicology- Science of the adverse effects (unwanted effects) of drugs and other chemicals on living organisms Bioavailability: Is the term used to express the extent of drug absorption. (Keep in mind: If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then a much smaller amount of drug will pass into the circulation (i.e., will be bioavailable) First pass effect- A Large proportion of a drug is chemically changed into inactive metabolites by the liver. A Much smaller amount will be bioavailable. Half-life: is the time required for half (50%) of a given drug to be removed from the body. Measures the rate at which the drug is eliminated from the body. After approximately five half-lives, most drugs are considered to be effectively removed from the body. Steady state- Physiologic state in which the amount of drug removed via elimination is equal to amount of drug absorbed with each dose. Pharmacokinetics Drug Effects Peak level: highest blood level of a drug Trough level: lowest blood level of a drug Toxicity: occurs if the peak blood level of the drug is too high Pharmacotherapeutics Acute therapy: Acute therapy often involves more intensive drug treatment and is implemented in the acutely ill or the critically ill. It is often needed to sustain life or treat disease. Examples are the administration of vasopressors to maintain blood pressure, the use of volume expanders for a patient who is in shock, and intensive chemotherapy for a patient with newly diagnosed cancer. Maintenance therapy: It is used for the treatment of chronic illnesses such as hypertension. Supplemental (or replacement) therapy: Supplemental (or replacement) therapy supplies the body with a substance needed to maintain normal function. Examples are the administration of insulin to diabetic patients and of iron to patients with iron-deficiency anemia. Palliative therapy: The goal of palliative therapy is to make the patient as comfortable as possible. Palliative therapy focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. It is typically used in the end stages of an illness when attempts at curative therapy have failed; Supportive therapy: Supportive therapy maintains the integrity of body functions while the patient is recovering from illness or trauma. Examples are provision of fluids and electrolytes to prevent dehydration in a patient who is vomiting and has diarrhea, administration of fluids, volume expanders, or blood products to a patient who has lost blood during surgery. Prophylactic/Empirical therapy: Prophylactic therapy is drug therapy provided to prevent illness or other undesirable outcome during planned events. A common example is the use of preoperative antibiotic therapy for surgical procedures. Monitoring: Evaluating the clinical response requires familiarity with both the drug’s intended therapeutic action and its unintended. Therapeutic action: Ex: Reduced blood pressure following administration of antihypertensive drugs Adverse effects: Undesirable effects that are a direct response to one or more drugs. Cumulative effects: An effect that occurs when several successive doses of a medication are administered or when absorption of a medication occurs faster than excretion or metabolism. Therapeutic index: The ratio between the toxic and therapeutic concentrations of a drug. Drug concentration: The length of time the concentration of a drug in the blood or tissues is sufficient to elicit a response. Patient condition: How the patient is responding Tolerance: decreasing response to repeated drug doses Dependence: physiologic or psychological need for a drug Physical dependence: physiologic need for a drug to avoid physical withdrawal symptoms Psychological dependence: also known as addiction and is the obsessive desire for the euphoric effects of a drug. Drug interactions include: Additive effects (1 + 1 = 2) Synergistic effects (1 + 1 > 2) Antagonistic effects (1 + 1 < 2) think antidotes Incompatibility Adverse drug reactions: Pharmacologic reaction: Is an extension of the drug’s normal effects in the body. For example, a drug that is used to lower blood pressure in a patient causes a pharmacologic ADR when it lowers the blood pressure to the point at which the patient becomes unconscious. Hypersensitivity reaction: An allergic reaction involving the patient's immune system. Idiosyncratic reaction: Unpredictable reactions that occur in only a small percentage of patients receiving the drug and which do not involve known pharmacological properties of the drug. Drug interaction: Alteration in the pharmacologic or pharmacokinetic activity of a given drug caused by the presence of one or more additional drugs. Other drug effects: Teratogenic: Teratogenic effects of drugs or other chemicals result in structural defects in the fetus. Mutagenic: Mutagenic effects are permanent changes in the genetic composition of living organisms and consist of alterations in chromosome structure, the number of chromosomes, or the genetic code of the deoxyribonucleic acid (DNA) molecule. Carcinogenic effects: Carcinogenic effects are the cancer-causing effects of drugs, other chemicals, radiation, and viruses. Chapter 3 Life Span Considerations- The human body changes from the beginning of life to the end of life. These lifespan changes have dramatic effects of the four phases of pharmacokinetics (absorption, distribution, metabolism, and excretion). Special considerations: Pregnancy Newborn Pediatric Older adult Neonatal and Pediatric Considerations: Pharmacokinetics Absorption is altered due to: Gastric pH less acidic until 1 to 2 years of age Gastric emptying slowed First-pass elimination is reduced due to an immature liver Intramuscular absorption faster and irregular Distribution is altered due to: Greater total body water means lower fat content. Decreased level of protein binding Immature blood–brain barrier—more drugs enter the brain Metabolism is altered due to: Liver immature; does not produce enough microsomal enzymes Older children may have increased metabolism, requiring higher doses than infants. Excretion is altered due to: Kidney immaturity affects glomerular filtration rate and tubular secretion. Decreased perfusion rate of the kidneys may reduce excretion of drugs. Factors affecting pediatric dosage. Skin is thin and permeable. Stomach lacks acid to kill bacteria. Lungs have weaker mucous barriers. Body temperatures less well regulated, and dehydration occurs easily. Liver and kidneys are immature, impairing drug metabolism and excretion. General Considerations Prepare all equipment and supplies first. Have caregivers stay as appropriate. Assess for comfort methods before, during, and after drug administration. Considerations for older adults Decline in organ function occurs with advancing age. Drug therapy in older adults is most likely to result in adverse effects and toxicity. Older adults: older than age 65 years High use of medications Polypharmacy Noncompliance, nonadherence Increased incidence of chronic illnesses Sensory and motor deficits Older adults: Pharmacokinetics Absorption: Gastric pH less acidic Gastric emptying and movement through the GI tract is slowed Blood flow to GI tract reduced Absorptive surface of GI tract reduced Distribution: Lower total body water percentages Increased fat content Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs) Metabolism: Aging liver produces fewer microsomal enzymes, affecting drug metabolism. Reduced blood flow to the liver Excretion Decreased glomerular filtration rate Decreased number of nephrons Drugs are cleared less effectively because of decreased excretion. Chapter 4 Ethnopharmacology: Body of knowledge for understanding the specific impact of cultural factors on patient drug response. Lack of clarity in terms: race, ethnicity, and culture Cultural Considerations Pharmacogenomics: study of how certain genetic traits affect drug response Drug polymorphism Adherence with therapy Environmental and economic considerations Pharmacokinetics Pharmacodynamics Varying drug responses in different racial or ethnic groups Health beliefs and practices Barriers to adequate health care for the culturally diverse U.S. patient population Language, poverty, access, pride, and beliefs regarding medical practices Medications may have a different meaning to different cultures. Cultural Assessment: Languages spoken: need for interpreter Health beliefs and practices Past uses of medicine Herbal treatments, folk remedies, and home remedies Use of over-the-counter drugs Usual response to illness Responsiveness to medical treatment Religious practices and beliefs Support from the patient’s cultural community Dietary habits U.S FDA Drug Approval Process Informed consent- involves the careful explanation to the human test patient or research subject of the purpose of the study, the procedures to be used, the possible benefits, and the risks involved. This explanation is followed by written documentation on a consent form. The informed consent document, or consent form, must be written in a language understood by the patient and must be dated and signed by the patient and at least one witness. Informed consent is always voluntary. By law, informed consent must be obtained more than a given number of days or hours before certain procedures are performed and must always be obtained when the patient is fully mentally competent. The informed consent process may be carried out by a nurse or other health care professional, depending on how a given study is designed. Investigational new drug study Preclinical investigational drug studies: Current medical ethics require that all new drugs undergo laboratory testing using both in vitro (cell or tissue) and animal studies before any testing in human subjects can be done. In vitro studies include testing of the response of various types of mammalian (including human) cells and tissues to different concentrations of the investigational drug. In vitro studies help researchers determine early on if a substance might be too toxic for human patients. Many prospective new drugs are ruled out for human use during this preclinical phase of drug testing. However, a small percentage are referred for further clinical testing in human subjects. Clinical phases of investigational drug studies Phase I- studies usually involve small numbers of healthy subjects rather than those who have the disease that the new drug is intended to treat. The purpose of phase I studies is to determine the optimal dosage range and the pharmacokinetics of the drug and to ascertain if further testing is needed. Blood tests, urinalyses, assessments of vital signs, and specific monitoring tests are also performed. Phase II- studies involve small numbers of volunteers who have the disease that the drug is designed to diagnose or treat. Study participants are closely monitored to determine the drug’s effectiveness and identify any adverse effects. Therapeutic dosage ranges are refined during this phase. If no serious adverse effects occur, the study can progress to phase III. Phase III- studies involve large numbers of patients who are followed by medical research centers and other types of health care entities. The purpose of this larger sample size is to provide information about infrequent or rare adverse effects that may not yet have been observed during previous smaller studies. Information obtained during this clinical phase helps identify any risks associated with the new drug. Placebos may be given. Phase IV- studies are postmarketing studies that are voluntarily conducted by pharmaceutical companies to obtain further proof of the therapeutic and adverse effects of the new drug. Data from these studies are gathered for at least 2 years after the drug’s release. Often these studies compare the safety and efficacy of the new drug with that of another drug in the same therapeutic category. Black box warning: A black box warning is the strictest warning from the FDA and indicates that serious adverse effects have been reported with the drug. The drug can still be prescribed; however, the prescriber must be aware of the potential risk and the patient must be warned. Black box warnings are included in the prescribing information of the drug, and the text of the warning has a solid black border, thus the name black box. Drug recall: The FDA or the manufacturer may issue a drug recall anytime a problem with a drug is noted. There are three classes of recall that may be issued: • Class I: The most serious type of recall—use of the drug product carries a reasonable probability of serious adverse health effects or death. • Class II: Less severe—use of the drug product may result in temporary or medically reversible health effects, but the probability of lasting major adverse health effects is low. • Class III: Least severe—use of the drug product is not likely to result in any significant health problems. Legal Considerations State and federal legislation Nurse practice acts Scope of nursing practice Expanded nursing roles Educational requirements Standards of care Minimally safe nursing practice Differences between nursing and medical practice Guidelines from professional nursing groups American Nurses Association (ANA) Institutional policies and procedures; state and federal hospital licensing Specific Nurse Practice Acts Standards of Practice HIPPA Ethical Terms Related to Nursing Autonomy: Self-determination and the ability to act on one’s own; related nursing actions, include promoting a patient’s decision making, supporting informed consent, and assisting in decisions or making a decision when a patient is posing harm to himself or herself. Beneficence: The ethical principle of doing or actively promoting good; related nursing actions include determining how the patient is best served. Confidentiality: The duty to respect privileged information about a patient; related nursing actions include not talking about a patient in public or outside the context of the health care setting. Justice: The ethical principle of being fair or equal in one’s actions; related nursing actions include ensuring fairness in distributing resources for the care of patients and determining when to treat. Nonmaleficence: The duty to do no harm to a patient; related nursing actions include avoiding doing any deliberate harm while rendering nursing care. Veracity: The duty to tell the truth; related nursing actions include telling the truth with regard to placebos, investigational new drugs, and informed consent. Legal and Ethical Principles Duty- Being responsible for accurate assessment of a patient’s intravenous (IV) line and access site, monitoring the site during caustic drug infusion, and the timely reporting of changes in the patient’s condition. Breach of duty- Nurse does not notice that the IV site is swollen, red, painful, and warm to touch or that the IV has quit infusing properly. Causation- Nurse fails to note the signs and symptoms of extravasation at IV site (with a chemotherapy drug or other caustic drug) that results in the need for skin grafting. Damage- Extensive skin and nerve damage with several surgical skin grafts resulting in limited use of arm. Negligence- The failure to act in a reasonable and prudent manner or failure of the nurse to give the care that a reasonably prudent (cautious) nurse would render or use under similar circumstances. Chapter 5 Make sure you know how to convert mcg to mg (no formulas allowed) 1000mcg is 1mg, just divide. Make sure you know how to convert mg to mcg (no formulas allowed) 1mg is 1000mcg, just multiply. Near miss events: Event or situation that did not produce patient injury, but only because of chance. Must still be reported so that safety issues can be addressed and future incidents are prevented Strategies to minimize errors: Awareness (“speak-up”) Computerized prescriber order entry (CPOE) Bar codes and scanning devices Automated dispensing machines Effective communication T.A.C.I.T. – TACIT is a mnemonic. Therapeutic effect: Does the patient demonstrate therapeutic effects of the drugs? Are there signs of drug allergies or adverse reactions? Contraindications: Are there contraindications for giving any of the drugs? Interactions: Are there possible interactions among the drugs? Toxicity/overdose: Are there signs of drug toxicity of overdose? Preventing Medication errors: Multiple systems of checks and balances should be implemented to prevent medication errors. Prescribers must write legible orders that contain correct information, or orders should be entered electronically. Authoritative resources, such as pharmacists or current (within the past 3 to 5 years) drug references or literature, must be consulted. Nurses need to always check the medication order three times before giving the drug. The Rights of medication administration should be used consistently. Assessment Two patient identifiers Do not administer if you did not draw up or prepare yourself. Minimize verbal or telephone orders. Repeat order to prescriber. Spell drug name aloud. Speak slowly and clearly. List indication next to each order. Never assume anything about items not specified in a drug order (e.g., route). Do not hesitate to question a medication order for any reason when in doubt. Do not try to decipher illegibly written orders; contact the prescriber for clarification. Do not use unapproved abbreviations, acronyms. Never use a “trailing zero” with medication orders. Do not use 1.0 mg; use 1 mg. 1.0 mg could be misread as 10 mg, resulting in a 10-fold dose increase. Always use a “leading zero” for decimal dosages. Do not use .25 mg; use 0.25 mg. .25 mg may be misread as 25 mg. Take time to learn special administration techniques of certain dosage forms. Always verify new medication administration records. Read labels. Use generic names to avoid sound-alike trade names. Always listen to and honor any concerns expressed by patients regarding medications. Check patient allergies and identification. Know where to find information on medications, preparation, side-effects; Use only current sources. Mandatory second nurse verifications for high-risk medications and/or patient population Minimize interruptions when preparing/delivering medications. Preventing Pediatric Medication Errors Obtain and document accurate weight (kg) Report all medication errors. Know the drug thoroughly. Follow the Rights of medication administration. Avoid verbal orders in general. Avoid distractions. Communicate with everyone. Chapter 7 Criteria for OTC Status Use of OTC drugs potential Hazards May postpone effective treatment of more chronic disease states May delay treatment of serious or life-threatening disorders May relieve symptoms of a disorder but not the cause Toxicity Interactions with current prescription medications may occur Abuse Herbal and Dietary Supplements: Dietary supplement—orally administered alternative medicines, including herbal supplements Herbs—plant components, including bark, berries, roots, leaves, gums, seeds, stems, and flowers, used for their medicinal qualities Herbal medicine—using herbs to heal Nursing Process Assessment: Obtain thorough medication history, documenting all medications used (prescription, OTC, herbal products, vitamins, minerals, other dietary supplements). Assess allergies. Assess level of education and understanding. Assess for information specific to various products. Assess system functions (especially renal, liver, and cardiac). Assess for conditions that are contraindications. Assess for potential drug–drug and drug–herb interactions. Assess lifespan considerations: Herbal products may not be safe for pregnant or breastfeeding women, infants, or children. Nursing Process Diagnosis: Altered GI elimination Altered knowledge Altered need for sleep Altered physical activity Altered safety needs Altered interchange of gases Freedom from pain Ineffective health maintenance Insomnia Risk for injury Urinary retention Nursing Process Planning Goals and outcomes Individualized Realistic Achievable Nursing Process Implementation: *Patient education is important for patient safety. Information about safe use Frequency of dosing, dose How to take (with food, empty stomach, etc.) Strategies to prevent adverse effects, drug interactions, toxicity Ensure that patients recognize that manufacturers of herbal products and dietary supplements are not required to prove safety and effectiveness. “Natural” does not always mean safe. Nursing Process Evaluation: Patients need to carefully monitor themselves for therapeutic responses as well as adverse effects. Therapeutic responses will vary based on supplemental product used.