Patho Week 2 Lecture Notes PDF

# Protein Binding (Because we didn't go here the first week) # Distribution - A diagram of a person taking a drug with the following labels: - Parenteral drug - Storage sites - Tissue receptors or sites of action - Oral drug - Free drug - GI tract - Plasma - Prot...

# Protein Binding (Because we didn't go here the first week) # Distribution - A diagram of a person taking a drug with the following labels: - Parenteral drug - Storage sites - Tissue receptors or sites of action - Oral drug - Free drug - GI tract - Plasma - Protein bound drug - Metabolites - Liver (major site for metabolism) - Excretion (Kidneys - major site) From McKenry LM, Tessier E, Hogan M: Mosby's pharmacology in nursing, ed 22, St Louis, 2006, Mosby. # Distribution - A diagram of a blood vessel with the following labels: - Capillary cell wall - Albumin - Plasma - Bound drug - Albumin - Unbound free drug - Albumin - Capillary cell pore *Albumin is the most common blood protein and carries the majority of protein bound drug molecules* # Distribution - Protein binding - Drugs form bonds with proteins (plasma albumin) in the bloodstream - Binding is reversible - Bound drug (drug + protein complex) is inactive = circulating reservoir, cannot leave bloodstream - Unbound drug is free = play a therapeutic role at receptors # Practice What might happen if a patient with low albumin levels is administered a highly protein bound drug? a) Increased therapeutic effect b) Increased risk of toxicity c) Decreased drug efficacy d) Decreased drug toxicity # Practice When a protein bound drug interacts with another medication that also binds to the same protein, what is the expected outcome? a) Enhanced therapeutic effect b) Decreased drug efficacy c) Increased free drug concentration d) Decreased metabolism of the drug # Practice What is the primary effect of a CYP450 enzyme inducer on drug metabolism? a) It decreases the metabolism of drugs, leading to higher drug concentrations. b) It increases the metabolism of drugs, leading to lower drug concentrations. c) It has no impact on drug metabolism. d) It increases drug absorption. # The Nursing Process and Drug Therapy # Five Steps of the Nursing Process - A diagram with the following labels: - Assessment - Nursing diagnosis/Analysis - Planning - Implementation (including patient education, Rights of Medication Admin) - Evaluation # Clinical Judgement Model - A diagram with the following labels: - Noticing - Assessment - Recognize cues - Interpreting - Analyze cues - Prioritize hypotheses - Responding - Generate solutions - Planning - Evaluating - Take actions - Implementation - Evaluate outcomes - Clinical Judgement Measurement Model - Nursing Process - Tanner Clinical Judgement Model Copyright 2020, Assessment Technologies Institute, LLC Reprinted by permission, Assessment Technologies Institute, February 10, 2020. # AAPIE/CJM Medication Admin - A (recognize cues) - Does the patient need this medication (check indications / patient history), is it safe to give (check labs, VS, etc) - A/D (analyze cues / prioritize hypothesis) - allergic reaction? anaphylaxis? Decreased oxygenation, decreased oxygen exchange, what can I do to intervene and in what order - P (Generate solutions) - Outcome ID - patient will demonstrate increased oxygenation, improved airway clearance. Gathering equipment, ID patient needs - I - (Take action)- Teaching about the drug (take every 6 hours, may make you sleepy), drink water, 6 rights of medication administration - E - (Evaluate outcomes) - Did it work, do you see any adverse effects (decreased signs of inflammation related to allergic symptoms, decreased secretions, etc) # Six Rights of Medication Administration - A diagram of a pill bottle with a pill coming out *Ensures that a drug will be administered as prescribed* *Proper delivery is only the beginning of a nurse's responsibility* # The "Six Rights" of Medication Administration (what's missing?) Diphenhydramine 25 mg every 4 hours prn allergies | Patient's Rights | Example | |:---------------------------|:--------------------| | Right Patient | Luna Lovegood | | Right Drug | Docusate | | Right Dose | 200 mg | | Right Time | 0900 and 2100 | | Right Documentation | Given, Refused, Initials | | Right Route (missing) | | # Rights of Med Administration [https://youtu.be/lFM5I2PfuLc](https://youtu.be/lFM5I2PfuLc) - Right patient - Right drug - Right dose - Right route - Right time/frequency - Right documentation # Drug Names | Chemical | **Generic Name** | Trade name (proprietary or brand name) | |:-------------------------------------|:-----------------------------------------------------------------------------------------------------------|:-------------------------------------| | Acetylsalicylic acid | Aspirin | Ecotrin | | | | Acuprin | | Nomenclature of chemistry, chemical composition | Nonproprietary - Unique name assigned by US Adopted Names Council and listed in the USP | | | | Less complex than chemical name, but more complex than trade name | | | | Created by drug co. - Easy to communicate - Approval from FDA - Avoid similar names to avoid errors | | | | Can have many different trade names | | # Principles of Dosage and Administration - A diagram showing the following: - Read medication order and compare with MAR - Refuse to administer a drug that can be harmful - Verify that drug information on the MAR corresponds to the label on the container - Correctly identify the patient. # Principles of Dosage and Administration - Read medication label carefully and compare with the MAR at least 3 times. - When removing the drug from the supply drawer or medication cart. - When placing the medication in a medication cup, measuring cup or syringe. - Just before administering the drug to the patient before the container is discarded. - Look up information on any drug that you are unfamiliar with # Principles of Dosage and Administration - Verify drug calculations - Label all syringes and IV solutions immediately after preparing the ordered dosage. Keep the vial with the syringe - NEVER administer a medication prepared by another person - A diagram of a vial of medicine with a syringe next to it with the following labels: - NDC 42023-113-10 - Ketalar - 200 mg per 20 ml - the of Expiration Ketamine - Initials: - 10mg/mL - ****Change IV prior to expiration**** # Principles of Dosage and Administration - Remain with the patient until all medications are administered - Record the administration of each dose on the MAR after it has been given (6th right) - NEVER chart a drug as having been given until it has been administered - A diagram of a nurse scanning the patient’s wristband with a blue medication cart. <h1>Drug Legislation</h1> - 1996: Health Insurance Portability and Accountability Act (HIPAA) - Requires all healthcare related organizations as well as schools to maintain privacy of protected health information - BE FAMILIAR WITH THIS!! <h1>Drug Legislation</h1> - Controlled Substances Act (1970) - Established rules for the manufacture, distribution, and dispensing of drugs considered to have abuse potential - Restricted persons who have dispensing privileges - Classified controlled substances according to use and abuse potential <h1>Drug Legislation</h1> - Schedule I – no accepted medical use, high abuse potential (example: heroin) - Schedule II: hydromorphone, methadone, meperidine, oxycodone, fentanyl, morphine, codeine, hydrocodone - Schedule III: acetaminophen with codeine, buprenorphine, ketamine, anabolic steroids - Schedule IV: lorazepam, diazepam, midazolam, tempazepam - Schedule V: guaifenesin with codeine, promethazine with codeine - Schedule II - V - Accepted medical applications but have abuse potential, progressively less physical dependence from II - V - Nursing safeguards to prevent peer abuse. - Narcotic counts. - Witness for wasted doses. - Responsibility to report physical dependence of peers to BON - BE FAMILIAR WITH THIS!! # Medication Errors: Preventing and Responding # Types of Medication Errors - No error, although circumstances or events occurred that could have led to an error - Medication error that causes no harm - Medication error that causes harm - Medication error that results in death - A diagram of an exclamation point in a circle # Medication Errors - Most errors occur during administration of and documentation of drug use - Failure to administer ordered drug. - Administration of wrong dose, strength, quantity. - Administration of wrong drug. # Preventing Medication Errors - A diagram with the following labels: - Two patient identifiers - Assessment - Do not administer if you did not draw up or prepare yourself. - List indication next to each order. # Reporting Medication Errors - Report to prescriber and nursing management. - Document error per policy and procedure. - Factual documentation only. - Medication administered. - Actual dose. - Observed changes in patient condition. - Prescriber notified and follow-up orders. # Show What You Know! - A patient receives a double dose of an antihypertensive medication. The tablet was supposed to be cut in half, but the entire tablet is given. The patient’s blood pressure just before the dose was 146/98 mmHg. What should the student nurse do first? a) Notify the patient’s physician. b) Notify the charge nurse. c) Take the patient’s blood pressure . d) Continue to monitor the patient # Medication Reconciliation - Process in which medications are “reconciled” at all points of entry and exit to or from a healthcare entity. - Patients provide a list of all the medications they are currently taking (including herbals and over-the-counter drugs) . - Prescriber then assesses the medications and decides if they are to be continuous upon hospitalization. - Designed to ensure that there are no discrepancies between what the patient was taking at home and in the hospital. - How often? # Patient Teaching We will practice this later, you may need to come back to the next few slides later in class…but plan on skipping over these during the first part of class! # Patient Education: Assessment - A diagram with the following labels: - Adaptation to any illness - Barriers to learning - Cognitive abilities - Coping mechanisms - Cultural background - Education, including literacy level # Patient Education: Assessment - A diagram of a star with the following labels: - Psychosocial growth and development - Health literacy - Emotional status - Family relationships - Financial status # Patient Education: Implementation - A diagram with the following labels: - Teaching-learning sessions - Consideration of age-related changes - Consideration of language barriers - Safe administration of medications at home - Return demonstration with equipment # Patient Education: Documentation - A diagram with the following labels: - Learner assessment - Outcomes - Content Provided - Strategies Used - Patient response to the teaching session - Overall evaluation of learning # Patient Education: Evaluation - A diagram with the following labels: - Have the patient ask questions, provide a return demonstration - Behavior such as compliance and adherence to a schedule - Occurrence of few or no complications - Develop and implement new plan of teaching as needed for: - Noncompliance - Inadequate level of learning # Over the Counter (OTC) Drugs - Nonprescription drugs - Use for short-term treatment of common minor illnesses - More than 300,000 OTC drugs available # Audience Response System Question A 56-year-old man is taking OTC antacids for relief of indigestion. He tells the nurse that he consumes at least one bottle a week and has done so for more than 1 month because “it works for me.” The nurse’s main concern is that: a) this self-treatment is expensive. b) this self-treatment may be delaying treatment of a more serious problem. c) this self-treatment may be the best treatment of his indigestion. d) the long-term use of antacids may make the indigestion worse. # 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 # Nursing Implications - Herbal products and dietary supplements are not required to prove safety and effectiveness - May not be safe for pregnant or breastfeeding women, infants, or children. - “Natural” does not mean safe. - Monitor for unusual or adverse reactions as well as therapeutic responses.