Nursing Process in Pharmacology PDF

Nursing Process in Pharmacology Drug discovery and development - long history and dates drug administration appropriate delivery of patient care back to the early...

Nursing Process in Pharmacology Drug discovery and development - long history and dates drug administration appropriate delivery of patient care back to the early days of human civilization. NURSING PROCESS (PHARMACOLOGY: - drugs were not just Patient Centered Collaborative Care) used for physical INCLUDES: remedies but were assessment also associated with o subjective religious and spiritual o objective healing. Patient Problem (diagnosis) - Sages or religious Planning Implementation leaders were often Evaluation the administrators of drugs. NURSE’S RESPONSIBILITIES - medicines were Patient teaching derived mainly from Know obstacles: plant products and o Pain must first be relieved supplemented by o Language barrier animal materials and o Age (young or elderly) minerals. General information shall be provided - Drugs were most on how to take the drug discovered through a o Written information or combination of trial instruction shall be provided and error (Patient teaching card) experimentation and o Name of drug observation of human o Reason for taking the Rx and animal reactions o Time sched when to take the 1800’s medicines o Possible side effects/adverse - Drug discovery and events development started o Notification of HCP if side to follow scientific effects occur techniques o Health care provider’s After World War 1 telephone number o Warning information - modern (pregnant, not to take with pharmaceutical alcohol industry came into Side effects being Self-administration - Drug discovery and Drug cards (abroad)-optional development Diet following scientific principles was firmly Other important nursing considerations established Drug allergies Expiration Cultural beliefs/ religious Montoya, J. A. V. SN DRUG DEVELOPMENT standard of designing, conducting, PROCESS OF BRINGING A NEW DRUG monitoring, auditing, 1. Involves rigorous testing and recording, analyzing optimization of selected compounds and reporting clinical to identify the drug that is most trials. effective - Enforce the provision 2. Takes 10-12 years with a cost of more of several laws than 1 Billion US Dollars for each drug (Accessible cheaper 3. Out of 5,000-10,000 compounds and quality medicine beginning preclinical testing, only 1 Act, The Generics Act makes it through the FDA of 1998, Laws on 4. Pre-clinical research on Counterfeited drugs, microorganism and animals, Food Fortification 5. Filing for regulatory status for an Law, Milk Code of the investigational new drug to initiate Philippines etc). clinical trials on humans - Before: Bureau of 6. Include the step of obtaining Food and Drug regulatory approval with a new drug (BFAD): Health application to market the drug Regulatory agency under DOH (food, food supplements, cosmetics, drugs, household hazardous, insecticide, medical devices, diagnostics, vet products) 2. PRECLINICAL TRIALS - Done prior to the Drug Development Process implementation of the clinical trials (using human subjects) - Determine TOXIC and PHARMACOLOGICAL efficacy through/using ANIMAL TESTING PHARMACEUTICAL RESEARCH - Able to determine genotoxicity (damage 1. FDA (Food and Drug Administration genetic information in Act of 2009) RA 9711 a cell in addition to - Follow the Good drug absorption, Clinical Practice distribution, Consolidated metabolism and Guidelines excretion. (International Ethical 3. HUMAN EXPERIMENTATION and Scientific quality Montoya, J. A. V. SN  - NIH Revitalization 4. Phase 4: Drug effect studies after Act: help to establish it has been marketed (effects in guidelines in including various population, assess side women/minorities in effects associated with LONG clinical trials and that TERM USE. to be included in CORE ETHICAL appropriate numbers PRINCIPLES/GUIDELINES FOR in National Institute RESEARCH INVOLVING HUMANS of Health -supported researches 1. RESPECT FOR PERSON - Encouraging study in a. Incorporates at least two children: Best ethical convictions. Pharmaceutical in - First, that individuals Children 2002 (BPCA) should be treated as and Pediatric autonomous agents. Research Equity Act - Second, that persons 2003 (PREA). with diminished Stages autonomy are entitled to protection. b. principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy. HUMAN EXPERIMENTATION - Right to refuse to participate in a Multidisciplinary team approach research. Required to ENSURE SAFETY and - Right to withdraw QUALITY in all phases anytime without Phases: 1. Phase 1: Small group of people penalty /First time to evaluate safety AUTONOMY (dosage range) and side effects. 2. Phase 2: Larger group to see if its Integral part of respect for person effective, further evaluate safety Should have decision of their own (used in larger group). Patient can refuse any or all 3. Phase 3: Large group confirm treatment except decision will pose EFFECTIVENESS, MONITOR SIDE threat to others EFFECTS, COMPARE WITH Right to refuse to participate in a COMMONLY USED KNOWN research study TREATMENTS/Collect information Right to withdraw from study at that will allow the drug to be used anytime without penalty safely. INFORMED CONSENT Montoya, J. A. V. SN  Roots: Nuremberg Code in 1947 distribution of benefits and burden is (Right to be informed and that equitable participation is voluntary, without Recruitment and selection of coercion participants must be done in a fair If with legal age; but if 12-15 years and equal manner. old: needs assent form Appropriate protections for research Children 11 and below: with parents participants consent ROLES OF NURSES If coercion is suspected, nurses are obligated to report it promptly ANA (American Nurses Association Health care provider need to explain Code of Ethics) - Guide for carrying out what is expected; respond to query nursing responsibilities in manners consistent Provided with Inclusion and exclusion with quality in nursing care and ethical criteria, study protocol, study related obligations of the profession. foremost duty is documentation. to care for the patient (Florence Nightingale principle) INFORMED CONSENT CHECKLIST Nurse: responsible for BOTH the Statement that the study involves safety of the subjects/patients and integrity of research the research protocol. Purpose & Explanation Duration DRUG STANDARDS/LEGISLATION Id, description of procedures and experiments FEDERAL LEGISLATION reasonable foreseeable Ensure safety; Protect public from risk/discomfort and benefits drugs that are impure, toxic, Disclosure of appropriate alternative ineffective or not tested before public procedure/courses of treatment or sale. courses of treatment if any. Confidentiality Food and Drug Act of 1906 - America’s compensation or whether any first law to regulate drug & Prohibit sale medical treatment is available when of misbranded and adulterated drugs, not injury occurs addressing safety and effectiveness Contact person to answer when with Federal Food, Drug and Cosmetic Act query (1938) - Ensure that a drug is safe before That the participation is voluntary marketing/labelling with accurate info BENEFICENCE and have detailed literature in the drug packaging explaining adverse effects Duty to protect the research subjects from harm Kefauver-Harris Amendment (1962) - RISK BENEFIT RATIO (Benefits > Risk Tightened control on drug or vise versa) safety/evaluation of testing method used No matter how noble the intentions > by manufacturers; provide process for calculation of risk withdrawal of approved drugs when safety/effectiveness is in doubt JUSTICE 1950: Thalidomide, a sedative Selection of research subject shall be hypnotic during 1st trimester gave birth FAIR to infants with extreme limb deformity. Montoya, J. A. V. SN  OTHERS GENERIC ACT of 1988 (Republic Act No. 6675)- consisting of 15 sections. the policy to The Sherley Amendment (1912) - False promote, require and ensure the production Treatment Claims of adequate supply, use and acceptance of Soothing syrup for teething and colic drugs (including for animal use) identified by in infants, contained morphine and led to their generic names. death of many infants Objective: PROMOTE, ENCOURAGE AND Harrison Narcotics Tax Act (1914) - REQUIRE THE USE OF GENERIC Requires prescription (on those exceeding TERMINOLOGY. set narcotic limits) Ensure: ADEQUATE SUPPLY OF DRUGS WITH Durham-Humphrey Amendment (1951) - GENERIC NAMES AT THE LOWEST POSSIBLE Distinguished between drugs that could COST be sold with or without prescription NURSE PRACTICE ACTS COMPREHENSIVE DRUG ABUSE PREVENTION -Generally: Nurses cannot prescribe AND CONTROL ACT (1970) or administer drugs WITHOUT A HEALTH Nurse (key creating a culture of PROVIDER ORDER safety/accountability related to controlled Consequences: License revocation if found to substances. administer without order & Can be Verification of orders before prosecuted for giving the wrong drug/dosage/ administration omitting a drug dose or giving a drug by a Accounting of all controlled drugs wrong route. Documentation of all discarded/waste DRUG COUNTERFEITING (>10%) medications; patients record after administration Worldwide, estimated as >10% of all Keep all controlled drugs in a locked drugs available are counterfeit/fake. May storage area (narcotics under double contain incorrect ingredient, insufficient lock) amount of active ingredient, no active ingredient, contain impurities and S2 PRESCRIPTION: S2 License is solely contaminants/distributed in fake packaging. given to any authoritative person who is acknowledged by law that can prescribe DRUG NAMES dangerous drugs. Generic name: must be approved by FDA - Physicians BEFORE THEY CAN BE MARKETED - Veterinarians Non proprietary; universally accepted - Dentists Not owned by any drug company DRUG SCHEDULES Given in “Lower case letters” Brand or Trade name Proprietary name Chosen by drug company, usually a registered trademark Always begin with a capital letter Montoya, J. A. V. SN GENERIC VERSUS BRAND NAMES Nasal Sprays Weight control drugs GENERIC BRAND Drugs for dermatitis/fungal infection Given in lower case Always begin with a letters capital letter Fluoride toothpaste Ex: “furosemide” Ex: “Lasix” Corn and callus removal products With same active Herbal Products ingredients as PHARMACOGENETICS- study of how a patient branded but are usually less genome affect his/her response to expensive because medications & study of the variability in drug manufacturers do response due to heredity. not have to do Clinical uses extensive testing. As it is clinically tested Mapping of human genome, for safety and personalizes medicine based on genetic efficacy by the profiles pharmaceutical company that first PHARMACOGENETIC TESTING CYCLE’ formulated the drug NON PRESCRIPTION DRUGS- Over-the-counter medicine, also known as OTC or nonprescription medicine, refers to medicine that you can buy without a prescription. FDA determines are safe and effective for use without a doctor's prescription OTCs often do more than just relieve aches, pains, and itches. can prevent diseases like tooth decay. cure diseases like athlete's foot. help manage recurring conditions like G6PD DEFICIENCY- Glucose-6-phosphate vaginal yeast infections or migraine. dehydrogenase deficiency US Food and Drug Administration (FDA) that Haemolysis/Hemolysis-destruction of red determines whether medicines are blood cells (erythrocytes). prescription or nonprescription. Nursing process in pharmacogenetics The term prescription refers to medicines that are safe and effective when used under a Concept doctor's care, Assessment DIAGNOSIS/PATIENT PROBLEM OTC’s PLANNING Vitamins INTERVENTIONS Colds prep EVALUATION Analgesic CLINICAL APPLICATION OF Antacids PHARMACOGENETICS Laxatives Antihistamines improve quality outcomes Sleep aids customize patient plans of care decrease age of drug therapy Montoya, J. A. V. SN  predict patients response to drug Drug lipid solubility therapy Regional blood flow/ cardiac save time and money by reducing output/ tissue perfusion ‘’trial and error’’ in drug prescribing Ph decrease treatment failure Ability of drug to bind tissue and plasma protein 3. Drug metabolism - aka ONCE A DRUG IS ADMINISTERED- IT GOES Biotransformation, body chemically THRU PHASES changes drugs into a form that can be excreted 1. KINETIC: Body to drug - Liver (primary site of Processes: metabolism) thru liver enzymes a. ABSORPTION - Drug half-life-time it b. DISTRIBUTION takes for the amount c. METABOLISM of drug in the body to (BIOTRANSFORMATION) be reduced in half d. EXCRETION (ELIMINATION) - If Metabolism rate is affected (decreased): Drug absorption toxicity resulted due Movement of drug into the to drug accumulation bloodstream after administration Metabolism DISSOLUTION: drug in solid form is taken by mouth (80%), disintegrate LOADING DOSE: into small particles and combine with Dose larger than the dose liquid to form a solution and to be needed to maintain the drug absorbed from GI to bloodstream at steady state Bioavailability - Percentage of Use in drugs with long half administered drug available for activity life where some may not be Oral: usually not 100% acceptable to wait for a Intravenous drugs: 100% steady state to be achieved Affecting bioavailability 4. Excretion- Elimination of the drug from the body drug form - Kidneys (main) route of administration - bile then thru feces gastric mucosa/motility - lungs ( for volatile administration with food and other drugs and those drug drugs metabolized as CO2 changes in liver metabolism caused by and water) liver dysfunction or inadequate - saliva (passive hepatic flow diffusion) 2. Drug distribution -Movement from circulation to body tissues URINE PH (NORMAL:4.6-8) Influenced by: Renal Function Test Vascular permeability/cell permeability o BUN Montoya, J. A. V. SN  o Estimated GFR (depends on creatinine - no first-pass level, age, body size, and gender) metabolism 4. Rectal- produce local or systemic Drug administration effects. QUITE UNRELIABLE. very 1. Enteral- entering the intestinal tract. useful during vomiting and in patients 2. Oral- Given by mouth is the most that are unable to take medications common route of drug administration by mouth. & With the most complicated - 75% of drainage of pathway to the target tissues the rectal region - drugs are absorbed in bypasses the portal the intestinal tract by circulation, passive transfer and minimizing first-pass usually end up in the effect. portal circulation - the inferior and encountering the liver middle rectal veins and thus high chance are linked to the of passing the first- systemic circulation pass effect. whereas the superior rectal vein joins the First-pass effect Feedback- Usually, oral inferior mesenteric route. also known as first-pass metabolism or vein and from there pre-systemic metabolism. drug enters the onto the portal vein. liver (portal circulation before entering the 5. Parenteral- This route of systemic circulation) administration avoids the GIT. used - Undergoes extensive for drugs that are poorly absorbed or biotransformation unstable in the GIT, for unconscious - Decreasing the patients and when acute onset is concentration rapidly required. before it reaches its 6. Intravenous (IV)- Injection straight target. into the systemic circulation is the - Beneficial in some most common parenteral route. It is where inactive form the fastest and most certain and becomes active controlled way. (codeine to - bypasses absorption morphine) barriers and first-pass 3. Sublingual- can be classified into metabolism (LIVER) parenteral as well & Does not enter - used when a rapid the lower gastro-intestinal tract. effect is required, placed under the tongue thus going continuous oral. Drug diffuses into the capillary administration and network and enters the system large volumes. circulation directly Risks: - very rapidly absorbed - low infection risk cannot recall injected drugs, - avoiding the rough introduction of bacteria through environment of the contamination git Montoya, J. A. V. SN  as well as too rapid delivery or too 13. Intrathecal/intraventricular - Drug high concentration may produce administration into the cerebrospinal strong adverse effects. fluid (CSF). Used in cases of CNS 7. Intramuscular (IM)- Produces a faster cancers, cryptococcal meningitis etc. effect than oral administration. The Types of injections drug can be aqueous solutions or depot preparations (in a form of ester 1. Subcutaneous Injection- Delivers or salt) meds into layer of fats under the skin - rate of absorption 2. Intramuscular Injection- Delivers depends greatly on meds into muscle the site of injection 3. Intravenous Injection- Delivers meds and on local blood into veins flow. 4. Intraosseous Injection- Delivers meds - The absorption of the into bone marrow aqueous is fast and 5. Intradermal Injection- Delivers meds the depot form is between the layer of skin slow. Potential Complications: - The advantage of the depot form is that it 1. Infection can provide a 2. Reaction sustained dose over 3. Pain an extend period of 4. Administration error time. 5. Needlestick injuries 8. Subcutaneous (SC)- subcutaneous injections is slower than that of IV PHARMACODYNAMICS- DYNAMIC (DRUG route. needs absorption similar to in the body). Study of effect of drugs on Intramuscular injection. it minimizes the body. describing the movement of the risks associated with IV injections. the drug through the body. provide Drug 9. Inhalation- Use in gaseous drugs or RESPONSE: those that can be dispersed in an - Primary Physiologic- aerosol. produces an effect almost as desirable effect of the fast as with IV. provides rapid delivery drug across the mucous membranes of the - Secondary respiratory tract. used for asthmatic Physiologic: can be drugs, and anesthetics undesirable or 10. Intranasal-directly into the nose. desirable effects Includes agents such as nasal - Both decongestants or cocaine 11. Topical- it is applied where and when Dose-RESPONSE relationship a local effect of the drug is desired Body’s physiologic response to (top of SKIN). changes in drug concentration at the site of 12. Transdermal- Drug administration action through the skin. It can achieve systemic effects but rate of - High Potency: absorption can vary markedly Produces significant depending on the physical therapeutic responses characteristics of the skin at at low concentration application. (INSIDE THE SKIN). Montoya, J. A. V. SN  - Low potency: - Inconvenient, to Produces minimal severe, to life therapeutic effect at threatening low concentration - Desirable Therapeutic index: efficacy: Relation between Chronic illness, age, weight, gender, ethnicity the therapeutic and the toxic dose of the drug play a role. (difference between two points). ADVERSE REACTIONS-UNINTENTIONAL, - Narrow TI- Requires UNEXPECTED THAT MAY OCCUR IN NORMAL careful monitoring to DRUG DOSAGES. ensure patient safety - REACTIONS MAYBE THERAPEUTIC RANGE: Range of doses that MILD TO SEVERE produces therapeutic response without INCLUDING causing significant adverse events to patients. ANAPHYLAXIS (CARDIOVASCULAR COLLAPSE) ONSET, PEAK, DURATION OF ACTION - ALWAYS UNDERIBLE, MUST BE REPORTED Onset: Minimum amount of drug SO AS TO REPRESENT required for drug effect VARIANCES FROM Peak: Drug reaches highest PLANNED THERAPY concentration in the blood DRUG TOXICITY-WHEN DRUG LEVEL EXCEED Duration of Action: Length of time the THE THERAPEUTIC RANGE. drug exerts a therapeutic effect - SECONDARY TO Therapeutic Drug Monitoring- steady state OVERDOSAGE has been achieved (INTENTIONAL OR UNINTENTIONAL) OR - drug concentration of DUE TO DRUG drug can be ACCUMULATION determined by - FACTORS: DISEASE, measuring peak and GENES, AGE trough drug levels. - Peak and trough TOLERANCE/PLACEBO EFFECT levels are requested TOLERANCE- DECREASE RESPONSE TO for drugs that have A DRUG OER A COURSE OF THERAPY narrow therapeutic index and are PLACEBO EFFECT- RESPONSE NOT considered toxic ATTRIBUTED THE CHEMICAL PROPERTY OF A DRUG. Side effect, a/r, drug toxicity - CAN BE POSITIVE OR All drugs has side effects (secondary NEGATIVE. effects), even in correct drug usage. - CAN BE INFLUENCED - Predictable BY THE BELIEFS, ATTITUDES AND EXPECTATIONS OF THE PATIENTS Montoya, J. A. V. SN  - CAN BE Complementary & Alternative Therapy PSYCHOLOGICAL IN Dietary Supplement Health and Education Act ORIGIN BUT RESULTED TO - 1994, US Congress CHANGES IN HEART enacted RATE, BP AND PAIN - Intended to SENSATION supplement diet - Composed of 1 or Drug interactions more dietary Pharmacokinetic interaction- Changes that ingredients (Vitamins, occur in the absorption, distribution, minerals, herbs or metabolism and excretion of one or more other botanicals, drugs. amino acids, and certain other Absorption: Drug can block, decrease substances) and their or increase absorption of another constituents drug (laxative, increases intestinal - Intended to be taken motility, decrease other drug by mouth in forms absorption) such as tablets, METABOLISM: Cimetidine inhibit capsule, powder, enzyme decreasing metabolism of softgels, gelcap or theophylline, resulting to liquid accumulation - Labeled as being a EXCRETION: Antacids may alkalinized dietary supplement urine, promoting excretion of weak acids like aspirin Dietary supplements are regulated through the US Food and Drug Administration (FDA) ADDITIVE DRUG EFFECTS- when 2 drugs are administered in combination and the Labels are required to have the following: response increased beyond what either could Name of supplement produce alone (desirable or undesirable) Amount of supplement (net quantity) Synergistic drugs- when 2 or more drugs are Nutrition labeling given together, one drug can have a Ingredient list synergistic effect to another. effect of 2 drugs Name and Place of the manufacturer, given together is substantially greater that packer and distributor that of either drug alone. decrease drug dosing of the other. Types of Claims: Antagonist drug effect- when drug with Health claims antagonizing effect area administered Structure and Function claims together, one drug reduces /block the effect Nutrient content claims of the other/ can be beneficial or otherwise Seal of Approval Awarded to products that meet criteria similar to that of Current Good Manufacturing Practices (CGMPsFDA proposed standards for marketing and labeling dietary supplements in 2003) Montoya, J. A. V. SN Herbal Preparations (menstruum) poured into the material and 1. DECOCTION: Tea made from boiling allowed to steep for a plant material certain length of time. 2. INFUSION: Tea made by pouring CUTTING/SCOOPING: collection of water over plant material and the desired part into a container through mixture is then allowed to steep. scooping. - Water is usually boiling (hot tea Commonly used herbal remedies usually is an excellent way to administer Astragalus: adjunct to boost immune herbs), but cold system, such as Hepatitis and Cancer, infusion is also an to limit effects of colds and flu. But option some species contain neurotoxin and 3. TINCTURE: Extract of plant made by therefore not safe for human soaking herb in a dark place with a consumption desired amount of either alcohol, Chamomile: treat sleeplessness, glycerin or vinegar in 2-6 weeks anxiety and stomach or intestinal - Liquid is strained ailment; with some benefits in skin from the plant condition and oral ulcers due to material chemotherapy or radiation treatment. 4. LINIMENT: Extract of plant is added s/e: allergic reaction to anaphylaxis either to alcohol or vinegar and is Cinnamon: use in treatment of applied topically bronchitis, GI problems, anorexia and 5. POULTICE: Topical application of a DM. Contains coumarin that can soft, moist mass of plant material possible affects to decrease blood usually wrapped in a fine woven clotting. cloth. Garlic: reported to lower cholesterol, ESSENTIAL OIL: Aromatic volatile oils decrease blood pressure and reduce extracted from the leaves, stems, heart disease. Also been used to flower, and other parts of plant prevent cancer of the stomach and - Dilution of this highly colon. S/E: heartburn and upset concentrated oil stomach. Reduces blood clotting HERB-INFUSED OIL: Process of hence cautioned to those with extraction in which the volatile oils of bleeding disorders a plant substance is obtained by Ginger: use to treat post-operative, soaking the plant in a carrier oil for pregnancy-related, and approximately 2 weeks then straining chemotherapy-related nausea as well the oil as motion sickness and diarrhea. May - Oil contain the plant relieve pain, swelling, and stiffness aromatic from osteoarthritis and rheumatoid characteristic. arthritis. S/E: gas, bloating, heartburn PERCOLATION: Extract the soluble and nausea. constituents of a plant with the Ginseng: boost immune system, assistance of gravity. increases self well-being and boost - Material is moistened stamina. Use in erectile dysfunction, and packed into tall Hepa C and menopausal symptoms conical vessel, liquid (breast tenderness and menstrual Montoya, J. A. V. SN  irregularities. Lowers BP and glucose Right Patient levels. S/E: Headache, GI upset, and -Requires at least 2 forms of allergic reactions. identification before drug administration Gingko: use in asthma, bronchitis, fatigue and tinnitus. In recent time, Right drug improve memory , prevent Alzheimer and other dementias. S/E: headache, -Determine the right drug before administration. Nurses next step is to scan the nausea, GI upset, dizziness, allergic reactions that include severe medication label to automatically validate the time, date and nurse administering the reactions leading to death medication Turmeric: used in heartburn, stomach ulcers, gallstone, inflammation and COMPONENT of a drug order cancer. Generally safe but high doses can cause nausea or diarrhea Patient’s name & birthdate Peppermint: used in indigestion, Date and order is written Irritable bowel syndrome, to cold Signature who took the VO or symptoms, headache, muscle and TO nerve pain. S/E: allergic reactions and Drug name and strength heartburns Drug Frequency and Dose (daily, etc) QUALITY &SAFETY EDUCATION FOR NURSE Route of Administration (Competencies) Duration of administration 6 Focus areas where quality and safety (for 7 days, for 3 doses) standards should be practice No of pill to be dispensed No of patient’s refill if any 1. Patient-family centered care: Respecting patient’s right NURSING INTERVENTIONS TO 2. Collaboration and Teamwork: inter- ENSURE: professional teams working together Verify identity comparing to 3. Quality improvement: Improving available records patient’s delivery of care Use 2 patients identifier 4. Evidence-based practice: safe delivery (repeat their names and date of care based on current research. of birth) 5. Safety -minimizing risk to patients Nurse must become familiar 6. Informatics: using technology to with the patient’s health improve care history Vital to safe medication administration in Always perform a health to nursing care toe assessment on the patient including complete vital signs 6 Rights of Medication Administration Read orders carefully. If 1. Right Patient unclear need to verify before 2. Right Drug administration 3. Right Dose Review patient’s laboratory 4. Right Route before administration of 5. Right Time medications 6. Right Documentation Montoya, J. A. V. SN  Read drug order carefully. If Hs –at bedtime unclear must verify with the Administer drugs at the specified ordering HCW time Administer drugs that are Know patient’s allergy affected by food, 30 mins to 1 hour Know the reason why patient before meals or 2 hours after a meal will receive the medicines (indications) Some foods are absorbed better Check for dosage calculations after eating (given after meals) or Check the drug label, drug those that can irritate the stomach name, amount of the drug Adjust medication schedule to fit including intended route the patient’s lifestyle activities, Know the date when the tolerances, preferences as much as medication was ordered and possible ending date CONTROLLED DRUGS: Check for patients who is scheduled RENEWED EVERY 48 HOURS. for any diagnostic procedures that Antibiotics 7-14 days contraindicate the administration of All orders- including first medications dose, one time, and as- Check the expiration date needed (PRN) medication orders- should be checked If it has passed, discard the carton against the original orders or return to pharmacy Right Dose Administer antibiotics in an even time intervals (3 x a day versus every -Refers to verification by the nurse 8 hours) to maintain therapeutic that the dose administered is the amount blood levels ordered, and that it is safe for the patient for whom it is prescribed Patients ongoing hemodialysis -Based on patient’s physical status: Withhold during hemodialysis (BP is lower ) -Weight Right route - Renal and Liver functions -Necessary for appropriate absorption -Sodium and potassium level Oral (most common) Right Time Form: -Right time refers to the time the prescribed dose is ordered for administration - Liquid - Pill Daily drug dosages are given in a - Sublingual specified intervals, such as: - Buccal OD-once a day - Feeding BID-twice a day - Topical TID- three times a day - Inhalation QID 4 x a day - Otic Q 6 hours - Ophthalmic Prn- pro re nata; as needed - nasal sprays Montoya, J. A. V. SN  - Supposity Medication Safety Zone- Distraction free - Parenteral environment, Medication room where nurses should not be disturbed, Dedicated room for Right documentation medication safety zone. -Requires the nurse to record Rights for safe medication administration immediately the appropriate information about the drugs administered (errors, side effects, A/E) Name of drug Dose Route Time and date Nurse’s initial or signature DRUG RECONCILIATION Important component of the culture of safety. Process of identifying the most accurate list of all medicines that the patient is taking at transitions in care. This prevent Different routes: discrepancies that can cause a drug error. Was created to provide drug continuity during Instillation optic care transitions, promoting patient safety Instillation Aerosol Oral Disposal of Medicines: Transdermal patch Sharps: Topical Intramuscular Needlestick safety and Prevention Instillation Otic Act- Requires employers to implement safer Subcutaneous medical devices for their employees, provide Intravenous a safe and secure workplace environment Suppository Dosage Forms- Drugs can be crushed, but not Form/route: all 1. Tablet/Capsules- Most common forms. Less expensive, High Alert Medications- Can Cause significant - Not given to patient harm to the patient if given in error & Can that are vomiting, have a major effect on the patient’s organ who lack gag reflex, or comatose Ex: epinephrine, Mg sulfate, insulin, - Not mixed with large Mg Sulfate injection. KCl etc amount of food and Look-alike and Sound-alike Medicines- Should beverages be aware of certain drug names sounding - Not able to consume alike, spelled similarly completely (not full dose) Ex: Dobutamine vs Dopamine/ - Do not mixed with Hydralazine vs Hydroxyxine milk formula Montoya, J. A. V. SN  - Irritating drugs with TUBE PLACEMENT food to decrease GI and assess the gastric discomfort; without residual food if it will alter - Residual versus absorption aspiration/electrolyte imbalance/poor Buccal/sublingual: meds shall remain nutrition in place until fully absorb - Placed in high fowlers 2. Liquids (elixirs, emulsion, or elevate head for at suspensions):- Dosing cups in least 30 degrees to ml/calibrated syringe (thru meniscus), avoid aspiration Given by ml, spoonful, tbspoonful and - Drug should be Read instructions in diluting crushed (ensure suspensions/instructions if need feasible); allow to shaking or dilution etc. flow by gravity 3. Transdermal- Patch placed on the skin - Flush with 10-15ml of affording systemic results, Perform water per drug hand hygiene and apply gloves in administration to administration to prevent transfer of maintain patency of medication, Application that has been tubing. 30ml when in contact with the patient shall not finished or as be reinserted in the package, Apllied prescribed by AP (I/O) not to tightly not to alter drug - 30 mins clamped delivery, & Never cut patch in half before the need to 4. Instillations- Liquid medications suction so as meds administered In drops, ointments and will be absorb sprays (eyedrops, eye ointments, 7. Suppository- Solid medical nasal spray, nasal drops) preparation that is cone or spindle 5. Inhalation- Metered dose inhaler: shape for insertion into the rectum handheld devices use to deliver (globular or egg shape for vagina and asthma medications via inhalation pencil shape into urethra) & Made in (mouth or nose), Capsule thru disk glycerinated gelatin/polyethylene haler (puncturing the capsule and glycol. powder is delivered thru inhalation). - Rectal: Useful in Ex: Inhalers, Nebulizers or with babies, uncooperative spacers patients and in cases 6. NGT/OGT (Nasogastric Tube of vomiting or certain (NGT/Orogastric Tube (OGT)- Thin digestive disorders, soft tube passed through a child's SIMS position, breath nose, down the back of the throat, slowly thru mouth, through the oesophagus and into the Small amount of stomach & Thin soft tube passed water soluble through a child's mouth, through the lubricant, Insert oropharynx, through the oesophagus beyond the sphincter, and into the stomach. Remain flat or on one - Before administration side for at least 30 of drugs, ALWAYS mins. CHECK FOR PROPER Montoya, J. A. V. SN  - Vaginal: inserted cubital *antecubital; dorsal gently thru an vein of hand, applicator, Lithotomy Newborns/infant: feet lower position, Lie for leg, head after other sites are sometime to allow exhausted, G20-21, 1-1 and ½ medication inches; (infants g24 1 inch; absorption, Provide children g22 1 inch) patient with sanitary IM sites shall be away from major nerves and pad; if able can be blood vessels. inserted by the patient herself. DRUG CALCULATION 8. Parenteral a. Intradermal: Local-preferred IV administration set- Nurses have an areas are lightly pigmented, important role in the preparation and free of lesions, hairless, G25- administration of IV solutions such as 0.9% 27, ¼ to ½ inch long; sodium chloride (normal saline, [NS]), 0.45% tuberculin syringe, 1 ml sodium chloride (½NS), 5% dextrose in water calibrated in increments of (D5W), and Lactated Ringer’s solution (LR) 0.01. and also IV drugs. b. Subcutaneous: Systemic effect- Absorb thru capillaries; slower than IM route, Usually may contain 0.5 to 1 ml, G25- 27, 3/8 to 5/8 inch long; 3/8 inserted in 90 degree angle; 5/8 in 45 degree angle, Uses 1-3 ml syringe and can deliver 0.5 to 1ml amount of medication. c. Intramuscular: Systemic effect- Effect more rapid than SQ, used for solution that are viscous, Many risk hence should be extra careful, Consider: volume of drug to be administered, site location, angle of injection (90degree Microset with Volume controlled chamber/ angle), patient position, Electronic Infusion advantage and disadvantage of site, Underweight should be evaluated for adequate muscle mass, Use g18-25, 5/8 to 1 and ½ length needle, Preferred sites: ventrogluteal, Deltoid. d. Intravenous: systemic- More rapid than IM and SQ, Adults: cephalic, basilic, median Montoya, J. A. V. SN  Macrodrip set- A set that delivers large drops draw up in a syringe to deliver the desired (10– 20 gtt/mL) dose? microdrip (minidrip) set- one that delivers x=D/H x Q small drops (60 ugtt/mL) x=? At times, primary IV fluids are given at a slow x=ml since the given is 2mg/ml rate, ordered to keep vein open (KVO), also therefore, quantity is only 1 called to keep open (TKO) UNIT CONVERSION 4 𝑚𝑔 Units Metric English 𝑥= × (1𝑚𝑙) 2 𝑚𝑔 Weight 1kg = 1000g = 2.2lb 1g = 1000mg = 4 1mg = 1000mcg = 𝑥= × (1𝑚𝑙) 2 1mcg = 1000ng = Fluid 1L = 1000mL = 𝑥 = 2 × (1𝑚𝑙) Volume 240Ml = 1 c (cup) 𝑥 = 2𝑚𝑙 30ml = 1 oz (ounce) 15ml = 1t Dosage Calculations based on Weight: (tablespoon) 5ml = 1t Kg=weight (Teaspoon) Per kg=dosage ordered 60gtt = 1t (drop) x=required dosage Length 1km = 1000m = x= kg x per kg 1m = 100cm = 1cm = 10mm = then apply x=d/h x q formula 2.54cm = 1 inch = 25.4mm = 1inch = when to convert? Drug Calculation When the units are not aligned or if Drug Dosage: the desired dose/ordered dose is not aligned with the unit of hand/stock. x= D/H x Q Formula to get DOSAGE PER DAY: D= desired dose (amount)/Ordered amount D=Desired dose/Ordered Dose H=at Hand/Stock W=weight in kg Q=Quantity x= Dosage per day NOTE: When medication is given in tablets, the QUANTITY = 1 since the amount of x=D÷W medication available is specified per (one) IV infusion calculations tablet. 𝑚𝑙 𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑛 𝑚𝑙 Ex. a provider requests lorazepam 4 Mg IV = ℎ𝑟 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎ𝑜𝑢𝑟𝑠 Push for a patient in severe alcohol withdrawal. The clinician has 2 mg/mL vials on If time is given in minutes, convert hand. How many milliliters should he or she first: Montoya, J. A. V. SN  𝑔𝑖𝑣𝑒𝑛 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 Electrolytes- Electrolytes are charges particles ℎ𝑟 = 60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠/ℎ𝑟 (ions) that are dissolved in body fluids. Then do the infusion formula Drop per minute: 𝑔𝑡𝑡𝑠 𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑛 𝑚𝑙 = × 𝑑𝑟𝑜𝑝𝑓𝑎𝑐𝑡𝑜𝑟 𝑚𝑖𝑛 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 If time is given is in hour, convert first. In doctor caponpon formula: 𝑔𝑡𝑡𝑠 𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑖𝑛 𝑚𝑙 Composition of Body Fluids = ℎ𝑟 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎ𝑟 Then she will now convert hour into minutes with the drop rate: ℎ𝑜𝑢𝑟 = unit conversion 60𝑚𝑖𝑛 𝑔𝑡𝑡𝑠 𝑔𝑡𝑡𝑠 ℎ𝑜𝑢𝑟 = × × 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 𝑚𝑖𝑛 ℎ𝑜𝑢𝑟 60𝑚𝑖𝑛𝑢𝑡𝑒𝑠 Drug Labels Major Cations 1. Extracellular a. Sodium (Na+) 2. Intracellular a. Potassium (K+) The following provides additional information What electrolytes do? provided on drug labels. Kadian 1 is the brand (trade) name and morphine sulfate 2 is the - Promotes generic name. The formulation 3 is 60 mg per neuromuscular capsule , and the container holds 100 4 impulses capsules. It is a Schedule II 5 drug, which is a - Maintain body fluid controlled substance because of its potential volume and for abuse. The label indicates how the drug is osmolarity to be stored, 6 and the lot number 7 also - Distribute body water appears. between fluid compartments Montoya, J. A. V. SN  - Regulate acid base -Those with genitourinary disease, balance adrenal insufficiency, cancer, poorly controlled DM Electrolytes Imbalances Signs: ECG changes , Paresthesia, Gi Hyponatremia/hypernatremia hyperactivity etc Hypokalemia/hyperkalemia Hypomagnesemia/hypermagnesemia Sodium Normal Level 135-145 mEq/L Hypocalcemia/hypercalcemia -Major cation in the ECE; found in Hypophosphatemia/hyperphosphate most body fluid. Play a major role in fluid mia volume balance and is the primary Hypochloremia/hyperchloremia determinant of plasma osmolality. Important Potassium Normal Level: 3.5-5mEq/L in the maintenance of neuromuscular irritability and conduction of nerve impulses. -Primary intracellular cation; 98% found within the cell. Essential for Low level: Hyponatremia- caused by a neuromuscular activity and cellular loss of Na containing fluids, deficient intake or metabolism. water gain. - Affect cardiac and skeletal muscle - Vomiting, diarrhea, NGT suctioning, - Play major role in muscle and nerve burns, wound cell electrodynamic drainage, trauma, Low level: Hypokalemia-brought about by renal failure, heart excessive loss rather than deficient intake failure, excessive hypertonic IVF, Causes: Diarrhea, suctioning, surgery, thiazide abdominal surgery, draining fistula, diuretic diuretics therapy, burns, TPN, prolonged laxative use, - Symptoms: muscle etc weakness, decrease DTR, tachycardia, Symptoms: muscle weakness, fatigue, Headaches, lethargy, paresthesia, leg cramps, decrease bowel confusion, seizure, motility, paralytic ileus, confusion, coma etc dysrhythmia and cardiac arrest. high level: Hypernatremia- Caused by sodium high level: Hyperkalemia- Brought about by gain, sodium retention or water loss. excessive intake, impaired renal excretion Common cause: Common cause: Renal failure, Medications that interfere with potassium - Excessive sodium excretion. intake, deficient water intake Person at risk in developing - Hypertonic tube hyperkalemia feedings, hypertonic -Premature IVF - Cushing -Older adults syndromeCorticoster oid use - AKF Montoya, J. A. V. SN Signs: transmission of neuromuscular activity and mediator of neural transmission in the CNS - Edema - Muscle twitching, Low level: Hypomagnesemia is the most hyperreflexia, seizure undiagnosed electrolyte deficiency as usually - Coma it is asymptomatic until level approaches 1mEq/L. Calcium Normal Values 8.6-10.2 mg/dL- Most abundant mineral in the body. Necessary for Brought about by: prolonged transmission of nerve impulses and normal parenteral nutrition without Mg contraction of skeletal and heart muscles, supplementation, diuretics, certain regulation of heart and BP, maintenance of antibiotics, laxatives and steroid use; chronic muscle tone and formation of blood clots. alcoholism, prolonged fasting, starvation Low level: Hypocalcemia- because of calcium Symptom: Lethargy, weakness, loss from bones (demineralization). personality change, tetany (hyperreflexia) Common causes: Acute Pancreatitis, high level: Hypermagnesemia-Caused by widespread bony metastases, excess intake of magnesium salt hypoparathyroidism, diarrhea, alcoholism, Common cause malnutrition, use of loop diuretics, Vit D deficiency, multiple blood transfusion. - Medications like laxatives and antacids Symptoms: anxiety, irritability, tetany, - Patient with CKD who twitching, hyperactive DTR, spasms, ECG ingests products changes, dysrhythmia. containing high level: Hypercalcemia-Caused by magnesium hyperparathyroidism, malignancy, excessive Signs: calcium intake, prolonged immobilization, multiple fractures, thiazide diuretics and - Weakness, nausea, steroids dizziness, confusion Signs Chloride normal values 96-106 mEq/L- Principal anion of ECF (extracellular fluid). - Fatigue Major contributor to acid-base balance, - Muscle weakness gastric juice acidity and osmolality of ECF - Depressed DTR - Confusion and Hypochloremia -Low levels of chloride in impaired memory blood - Anorexia, constipation usually Caused by fluid loss - Kidney stones. Signs: - ECG changes and dysrhythmias - Weakness, Lethargy and unconsciousness - Fatigue Magnesium Normal Values 1.5-2.5 mEq/L- - Difficulty in breathing Most plentiful in the ICF (intracellular fluid). (slow shallow Play a major role in maintaining normal breathing) calcium and potassium balance. Promote - Tremors, twitching - Decrease BP Montoya, J. A. V. SN Hyperchloremia- High levels of chloride in d. Cancer blood & excess of chloride in the blood e. Starvation/Crash Diet 3. Increase Vitamin Requirement Caused by conditions like diarrhea, a. Early Childhood kidney disease, certain medications or eating b. Debilitating Disease too much salt c. Gi surgery Signs: 4. Inability to use vitamins a. Liver Disease, Renal - Diarrhea Diseases - Vomiting - Fatigue Acute Malnutrition- Malnutrition is a - Weakness condition in which the body does not receive - Difficulty of breathing the correct amount of nutrients it needs to function properly. Inadequate intake of Vitamins and minerals essential nutrients is commonly referred to as Vitamins- Organic substances necessary for macronutrient deficiency and micronutrient normal metabolic functions. Body needs only deficiency. a small number of vitamins daily, which are - Macronutrient obtained thru diet. Malnutrition Shall be increased among: - Micronutrient Malnutrition - People experiencing rapid growth MACRONUTRIENT-The nutrients we need in - Children who are larger quantities that provide us with energy. malnourished Include Protein, Fat, and or calories. Deficit - Pregnant and leading to stunting and wasting (Marasmus breastfeeding and Kwashiorkor). Macronutrient deficiency - Patients with refers to a lack of the nutrients required in debilitating illnesses large amounts for normal growth and - with Malabsorption development. Macronutrients include: Issues - Carbohydrates - Inadequate diet - Protein (alcoholics, geriatric - Fat patients) MICRONUTRIENT- Micronutrient deficiency is Vitamin deficiencies requiring vitamin a lack of essential vitamins and minerals supplements required in small amounts by the body for 1. Inability to metabolize or absorb proper growth and development. vitamins: Micronutrients include, but are not limited to: a. Malabsorption Disorders - Vitamins A, D, E, K b. Diarrhea (Fat Soluble c. Infectious and Vitamins)- Inflammatory Disease Metabolized slowly, 2. Increase Vitamin Losses stored in fatty tissue, a. Fever from Infectious liver, and muscle in process significant amounts b. Hyperthyroidism and excreted in urine c. Hemodialysis Montoya, J. A. V. SN  at a slow rate. Vit A 200,000IU for 12-71 and D, Toxic if taken months in large amounts, Severe Pneumonia, Persistent - Water Soluble Diarrhea, Malnutrition (6-11 months): Vitamins (Vit B complex, Folic -100,000 IU upon Diagnosis (Folate), Vit B12)- Not except when the child was given Vit A usually toxic unless Capsule less than 4 weeks before Dx. taken in extremely excessive amounts. Severe Pneumonia, Persistent Not stored in the Diarrhea, Malnutrition (12-71 mons) body hence steady - 200,000 IU upon supplementation is Diagnosis except required. Excreted in when the child was the urine. given Vit A Capsule - Minerals (Calcium, less than 4 weeks Iodine, Iron, Zinc)- before Dx Needed for body Malnutrition in 6-12years old: function 200,000 IU upon diagnosis except Fat soluble vitamins when the child was given VAC less than 4 weeks before Dx Vit A (retinol and beta carotene)- Fat Soluble Pregnant: 10,000IU to be started at Vitamins. Taken orally and is readily absorbed. 4th month until delivery(not among Required in the development of healthy eyes, those already taking prenatal vitamins gums, teeth, skin, hair, glands and immune containing Vit A function (Bone growth and maintenance of Post-partum: 200,000IU 1 dose within epithelial tissues). 4 weeks after delivery Food Sources: - Darkly colored fruits Vit D- Role in regulating Calcium an and vegetables Phosphorous, OTC Vit D usually contain Vit D3 (mangoes, that once absorbed, Vit D is converted to cantaloupe, carrots, Calcifediol to Calcitriol. Excretion is thru bile, sweet potato, Vitamin D is a fat-soluble vitamin naturally pumpkin. produced in the body. It is essential to the - Animal Origin (Dairy absorption of calcium for proper bone Products, meat, fish development and function, Vit D taken with oil and fish) Calcium can reduce incidence of fracture. Deficiency: Night Blindness ; skin lesion Vitamin D is found in: DOSE OF VIT. A - Cod and cod liver oil, Measles: Egg yolks Milk and butter Salmon and - 6 Mons to 11 Mons: shrimp Fortified 100,000IU upon cereals Diagnosis And Vitamin D deficiency can cause rickets, a deficiency disease of infants and children in Montoya, J. A. V. SN which bones are not mineralized. In rickets, doses are based on coagulation bones become soft and may bend, distort, status. As treatment: Initially, 1 mg via and/or fracture. Rickets is one of the most SC/IM/IV with or without common childhood diseases in many prothrombin complex concentrate developing countries. (PCC) or fresh frozen plasma (FFP). - Dose: 600-800iu/day Water Soluble Vitamins Vit E- Has antioxidant property (loose Vit B complex electrons or free radicals that can damage Thiamine: deficiency may result to cells, Potential for Vit e to reduce CVDs polyneuritis and cardiac pathology seen in (reduced plaques in arteries by preventing Beri-beri WBC in sticking to the artery walls)) and Alzheimer’s Disease. Riboflavin: deficiency may cause scaly dermatitis, cracked corners of the mouth and - Dose: 15mg/day not inflammation of skin and tongue. to exceed 1000mg/day (oral Pyridoxine: Deficiency may occur with intake) alcoholics alleviate symptoms of neuritis - Should not be taken caused by INH with Iron (interfere with vit E absorption) Vit C- Use in treatment of Vit C deficiency (SCURVY);, Increased wound healing, for Side effects of large doses: fatique, burns, preserve integrity of Blood vessels, weakness, nausea, GI upset, seen in patients with restricted diets and headache, bleeding and breast those who abuse alcohol. tenderness - RDA: 75mg/day- Vit K- Needed for synthesis of prothrombin 90mg/day and several clotting factors. - Severe deficit like scurvy: 500mg - Prevents Hemorrhage- Antidote for 1000mg x 2-4 weeks oral anticoagulant overdose and treatment of - IV: 200mg/day x 1 Hypoprothrombinemia of Vit K Deficiency week or can still - recommended continue until immediately after symptoms resolved birth for newborn Special precaution: drug interactions that is Vit K deficient with aspirin ( Ae: stones, - As prophylaxis: For hyperuricemia, Hemolytic anemia, healthy neonates: 1 Deep Vein Thrombosis) mg via IM injection at birth. Vitamin B12- Vitamin B12 is a water-soluble - For preterm vitamin that exists in several forms. Vitamin neonates: B12 is needed for proper red blood cell 2.5kg: nerve cells. It is also essential to making DNA, 1mg via IM or IV inj the genetic material in cells. Vitamin B12 is found in fortified cereals and found naturally Dose is given soon after birth. The in foods that come from animals, including: amount and frequency of further Montoya, J. A. V. SN  Fish - Folic acid is available Meat in most multivitamins Poultry and in some foods. Eggs Supplementing the Milk and milk products diet with vitamins and foods rich in folate or What is Vitamin B12 Deficiency? folic acid can help -Vitamin B12 deficiency results from prevent and treat inadequate dietary intake or impaired folate deficiency. absorption MINERALS- Zinc is an essential mineral found -Vitamin B12 deficiency can be in over 200 enzymes that are involved in a treated by: Supplements: oral pills, under the wide range of functions in the body. These tongue pills, liquid, nasal sprays, or injection zinc-containing enzymes play a role in or by Increasing consumption of animal immune function, wound healing, and making products DNA and other proteins. Zinc supports normal growth and development during childhood Folate - Folate, also known as vitamin B9, is a and adolescence, and is required for proper water-soluble vitamin naturally found in sense of taste and smell. Foods high in zinc foods. include: Meats and seafood, Eggs, Whole grains and oats Nuts and seeds, Leafy greens, Necessary for the production and Vegetables and herbs ,Yogurt. maintenance of new cells. It is especially important during periods of rapid cell division What is Zinc Deficiency? and growth such as infancy and pregnancy. Both adults and children need folate to make -Because zinc plays so many roles in normal red blood cells and prevent anemia. the body including brain development, a deficiency of zinc can impact multiple bodily Folate can be found naturally in the functions and result in a wide variety of following foods: symptoms - Leafy greens (e.g. IODINE- Iodine is a nutrient essential for spinach and turnip normal functioning of the thyroid gland, greens) Peas and production of thyroid hormones and beans Fruits and metabolism. Iodine is typically found in small vegetables amounts in food and varies depending on - Folic acid (synthetic environmental factors such as the soil folate) is commonly concentration of iodine and the use of added to enriched fertilizers. grain products such as: Cereals Rice Pasta -Iodine deficiency is the world’s most Bread Flour common, but preventable, cause of mental retardation. A lack of iodine in the diet can FOLATE DEFICIENCY- Inadequate dietary affect thyroid gland function and result in a intake of folate can slow growth rate in condition called goiter. infants and children. Advanced folate deficiency can lead to anemia in adults. -Sources of dietary iodine includes: Bread (fortified), Iodized table salt Dairy Treatment: products (e.g. cheese, cow milk, yogurt), Eggs, Soy milk and soy sauce, Shellfish Montoya, J. A. V. SN IODINE DEFICIENCY- Iodine is not produced by - 2000 calories per day the body, so it must be obtained through diet. (critically ill=50%more Sufficient thyroid hormone is not produced than the normal without enough iodine. Iodine deficiency can energy requirement. lead to enlargement of the thyroid (goiter), - Needed if 10% weight hypothyroidism, and mental retardation in loss in 3-6 mons or no infants and children whose mothers were