Intro To Basics V.1 2023-10-24 17_18_01.pdf

The nursing processes: ADPIE • Assessment • Nursing Diagnosis • Planning • - Goals • - Outcome criteria • Implementation, including patient education • Evaluation Assessment: Data collection, review, and analysis • Medication profile • Any and all drug use • Home or fold remedies, natural health pr...

The nursing processes: ADPIE • Assessment • Nursing Diagnosis • Planning • - Goals • - Outcome criteria • Implementation, including patient education • Evaluation Assessment: Data collection, review, and analysis • Medication profile • Any and all drug use • Home or fold remedies, natural health products or homeopathic treatments • Alcohol, tobacco, caffeine intake • Current or past illicit drug use • Prescriptions and over-the-counter (OTC) medications • Past or present health history and associated drug regimen • Family history; growth and developmental stage • Issues related to age and medication regimen • Allergies Medication reconciliation: comparing a patients medication orders compared to medications that patient is currently taking Diagnosis • used to communicate and share information about the patient and the patients experience • Description of patient problems based on assessment data Planning • Identification of goals and outcomes criteria. • Expected outcomes of prescribed drug therapy • Concrete descriptions of patient goals • Provide a standard for measuring movement towards to goals Implementation Is guided by the preceding phases of the nursing process • Initiation and completion of specific nursing actions related to medication administration, monitoring with anticipated outcomes in mind • Independent, collaborative, dependent • Based on nurses judgement and knowledge Evaluation Is systematic, ongoing, and dynamic part of the nursing process. • Determining the status of the goals and outcomes of come • Monitoring the patients response to drug therapy • Therapeutic • Expected • Adverse, and possibly toxic responses • Documentation must be accurate, clear and concise Ten Rights of Medication Administration • Right drug/Medication • Right dose • Right time • Right route • Right patient • Right reason • Right documentation • Right evaluation (or right assessment) • Right patient education • Right to refuse Time critical • Facility-defined medications: Administer at exact time when necessary (e.g., rapid-acting insulin), otherwise within 30 min before or after scheduled time Non-time critical • Daily, weekly, monthly medications: administer within 2 hours before or after scheduled time Medications prescribed more frequently than daily but no greater than q4h: Administer within 1 hour before or after scheduled time Medication Errors Major problem, regardless of health care setting • Defined as “ any Preventable even that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care provider, patient, or consumer”. • Must consider patient-related and system-related factors when examining medication errors. Pharmacology (Study of Drug) • Science of the interaction between chemical substances & the body Pharmaceutics • Study of how various drug forms influence the way in which the drug affects the body — — — liquid, capsule, enteric-coated Pharmacotherapeutics • The study of science of drugs Pharmacognosy • The clinical use of drugs to prevent and treat disease Pharmacokinetics (ADME) The study of what the body does to the drug • absorption — — The transfer of a drug from its site of administration to the bloodstream — — Bioavailabilty describes the extent of drug absorption • distribution — — The transport of a drug from the bloodstream to tissue sites where it will be effective — — Most are bound to the carrier-protein albumin • Metabolism — — or biotransformation, the biochemical alteration of a drug into: an inactive metabolite, a more soluble compound, a more potent metabolite or a less active metabolite • Excretion — — Process of removing medications or their by-products from the body Drug Names Chemical Name • Drug chemical composition ———(RS)-2-(4-(2methylpropyl)phenyl)propanoic acid Generic Name • Nonproprietary name, or official name • Given to a drug approved by Health Canada — — — Ibuprofen Trade Name • Proprietary name • Drug has registered trademark, use of name restricted by the drugs patent owner — — — Advil, Motrin Drug Classification • By body system (Physiological classification) • Class of agent (Chemical classification) • Mechanism of action (therapeutic classification) • Indication (intended action or effect) Phases of drug activity Dose of formulated drug (Administration) 1 Pharmaceutical Phase • Disintegration of dosage from dissolution of drug (Drug available for absorption) 2 Pharmacokinetic Phase • Absorption, distribution, metabolism, excretion (Drug available for action) 3 Pharmacodynamic Phase • Drug-receptor interaction Effect Pharmacodynamics The study of what the drug does to the body • Mechanism of interactions of drugs at their site of activity Absorption Route of administration affects the rate and extent of absorption of the drug Route • Enteral route (PO) - Largest • Sublingual (SL) and buccal • Topical • Transdermal - slowest • Inhalation - smallest • Parenteral route — Intradermally (ID) — Subcutaneously (SQ/SC) — Intramuscularly (IM) — Intravenously (IV) - Fastest First-Pass Effect • Drugs given via intestine must first pass through liver before reaching circulation - Large proportion of drug is chemically changed into inactive metabolites • Same drug given intravenously bypasses the liver, preventing the first-pass effect Bioavailability = The extent of drug absorption Distribution Transport of a drug by the bloodstream to its site of action • Areas of rapid distribution — — Areas with extensive blood supply • Heart, liver, kidneys, brain • Areas of slow distribution — — muscle, skin, fat Drugs bind to proteins (most common protein is albumin) and are inactive • unbound portion of drug is active * most abundant carrier (binding) protein Medications that are highly bound to proteins have a longer duration of action Metabolism aka Biotransformation Drug transformed into any of the following: • inactive metabolite • A more soluble compound • A more potent metabolite • A less active metabolite Organ most responsible is the liver • other metabolic tissues include skeletal muscles, kidneys, lungs, plasma, and intestinal mucosa Affected by: • Age • First pass effect • Nutritional status • Patient health Excretion Elimination of drugs from the body Drugs and their metabolites exit the body through • Kidney (primarily) • Liver • Bowel • Lungs Less often: • Bile • Saliva • Tears • Milk Therapeutic drug monitoring Peak • The time it takes for a drug to reach its maximum therapeutic response Trough (minimum effective concentration) • lowest blood level of a drug Duration • Time that a drug concentration is sufficient to elicit a therapeutic response Half-life • Time required for half (50%) of a given drug to be removed from the body • Measure of the rate at which the drug is eliminated from the body • Determine the dosing interval Toxicity • Occurs if the peak blood level of the drug is too high Mechanism of action (MOA) Drugs can produce actions in several ways; • the effect depends on the cells/tissues targeted • MOA refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect Drug exert their actions in three basic ways 1. Through receptors 2. Through enzymes 3. Through nonselective interaction Receptors Cellular macromolecule to which a medication binds in order to initiate its effects • drugs that produce/activate/mimic a response are called agonists - analgesics, stimulants • drugs that block/inhibit a response are called antagonists - Beta Blockers, Naloxone Drug - Receptor Interactions Competitive antagonist • Drug competes with the agonist for binding to the receptor. If it binds, there is no response Noncompetitive antagonist • Drug combines with different parts of the receptor and inactivates it; agonist then has no effect Enzyme Interactions Enzymes; substances that aid in speeding up the metabolism (chemical reaction in our bodies) • they catalyze nearly every biochemical reaction in a cell Enzymes act on substrates as a lock and key method. Selective interaction drug interacts with an enzyme to alter a physiological response by either inhibiting or enhancing the action of the enzyme Nonselective Interactions Drugs that do not interact with enzymes or receptors to alter a physiological or biological function of the body Instead, use: - cell membranes and cellular processes as their main targets • Either physically or chemically cellular structures or processes (Cancer drugs/antobiotics) Simple Occupancy Theory The intensity of response to a drug is proportional to the number of receptors occupied; maximal response is reached with 100% receptor occupancy. Pharmacotherapeutics Using medications in practice • The clinical use of drugs to prevent and treat diseases • Desired therapeutic outcomes in patient-specific, established in collaboration with the patient • Outcome goals need to be realistic. Types of therapy: • Acute: Immediate need of time • Maintenance: Maintain steady state (ongoing) • Supplemental/Replacement: Addition to or supporting needs (down regulate) • Palliative: Comfort (managing not curing) • Supportive: Mitigating side effects (protective) • Prophylactic: preventative Monitoring A key responsibility for nurses Nurse observes for the effectiveness of drug therapy • AKA: clinical response • This must be evaluated (ADPIE) • Watch for adverse effects (ADPIE) Nurses must be familiar with the drug: • Intended therapeutic action • Unintended but potential adverse effects Nurses must be familiar with drugs ability to change over time: • Tolerance — A decreasing response to repeated drug doses • Dependence — A physiological or psychological need for a drug • Interactions — Alteration of the action of the drug — May occur with: other prescribed drugs, over the counter medications, Natural health products — — Can be additive/cumulative (1+1=2) — — Synergistic (1+1=>2) — — Antagonistic (1+1=<2) — — Incompatible Adverse drug reactions • any reaction to a drug that is unexpected and undesirable and occurs at therapeutic drug dosages. Four Categories • Pharmacological reaction: or adverse drug reaction (under normal conditions) • Hypersensitivity (allergic) reaction : Immune system flares up (overreactive) • Idiosyncratic reaction: unique (abnormal) depending on individual • Drug interaction