Introduction to Basics of Nursing PDF

Summary

This document provides an introduction to the basics of nursing. It covers the nursing process, including assessment, diagnosis, planning, implementation, and evaluation. It also details the ten rights of medication administration and introduces core pharmacology concepts such as the science of drug interaction, pharmaceutics, and pharmacokinetics.

Full Transcript

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

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