Lecture 2 2011 1 pharm (student)-1
-
Upload
university-of-miami -
Category
Health & Medicine
-
view
467 -
download
1
Transcript of Lecture 2 2011 1 pharm (student)-1
Lecture 2NUR 307Juan M Gonzalez BSN, RN
Drug Administration Nurses have a duty to protect their
patients Administration of medications is a large
part of what nurses are responsible for Just because it’s ordered does not mean
that we can’t question it Patient safety will ALWAYS come first Remember, the 1st way a nurse can kill a
patient is with drugs
Nurses’ Responsibilities Nurses are responsible and held
accountable for all medications they administer
You must know the drugs before you give them
Just knowing a part of a medication is not enough
If you don’t know it.. DON’T GIVE IT
What do I need to know?? Trade and generic name Classification Intended use & therapeutic effect Contraindications & special consideration Dose ranges & safety Expected side affects Adverse reactions
How to intervene for them
What else do I need to know? Your patient
Why are they taking it? Do they need it? What has your assessment revealed? What are you responsible for? Is this safe? Is it beneficial?
Bad, Bad, Bad Toxic Epidermal Necrolysis
Sloughing off Stevens-Johnson Syndrome
1-14 days Do they have a cold?
Anaphylaxis Can’t breathe
Allergic reaction Itchy
Be RIGHT all the time Right Patient Right Med Right Dose Right Route Right Time Right to Refuse Right Documentation Right to Know/Be Informed/Education Right Indication
Three Times’ the charm! Your not Santa- check it # times!!!
MAR Preparation Administration
No More UH-OHs Preventing Errors in Medication
Have complete information about the patient, including allergies
Be current on medication warnings Appropriate labeling of medications Avoid distractions
Ways of Noncompliance Not taking the medication Taking it on a different schedule Changing the dose &/or times Taking too much of it Not following dietary guidelines
Many meds have food and fluid restrictions Many need to be taken on an empty
stomach
Orders & Times Orders
STAT, immediately, now, single, repeat, prn Standing, routine, pre-med
Times BID, TID, QID 2X, 3X,4Xs daily Typically times start @ 9am
Abbreviations See chart page 20
Common Effects & Interventions
Drowsiness Switch from day to evening dosing Teach safety
No driving, fall precautions Nausea
Take with food or small snack Absorption interference
Take in-between meals
Measurements Metric
Safest one to use Memorize this one
Apothecary/Household Officially on the ‘do not use’ list Only focus on the teaspoon & tablespoon
equivalents
Routes Enteral
PO (oral) NG (nasogastric tube) GT (gastrostomy tube)
Topical Cream or fluid
Parenteral Uses a needle to deliver the drug
Enteral Tablets & caplets
Watch for 1st-pass problem Inactivated before they can do their job
Enteric coating- don’t crush Time released- don’t crush
SR, XR, LA Sublingual
Under the tongue Buccal
Between gum & cheek NG/GT
Meds must be crushed or in liquid form
Topicals Creams
Most common Vary in texture Used for the local effect OR systemic condition
Need to know which one and why Patches
Make sure the old one is off Rotate sites
Liquids Flushes, irrigation, drops
Inhalants Rapid onset
Parenteral Intradermal (ID)
Allergy shots Subcutaneous
Insulin, Heparin, vaccines Intramuscular (IM)
Pain meds, anti-infectives Intravenous (IV)
Directly into the bloodstream
Errors Preventable National Coordinating Council for
Medication Error Reporting and Prevention (NCC MERP)
#1 cause of preventable patient morbidity & death
NO acceptable rate (%) of errors
Reporting Errors At the Federal Level (FDA) MEDWATCH (1992) NCC MERP (1995) Reporting errors will also help others
avoid making similar mistakes Safety 1st
Documenting Errors Every facility has a policy & procedure Must include what was done about the
error (VS, labs, antidote) List who was notified Incident Reports Sentinel Event
Categorizing Errors Categories A-I Category A- No actual error Category B-D- Error, no harm Category E-H- Error,harm Category I- Error, DEATH
See page 89, figure 9.2
Reduction/Prevention Risk Management Education
Patient Staffing
Big Brother Government & other agencies are in
place to track errors FDA’s safety administration & adverse
event reporting program (MEDWATCH) Institute for Safe Medication Practices
(ISMP) MEDMARX
Anonymous reporting program (hospitals)
ANTHRAX Bioterrorism Agent Carried by ‘hoofed’ animals Can be spread a variety of ways ‘spores’ S/S appear with 1-6 days of exposure Manifestations depend on how it was
acquired
Manifestations of AnthraxTYPE DESCRIPTION SYMPTOMS
Cutaneous Most commonOpen woundCurable if Tx within 1st few weeks
Skin lesion turn into black scabsCan’t be spread person-to-person
Gastrointestinal Rare, ingestedLethal (50%)- if not Tx
Sore throat, swallowing probs, cramps, diarrhea, abdominal swelling
Inhalation Least commonMost dangerousMust be Tx within days
1st- fever, fatigueThen SOB, CoughDeath within 4-6 days
Anthrax Treatment Ciprofloxacin
Over-use leads to resistant strains Minimize Rx Only given if proven contamination
Vaccine Not 100% proven Limited to those with high risk of exposure 3 injection at 2 week intervals, then 3 more
injections at 6, 12, and 18 months Yearly booster
Using the Nursing Process in Pharmacology
The 5 Steps of the Nursing Process Assessment Diagnosis Planning Intervention Evaluation
The Nursing Process in Pharmacology
The nursing process guides decisions about drug administration to ensure patient safety and to meet medical and legal standards.
Assessment On-going Begin with a baseline assessment
To have measurements that you can determine effectiveness of treatment
Includes objective & subjective data Anything & everything that is pertinent
needs to be addressed Systematic approach
Subjective Data Always in “” quotes From the patient, family, staff, or chart Subjective means words stated Examples:
“I don’t feel well” Chart states “combative” MD reported “pt noncompliant with
regimen initially”
Objective Data Concrete Measurable Diagnostics Physical Findings Behavior Disease History: age, smoking/alcohol,drugs
Objective Data Examples Vital Signs Behavior
Grimacing Crying
Labs Drug levels Electrolytes
Disease Cardiac Asthma
History Smoker Alcoholism
Physical Findings Crackles in lungs 2+ pitting edema in lower extremities bilaterally
Labs Levels
Therapeutic vs Toxic range System Function
Renal BUN, creatinine, Na, K, etc
Hepatic Liver enzymes LFTs
Cardiac Enzymes BNP, LYTES
Pulmonary
Assessment On-Going New findings Therapeutic Benefits Adverse Effects/Side Effects How will they continue taking the med Financial constraints Transportation
To/From For labs
Other Assessment Data Any other medications
OTC Herbal Rx PRN ALL meds Allergies & Sensitivities
Including foods
Nursing Diagnosis NANDA defines Based on your assessment findings Should encompass all medications If there’s a med, there’s a Nursing Dx Patient Focused
Not about you (U)
PLANNING Establishing Goals & Outcomes This where we begin prioritizing,
formulating outcomes (goals), and selecting interventions to reach the goals
Goals Long-term: within the lifetime Short-term: within a few days
Outcomes: Objective measurements
Goals (Examples) Long-term
The pt will maintain adequate oxygenation =< 98% by the end of 6 weeks
Short-term The pt will have an increase in oxygenation
levels from 90% to 95% by May 26th Outcomes
The pt will demonstrate correct use of the incentive spirometer 2x shift
Planning & Pharmacology Medication Administration
Overall goal: Safe & effective administration of medication
Patient Education Overall goal: Patients comprehend the
purpose of every medication, the correct way it is to be administered, and what to do if problems arise.
Implementation/Intervention Putting the plan into action This is what you will be doing for the patient It is specific
Includes not only what, but how, when and where
This is how we ‘care’ for our patients It’s a ‘List of Directions” ANY nurse should be able to read and follow
this, not just you
Implementation/Intervention Monitoring the medications
Effects of Side effects/adverse effects Compliance Therapeutic benefits Objective data: vs, labs, relief of s/s Education Scheduling on-going assessments
Evaluating Effects Comparing current status to baseline Using the established goals/outcomes Reassessing and revising goals and plan Re-evaluating priority Using findings to revise the plan, or to
move on to another priority if resolved
Anthrax Plan of Care example
Is it Anthrax? What form? What s/s is the patient exhibiting? What does the patient tell you? What objective data do you have? What other information do you need?
Anthrax Plan of Care example
What test determines it is anthrax? Inhaled? Contact? Difficulty breathing? Cold s/s? In pain? Having trouble breathing? VS, CXR, lab results? How long has it been? What have they tried
to help it? Did it help? Do they know how they were exposued?
Anthrax Plan of Care example
Depending on what s/s the patient is exhibiting and what form of anthrax they were exposed to.
Will include a medication regimen with cipro, and possibly other medications in combination to alleviate s/s and treat the exposure.
Anthrax Plan of Care example
Depending on what s/s the patient is exhibiting and what form of anthrax they were exposed to.
Will include a medication regimen with cipro, and possibly other medications in combination to alleviate s/s and treat the exposure.
Anthrax Plan of Care example
For the purpose of this course, we will only focus on those interventions that apply to meds
Cipro is an anti-infective We would be certain to include actions of
assess benefits and any adverse effects
Anthrax Plan of Care example
For the purpose of this course, we will only focus on the goals that apply to meds
Is the patient displaying s/s of improvement by taking the medication
Look at VS, labs, etc Is the patient having any side effects? Has the medication done what it needed to do? Is the situation resolved, or do we modify or
continue the plan?