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Chapter 2 - Application of Pharmacology in Nursing
Chapter 2 - Application of Pharmacology in Nursing
A. PRE-ADMINISTRATION ASSESSMENT
1. Goals
a. collecting baseline data needed to evaluate therapeutic and adverse
responses
b. identifying high-risk patients
c. assessing the patient’s capacity for self care
PRE-TEST ? What predisposing factor can make a patient high risk when giving
medications:
pathophysiological conditions
D. DOSAGE AND ADMINISTRATION
1. Read the medication order carefully. If the order is unclear, verify it with
the prescribing physician.
2. Verify the identity of the patient by comparing the name on the wristband
with the name on the drug
order or administration record.
3. Read the medication label carefully. Verify the identity of the drug, the
amount of drug (per tablet,
volume of liquid, etc.) and its suitability for administration by the
intended route.
4. Verify dosage calculations.
5. Implement any special handling the drug may require.
6. Don’t administer any drug if you don’t understand the reason for its use.
E. EVALUATING AND PROMOTING THERAPEUTIC EFFECTS
F. MINIMIZING ADVERSE EFFECTS – all drugs have the potential to produce undesired
effects. In order to help reduce
adverse effects, you must know the following about the drugs you’re
working with:
- major adverse effects that the drug can produce
- time when these reactions are likely to occur
- early signs that an adverse reaction is developing
- interventions that can minimize discomfort and harm
H. MAKING PRN DECISIONS – PRN medication order is one in which the nurse has
discretion regarding how much
drug to give and when to give it.
- PRN is an abbreviation that stands for pro re nata (Latin for as needed or
as the occasion arises)
- in order to implement a PRN order rationally, the reason for the drug use
and the patient’s medication
needs must be known
1. Drug Name – if the drug has been prescribed by trade name, the patient
should be given its generic
name too
- this information will reduce the risk of overdose that can result
when a patient fails to realize
that two prescriptions that bear different names actually
contain the same medicine
2. Dosage Size and Schedule of Administration – patients need to be
told how much drug to take and
when to take it
3. Technique of Administration – patients must be taught how to
administer their drugs
4. Duration of Drug Use – just as patient must know when to take their
medicine, they must know when
to stop
5. Drug Storage – certain medications are chemically unstable and hence
deteriorate rapidly if stored
improperly. Patients must be taught how to store their medications
correctly. - all drugs should be stored where children cannot
reach them
B. PROMOTING THERAPEUTIC EFFECTS – patients must know the nature and time course of
expected beneficial
effects
- non-drug measures can complement drug therapy; teaching patients
about non-drug measures can
greatly increase the chances of success
C. MINIMIZING ADVERSE EFFECTS – knowledge of adverse drug effects will enable the
patient to avoid some adverse
effects and minimize others through early detection
B. APPLYING THE NURSING PROCESS IN DRUG THERAPY – overall objective in drug therapy is
to produce maximum
benefit with minimum harm
- therapy must be individualized
a. Basic Goals
i. collection of baseline data needed to evaluate therapeutic
responses
- in order to know what baseline measurements to make,
the reason for the
drug use must be known
ii. collection of baseline data needed to evaluate adverse effects
- all drugs have the ability to produce undesired effects
- knowing what data to collect comes directly from your
knowledge of the drug
under consideration
iii. identification of high-risk patients
- just which individual characteristics will predispose a
patient to an adverse
reaction depends on the drug under consideration
- multiple factors that can increase the patient’s risk of
adverse reactions to
a particular drug include:
- impaired liver and kidney function - age
- body composition -
pregnancy
- diet - genetic
heritage
- other drugs being used
- practically any pathophysiological
conditions
- distinguish between factors that put the patient at
extremely high risk versus
factors that put the patient at moderate or low risk
- contraindication – a pre-existing condition that
precludes use of
a particular drug under all but the most
desperate
circumstances
- precaution – a pre-existing condition that
significantly increases
the risk of an adverse reaction to a particular
drug, but not
to a degree that is life threatening
iv. assessment of the patient’s capacity for self-care
- for drug therapy to succeed, the outpatient must be
willing and able to self-
administer medication as prescribed
- factors that can affect the capacity for self-care and
probability of adhering
to the prescribed regimen include:
- reduced visual acuity - limited
manual dexterity
- limited intellectual ability - severe
mental illness
- inability to afford drugs
- individual and/or cultural attitude toward
drugs
- conviction that the drug was simply not
needed in the
dosage prescribed
a.
Three objectives:
i. First, judge to appropriateness of the prescribed regimen
- the data collected during assessment must be analyzed
to determine if the
proposed treatment has a reasonable likelihood of
being effective and
safe
- judgment is made by considering:
- medical diagnosis - known actions of the
prescribed drug
- patient’s prior responses to the drug
- presence of contraindications
- question the drug’s appropriateness:
- if the drug has no actions that are known to
benefit individuals with
the patient’s medical diagnosis
- if the patient failed to respond to the drug in the
past
- if the patient has a serious adverse reaction to
the drug in the past
- if the patient has a condition or is using a drug
that contraindicates
the prescribed drug
ii. Second, identify potential health problems that the drug might
cause
- accomplished by synthesizing knowledge of the drug
under consideration
and the data collected during assessment
iii. Third, determine the patient’s capacity for self-care
- should indicate potential impediments to self-care
(visual impairment, reduced
manual dexterity, impaired cognitive function,
insufficient
understanding of the prescribed regimen)
- nursing diagnosis applicable to almost every patient is
“deficient knowledge
related to the drug regimen”
3. Implementation
a. therapeutic responses
- how frequently evaluations are performed depends on the
expected time course of
therapeutic and adverse effects
- based on laboratory tests, observation of the patient,
physical examination and patient
interview
- to evaluate therapeutic responses, compare patient’s current
status with baseline data
- to evaluate treatment, know the reason for drug use, criteria
for success, and
expected time course of responses
b. adverse drug reactions and interactions
- to make evaluates, know which adverse effects are likely to
occur, how they are
manifested, and their probable time course
c. compliance (adhere to prescribed regimen)
- include measurement of plasma drug levels, interviewing
patient and counting pills
d. satisfaction with treatment
- satisfaction with drug therapy increases quality of life and
promotes compliance
- factors that can cause dissatisfaction include unacceptable
side effects, inconvenient
dosing schedule, difficulty of administration, and high
cost
5. Patient Education