Pharmacology Unit 1 Syllabus Objectives plus Lecture Notes

Zinc

-plays role in tissue repair and DNA/RNA synthesis -Excess - copper deficiency, decreased HDL, lowered immune resp. -Source: root veggies -admin 1 hr before or 2 hr after antibiotics

Vitamin B2 (riboflavin)

-promotes tissue integrity -Deficit: dermatitis

Important fluid replacement interventions

-take daily weights -2 pounds = 1 L fluid -fluid overload = high BP, fast heartbeat, retain fluid, edema lower extremities, SOB, fluid in lungs -dehydration = low BP, fast heartbeat, decreased urine, "tented" skin

Alcohol

-tonic or poison -thins blood -red wine high in antioxidants

Protein

-resp. for tissue growth, repair and backup source of energy -breakdown to amino acids, nitrogen -obtain from leaner cuts of meat, fish, poultry, beans, nuts, whole grains, -high protein diet overtaxes kidneys

Fruits and Veggies

-rich vitamins, minerals, antioxidants, fiber, etc -lower heart disease, stroke risk -low calorie -best raw except tomatoes

Lipids

liquid fat emulsion solution

Calcium

-secreted by parathyroid gland -most abundant mineral in body, 99% bones & teeth, 1% blood & tissues -aids blood clotting, nerve impulse transmission, smooth muscle contraction, formation of bones, teeth -needs vitamin D to absorb, one deficiency = the other -sources dairy, seeds, nuts, fish with small bones

Carbohydrates (CHO)

-stored as glycogen in the liver and muscles -broken down into glucose -primary source of energy for all body processes, basic building block -complex = whole grains, beans, brown rice -simple = popcorn, potatoes, cookies, doughnuts -eat more complex, last longer than simple and stabilize blood sugars Don't overeat!

Discuss the role of the nurse in risk management

"Culture of Safety" -Do not use particular abbreviations to prevent confusion -Pay attention to "black box" warnings on drugs -Medication reconciliation by comparing a patient's medication orders to all medications being taking to avoid errors, duplications, dosing errors, and drug interactions -ID patients correctly, improve staff communications and use medicines safely -properly dispose of medications by never flushing down toilet unless instructed and mixing with used cat litter or coffee grounds; utilize drug "take-back" programs -safely dispose of sharps -instruct patients to be careful in splitting approved pills, warn against buying drugs off the internet and only buy drugs from approved pharmacies to prevent buying of counterfeit drugs -do not crush medications that aren't supposed to be crushed; none with the suffix ER, SR, XR, SA, CR, MR or XL as these are extended or sustained release drugs -pay special attention to high-alert medications in which errors could result in more serious consequences, and to look-alike and sound alike drugs -always prepare drugs in an distraction or interruption-free environment.

Colloids

volume expanders, ie amino acids, dextran or plasmanate

List the nursing interventions for clients receiving enteral nutrition

- Check tube placement by aspirating gastric secretion. For small intestine placement, x-ray confirmation may be needed -Determine gastric residual before feeding, more than 50% indicates delayed gastric emptying and HCP should be notified. -Check continuous route for gastric residual every 2 to 4 hours, if more than 50 mL, stop infusion for 30 min to 1 hour and recheck. -Raise head of bed 30 to 45 degree angle at all times during infusion of tube feedings. If contraindicated, position patient on right side -Deliver feedings according to the method ordered. -flush feeding tube accordingly, intermittent feedings and medications with 30mL water before and after; continuous feedings every 4 hours, blockages with warm water or cola. -monitor adverse effects such as diarrhea -dilute drug solutions osmolality to 500 mOsm when giving liquid medication thru the tube -Monitor vital signs and report abnormal findings -give additional water throughout the day to prevent dehydration -weigh patient at same time everyday with same scale and same clothing to determine weight gain or loss and compare with baseline weight -change feeding bag daily and ensure that nutritional solution is at room temperature.

State at least eight principles for health teaching related to drug therapy plans.

- Comprehensive drug use and health history - Reason for medication therapy - Expected Results - Side effects and adverse reactions - When to notify healthcare provider or pharmacist - Drug-drug, drug-food, drug-lab and drug-environment interactions - required changes in ADLs - Demonstration of learning, which can occur in several forms - Medication schedule, associated with ADLs and drug level of action as appropriate - Recording system - Discussion and monitoring of access to financial resources, medication and associated equipment - Development and support of backup system - Community Resources available

Explain the physiologic changes of the aging process that have a major effect on drug therapy.

- Gastrointestinal - increase in pH of gastric secretions, decrease in peristalsis with delaying intestinal emptying time, decrease in motility and decrease in first pass effect, all leading to slower absorption of oral drugs. - Cardiac and circulatory - decrease in cardiac output and blood flow, resulting in impaired circulation that can delay transportation of drugs to the tissues Hepatic - Decreased enzyme function and blood flow, resulting in drugs metabolizing more slowly and less completely Renal - Decreased blood flow, functioning nephrons and glomerular filtration rate, resulting in drugs excreted less completely.

Sodium (electrolyte)

-extracellular, reg. fluids, transmit nerve impulses -normal range 135-145 -hyponatremia <135 (due to vomiting, diarrhea, dehydration) results in muscles weakness, headaches, abdominal cramps, irritability. -severe, hypertonic IVF or mild, salt tablets or saline IVF, limit water intake -hypernatremia >145 (due to drugs steroids, cough meds, antibiotics) results in flushed skin, elevated temp, elevated BP, dry tongue, thirst -diuretics, limit Na food intake

Explain the meaning of pharmacodynamics, dose-response, maximal efficacy, the receptor and non-receptors in drug action

- Pharmacodynamics - Study of the way drugs effect the body. Primary effect is the desired effect of the drug, such as treating the symptoms of an allergy with Benadryl, while secondary effects can be desirable or undesirable, such as drowsiness with Benadryl. Dose-responsive - The relationship between minimal vs. maximal amount of the drug dose needed to produce the desired drug response. Maximal efficacy - maximum drug effect, which may be greater or less than other drugs (i.e. morphine has a greater efficacy for pain relief than tramadol hydrochloride) Receptor - drug binds to this site (protein in nature) to proteins, glycoproteins, proteolipids and enzymes to initiate or block a response. 4 receptor families are kinase linked receptors (ligand-binding domain for drug binding is on cell surface, activating an enzyme within the cell and triggering a response), ligand-gated ion channels (channel spans the cell membrane and opens, allowing the flow of ions in and out of cell), G protein-coupled receptor systems (3 components in response, the receptor, the g protein that binds with GTP and the effector that is an enzyme or ion channel.) and nuclear receptors (found in nucleus, which results in a slower response than the others) Non-receptors - Site where a drug does not bind?

Glycemic index

-# assigned to each food to classify carbs based on: fiber (more fiber = lower) ripeness (riper = higher) type (complex vs simple) fat/acid content (higher = slower breakdown) physical form (coarse vs fine)

fat-soluble vitamins

-A, D, E, K -stored in liver up to 2 years

Describe the nursing interventions related to administration of medications by various routes

-Assess patient's ability to swallow before administering oral medications; make patient is not NPO -Do not crush or mix medications in other substances without first consulting a pharmacist or reliable drug reference. Do not mix medications with sweet substances to trick children into taking them. Do not mix medications in an infant's formula feeding. -If the medication is or must be mixed with another substance, explain this to the patient. -Use aseptic technique when administering drugs. Sterile technique is required when administering parenteral therapy -Administer drugs at the appropriate sites for the route -Stay with the patient until oral drugs have been swallowed.

water-soluble vitamins

-B-complex and C vitamins -not stored, need daily supply -whole grains, fortified cereals

Characteristics of a goal

-Client centered, "patient will..." -realistic -measurable, how does pt demonstrate knowledge -specific date & time (short term = less than 1 week; long term = over 1 week)

Folic Acid (folate)

-DNA synthesis, protect cell nucleus esp. important in 1st trimester to develop CNS in fetus and prevent neural tube defects -Deficit: nausea/vomiting, fatigue, blood dyscrasias -Sources: leafy green veggies, fruits, organ meats, yeast

Describe the nursing implications of pharmacokinetics and pharmacodynamics

-Liver may not be functioning properly, leading to drug toxicity -Some patients may respond to lowest dose for therapeutic effects while others will need a higher dose. Always start from the lowest dose and work up until a therapeutic effect is felt -Kidneys may not be able to excrete the drug as well in some patients, which could lead to drug toxicity -Educate patients on how to properly take the drug, when to take it (help with scheduling if need be), what they are taking it for, etc -Advocate for patients with physicians, for example, to lower number of medications

Potassium (electrolyte)

-Normal range 3.5 - 5.3 -smooth muscle function -Hypokalemia <3.5 - (due to trauma, shock, vomiting, diarrhea, diuretic) results in dysrrhythmia, flabby muscles, abdominal distention -Give supplement, foods high in K (green leafy veggies, fruits) -IV must be diluted -Hyperkalemia >5.3 - (due to renal insuff. or too much given) results in abdominal cramps, tachycardia then bradycardia, decreased urine, numbness/tingling in extremities -limit K foods or give Kayexalate lowers by increasing BMs

Examine factors contributing to medical errors and evidence based methods for the prevention of medical errors.

-administering the drug -documenting the drug -dispensing -prescribing -monitoring -other Look-alike and sound-alike drug names Distractions and interruptions while preparing and administering medications

Vitamin K

-aids in blood clotting -antidote for Coumadin -Sources: green leafy veggies, meats, eggs

Vitamin B12 (cobalamin)

-aids in formation of RBCs -Deficit: pernicious anemia -doesn't absorb well PO, also given SL or IM

copper

-aids in formation of RBCs, connective tissue noraphephrine, dopamine -Deficit: anemias, decrease skin pigment -Excess: saturn ring in cornea, increase skin pigment -Sources: Shellfish, nuts, seeds

Vitamin B6 (pyridoxine)

-aids in metabolism of RBCs and protects nerve endings -given with INH (for tuberculosis) to prevent peripheral neuritis

Vitamin C (ascorbic acid)

-aids in tissue repair, iron absorption and CHO metabolism -taper off megadoses to prevent deficiency

Selenium

-antioxidant, protects against certain cancers, protects protein and nucleic acid structures, overall health & wellness -excess: skin irritations, garlicy odor to body, nausea/vomiting, hair loss -requires vitamin E -Sources: meat, seafood, dairy

Crystalloid

-basic IV fluids -fluid vol. replacement or maintenance -hypo, iso or hypertonic

Magnesium (electrolyte)

-contracts heart, needed for Vitamin C & Calcium metabolism. Similar to K levels -normal = 1.5-2.5 -hypomagnesemia <1.5 (due to K or Ca deficit) results in neuromuscular excitability and hyperactive deep tendon reflexes, ventricular dysrhythmias -magnesium sulfate -hypermagnesemia >2.5 (due to laxatives and antacids containing Mg) results in sedative effect, lethargy, hypoactive DTRs, hypotension, heart block if untreated -calcium gluconate

Fat

-insulate body, protect organs -major source of fuel, vehicle of transport fat-soluble vitamins -Fatty acids = part used for energy -triglycerides broken down from fatty acids, storage form -cholesterol - most manu. from liver, aids in hormone prod. LDL - bad, cardiac disease, loading cells w/cholesterol, HDL - good, clean out cholesterol from cells -saturated = solid at room temp, from animal products, cling to vessels -unsaturated = liquid at room temp, from plants, better choices. Monounsaturated = canola and olive (best), Polyunsaturated = sesame and sunflower oil -trans-fats = hydrogenated oils, increase risk heart disease, thicken blood, cling to vessels. In prepackaged foods

State nursing implications related to drug therapy in the older adult

-lab results should be monitored in relation to kidney and liver function -check serum drug levels and report abnormal findings to the nurse manager or HCP -communicate with the pharmacist or HCP when drug dose is in question. check drug references for recommended dosages for older adults -observe patient for adverse reactions when multiple drugs are being taken. -recognize a change from regular behavior or an increase in confusion, which is one of the first signs of drug toxicity. Report changes to HCP -Ascertain whether financial problems are preventing patient from purchasing prescribed drugs and inform about assistance programs

Vitamin A

-maintains tissue, skin integrity, bone growth and plays a role in vision, esp. night vision -hypervitaminosis A = hair loss, peeling skin, liver toxicity, teratogenic effects, anemias; mimic brain tumor like headache, altered mental status -Sources: fruit and orange veggies

List the nursing interventions for clients receiving parenteral nutrition

-monitor vital signs and report changes -determine body weight and compare with baseline weight -measure intake and output as fluid volume deficit or excess can occur; TPN solution is hyperosmolar, which could cause fluid shift and result in osmotic diuresis -monitor lab results and report abnormal findings, especially electrolytes, glucose and protein; compare lab changes with baseline findings -monitor temperature changes for possible infection or febrile state. use aseptic technique for changing dressings and solution bottles or bags. -check blood glucose level periodically; if glucose level is elevated when TPN is started, flow rate should start slow and be gradually increased as blood glucose levels decrease. Insulin may be added to correct elevated glucose levels. -refrigerate TPN solution when not in use since it is an excellent medium for bacterial growth -monitor flow rate, start with 60 to 80mL/h and increase slowly to ordered level to avoid hyperglycemia -hang dextrose 10% if TPN finishes before next time it is to be administered -have patient perform Valsalva maneuver (taking deep breath, holding it and bearing down) in absence of clamp to close tubing completely during solution bag/tubing change to prevent air embolus. Monitor cardiac status. -Check for signs and symptoms of overhydration; coughing, dyspnea, neck vein engorgement or chest rales and report findings. -Follow agency policy for changing dressing and tubing, usually tubing is changed daily and dressing is changed every 24 hours for first 10 days and every 48 hours after -do not draw blood, give medications or check central venous pressure via TPN line as result may be invalid.

Higher amount of vitamins needed:

-periods of rapid growth (pregnancy) -lactation -debilitating illness -inadequate diet

Vitamin E

-protect RBCs from hemolizing, antioxidant effects -excess fatigue, weakness, breast tenderness, bleeding, volemia, bruising, petechiae -don't give with iron or blood thinners(Coumadin), prolong bleeding time -Sources: fish oil, wheat germ, margarine, milk, grains.

Vitamin B1 (thiamine)

-protects nerve endings & heart and provides some energy source -Deficit: peripheral neuropathy, frequently in alcoholics, diabetics

Chromium

-reg. blood sugars -interaction w/ diabetic meds -Sources: whole grains, brewers yeast -don't use children under 6

Vitamin D

-reg. calcium and phosphorus -hypervitaminosis D = elevated calcium, pain bony areas, anorexia, nausea/vomiting, kidney stones -deficiency by not going outside, sunblock, osteoporosis -Sources: sunlight, dairy, fish

Vitamin B3 (niacin)

-reg. lipid/cholesterol -side effect of flushing, lessened w/ aspirin -Deficit: high cholesterol

iron

-resp. for hemoglobin regeneration -vitamin C enhances absorption -Deficit: oxygen deficient, SOB, low energy -Excess: hemorrhage, shock, no antidote for toxicity -irritating to stomach, constipation, stains teeth; admin Z-track IM or thru straw po -Source: red meats and green leafy veggies -don't take with tetracyclines, dairy or antacids

State nursing implications related to drug therapy in pediatric clients

-use appropriate drug references to obtain drug parameters or ranges, side effects and contraindications for use in children -monitor infants and young children closely for side effects. Changes in usual behavior may indicate side effects -communicate with the HCP about drug dosages that are questionable. Calculate dosages according to weight in kg or BSA

Describe the 4 processes of pharmacokinetics.

1. Absorption - Movement of the drug from the GI tract to body fluids by passive absorption (occurs by diffusion, no energy required), active absorption (requires an enzyme or protein to carry the drug against a concentration gradient, energy required) or pinocytosis (cells carry a drug across their membrane by engulfing it, energy required). 2. Distribution - Process by which drug becomes available to body fluids and body tissues; influenced by blood flow, drug's affinity to tissue and protein-binding effect 3. Metabolism or biotransformation - how the body inactivates or biotransforms the drug. The liver is the primary site of metabolism. 4. Excretion or elimination - The main route of drug elimination is through the kidneys (urine), other routes include bile, feces, lungs, saliva, sweat and breast milk

Define the 3 phases of drug action

1. Pharmaceutic phase - drug becomes a solution to cross the biological memberane 2. Pharmacokinetic phase - process of drug movement to achieve drug action, composed of 4 processes 3. Pharmacodynamic phase - the way the drug affects the body (primary effect, secondary effect or both)

Identify the steps of the nursing process and their purpose in relation to drug therapy

ADPIE A - Assessment - assess the need for the particular drug being administered, the patients signs/symptoms, current medications including OTC and prescription medications and their learning base D - Nursing Diagnosis - Knowledge deficit, especially if the client is on a new medication or is forgetful; noncompliance and ineffective therapeutic management. P - Planning - Goal Setting, includes expected outcomes. Must be client-centered, realistic, measurable and have a time frame. I - Implementation - What the nurse does: Administer, monitor, teach or perform E - Evaluation - Ongoing. Use concrete evidence to show if goals established have been met. If not met, revisit and reset the goals after concluding why they were not met.

Explain the pharmacokinetics and pharmacodynamics of pediatric clients that relate to drug dosing

Absorption - Degree and rate of absorption based on age, health status, weight and route of administration. Generally, as the child matures, absorption is more effective. Infants GI tract is not fully developed, gastric secretions are more alkaline, gastric emptying is slower, irregular peristalsis, greater GI surface area, immature enzyme function and microorganism colonization all affect drug absorption. Topical medications are absorbed more effectively than in adults because a child's skin is thinner and more porous. Distribution - Infants = 70% water, requiring high doses of water-soluble medications. Less body fat = lower fat-soluble drugs. Fewer protein receptor sites = higher amounts of free drug so dosage should be reduced and closely monitored. Blood brain barrier in infants are immature, allowing medications to pass easily into nervous tissue and increasing the chance for toxicity Metabolism - Children younger than 2 have decreased hepatic enzymes, resulting in slower drug metabolism. Children have higher metabolism, causing drugs to be metabolized rapidly and may require a higher medication requirement than adults (increased dosages or decreased durations between dosages) Excretion - Before 9 months, infants experience reduced elimination capacity of the kidneys. Drugs may accumulate to toxic levels because of this. Renal function, urine flow and medication effectiveness should be monitored

Explain the pharmacokinetics and pharmacodynamics of the older adult that relate to drug dosing

Absorption - slowed due to decrease in gastric acidity, blood flow to GI tract, reduction of motility and reduction of gastric emptying time. Distribution - water-soluble drugs are more concentrated because of decrease in body water. Fat-soluble drugs are stored and likely to have decreased effect due to higher fat-to-water ratio. Decrease in serum protein, fewer protein binding sites means more free drugs available to body tissues at receptor sites. Drugs with high protein affinity compete for protein binding sites with other drugs. Drug interactions result because of lack of protein sites and increase in free drugs Metabolism - Decrease in hepatic enzyme production, hepatic blood flow and overall liver function, causing a reduction in drug metabolism. This causes the half life of drugs to increase, which could lead to drug accumulation and toxicity Excretion - Decrease in renal blood flow and decrease in glomerular filtration rate. A decrease in renal function results in a decrease of drug excretion, thus drug accumulation results. Drug toxicity should be assessed continually while the patient takes the drug. Pharmacodynamics - May be more or less sensitive to drug action because of age-related changes in the CNS, changes in drug receptors and the affinity of receptors to drugs. Frequently, dosages must be lowered. Also consider organ function change in drug dosing.

Give examples of enteral solutions and explain the differences

Blenderized - liquid in consistency so they can pass easily through the feeding tube. These are prepared based on nutritional needs. They can be blended from natural foods for come as formulas ready for use. Commercial example - Compleat Polymeric - 2 groups are milk based and lactose free. Milk based polymeric preparations come in powdered form to be mixed with milk or water and do not provide complete nutritional requirement unless given in large amounts. It is frequently given as a supplement. Lactose free polymeric solutions are commercially prepared in liquid form for replacement feedings. These solutions can be used to treat specific disorders, like diabetes mellitus, hepatic and pulmonary disorders. Commercial examples of milk based - Meritene, Sustacal Commercial examples of lactose free - Boost, Ensure, Isocal, Osmolite Elemental or monoeric - used for partial GI tract dysfunction; available in powdered or liquid form and nutrients are easily absorbed in the small intestine Commercial examples - Criticare HN, Peptamen Liquid, Vital HN, Vivonex TEN

Explain the advantages and differences of the methods used to deliver enteral nutrition

Bolus Method - 250 to 400 mL rapidly administered through a syringe or funnel into the feeding tube 4 to 6 times a day, only takes 10 minutes for each feeding. It may not be tolerated well by the patient because of the large amount of solution in a short period of time and result in nausea, vomiting, aspiration, abdominal cramping and diarrhea. A healthy, ambulatory patient can normally tolerate this method well Intermittent enteral feeding - every 3 to 6 hours over 30 to 60 minutes by gravity drip or pump infusion. 300 to 400 mL of solution is usually given at each feeding and a feeding bag is commonly used. Intermittent infusion is an expensive method for administering enteral nutrition. Continuous feeding - given by infusion pump such as the Kangaroo set at a slow rate over 24 hours. 50 to 125 mL of solution is infused per hour. Generally used for the critically ill or those who receive feedings into the small intestine. Cyclic method - continuous feeding that is infused over 8 to 16 hours daily day or night. Daytime feeding scheule is used for patients who are restless or at greater risk for aspiration. Nighttime feeding schedule is used for ambulatory patients to allow more freedom during the day.

Identify the 2 processes that occur before tablets are absorbed into the body.

Disintegration - Tablet is broken down into smaller pieces Dissolution - Dissolving of the particles into a solution so the body can absorb the drug

Describe the complications that may occur with use of enteral nutrition and parenteral nutrition

Enteral - dehydration if insufficient water is given with or between feedings since some solutions are hyperosmolar and can draw water out of cells; aspiration pneumonitis if fed while lying down or unconscious, nurse should check for gastric residual by gently aspirating stomach contents before administering the next feeding and every 4 hours minimum between feedings; diarrhea due to hyperosmolar solutions and drugs, rapid administration of feeding, high caloric solutions, malnutrition, GI bacteria and drugs that contain magnesium. Parenteral - Catheter insertion complications such as: Pneumothorax - accidental puncture of the pleural cavity Hemothorax - catheter damages the large vein Hydrothorax - catheter perforates the vein, releasing solution into the chest All the above result in sharp chest pain and decreased breath sounds Total Parenteral Nutrition Infusion Complications: Air embolism - caused by intravenous tubing disconnected, catheter not clamped, injection port fell off, and improper changing of IV tubing; results in coughing, shortness of breath, chest pain and cyanosis Infection - caused by poor aseptic technique when catheter was inserted, contamination while changing tubing, mixing solution or changing dressing; results in temperature over 100 F, tachycardia, chills, sweating, redness, swelling, drainage at insertion site, neck, arm, or shoulder pain and lethargy Hyperglycemia - caused by fluid infused too rapidly, insufficient insulin coverage or infection; results in nausea, headache, weakness, thirst, elevated blood glucose Hypoglycemia - caused by fluids stopped abruptly or too much insulin infused; results in pallor, cold and clammy skin, increased pulse rate, "shaky feeling" headache, and blurred vision Fluid overload hypervolemia - caused by increased IV rate and fluid shift from cellular to vascular spaces because of hypertonic solutions; results in cough, dyspnea, neck vein engorgement, chest rates and metabolic complications

Explain the difference between enteral nutrition and parenteral nutrition.

Enteral nutrition is administered through the GI tract, either orally or through a feeding tube if the patient cannot swallow. Parenteral nutrition involves administering high calorie nutrients intravenously through large veins, such as the subclavian vein.

Identify various sites for parenteral therapy

five pareteral routes - intradermal, subcutaneous (subQ), intermuscular (IM), intravenous (IV) or intraosseous (IO)

Describe the "five plus five" rights of drug administration

Give 1 the right patient 2 the right drug 3 in the right dose 4 via the right route 5 at the right time. Additionally, 1 the right assessment 2 the right documentation 3 patient's right to education 4 right evaluation 5 patient's right to refuse

Describe the nursing interventions, including client teaching, related to vitamin and mineral uses.

Interventions Administer vitamins with food to promote absorption Store drug in light resistant container Use supplied calibrated dropper for accurate dosage when administering vitamins in drop form. Solution may be administered mixed with food or dropped into the mouth. Recognize the need for Vitamin E supplements for infants receiving vitamin A to avoid risk of hemolytic anemia Monitor for vitamin A therapeutic serum levels (80 to 300 international units/mL) Teaching Advise patients to take prescribed amount of drug Counsel patients to read vitamin labels to determine which vitamin is most appropriate for them Advise patient to consult with health care provider/pharmacist regarding interactions with prescription and OTC medications Discourage patient from taking megavitamins over a long period of time unless prescribed for a specific purpose. To discontinue long term megavitamin therapy, a gradual decrease in vitamin intake is advised to avoid vitamin deficiency Inform patient that missing vitamins for 1 or 2 days is not a cause for concern, because deficiencies do not occur for some time

Osmolality of body fluids

Iso-osmolar = balanced Hypo-osmolar = fewer particles than fluid, too much fluid, edema Hyper-osmolar = more particles than fluid, too little fluid, dehydration, excessive sweating, diarrhea, etc. Serum osmolality is 275 - 295mL (2 x serum Na + BUN/3 + glucose/18)

Tonicity ranges for IV solutions

Isotonic = 240 to 340 Hypotonic = <240 Hypertonic = >340 Use opposite type of fluid from imbalance to correct

Identify factors that modify drug response

Modified drug responses in absorption, distribution, metabolism, excretion, toxicity, pharmacogenetics, pre-existing disease state and drug-drug interaction. Some examples include geriatric and pediatric patients, immunocompromised patients.

Explain the role of albumin levels in enteral/parenteral feedings.

Monitoring albumin levels ensures that the patient is receiving adequate protein to maintain a positive nitrogen balance. Albumin level should be in the range of 3.5-5.

Describe the routes for enteral feedings

Nasogastric tube orally or nasally into the stomach; used for short-term enteral feedings; oral and gastric Nasoduodenal/nasojejunal nasally into the duodenum or jejunum; used for long-term enteral feedings; oral and small intestinal Gastrostomy tube through a temporary or permanent opening on the abdominal wall (stoma) into the stomach; used for long-term enteral feedings; gastric Jejunostomy tube through a stoma directly into the jejunum; used for long term enteral feedings; small intestinal

Calcium (electrolyte)

Normal = 4.5-5.5 -Hypocalcemia <4.5 (due to vitamin D deficit, multiple blood transfusions, inadequate intake, loss from diuretics, steroids or magnesium preps) results in anxiety, irritability, tetany (muscle cramps/spasms) -replacement drug like Calcitriol (IV must be dilated with D5W) admin slowly. metallic taste po Hypercalcemia >5.5 (due to parathyroid problem, bone tumor, multiple fractures) results in flabby muscles, pain bony areas, kidney stones, elevated BP -treat cause; Calcitonin to lower or Neutra Phos

Describe routes of administration

Oral - liquid, elixir, suspension, pill, tablet, or capsule; Sublingual - under tongue for venous absorption Buccal - between gum and cheek Feeding tube Topical - onto skin Inhalation - aerosol sprays instillation - nose, eye, ear suppository - rectal or vaginal five pareteral routes - intradermal, subcutaneous (subQ), intermuscular (IM), intravenous (IV) or intraosseous (IO)

What does PES stand for?

P - Problem (can be actual or potential) E - Etiology (what causes it?) S - Signs/symptoms (only on actual problem)

List safety guidelines for drug administration

Preparation 1. Wash hands 2. Check for drug allergies 3. Check medication order with health care provider's orders 4. Check label on drug container 3 times 5. Check expiration date 6. Recheck drug calculation of drug dose with another nurse as needed 7. Verify dosages that are potentially toxic with another nurse or pharmacist 8. Pour tablet or capsule into the cap of drug container. With unite dose, open packet at beside after verifying patient ID. 9. Pour liquid at eye level. Meniscus should be at line of desired dose. 10. Dilute drugs that irritate gastric mucosa or give with meals. Administration 11. Administer only drugs that you have prepared. 12. Identify patient by ID band or ID photo 13. Offer ice chips to numb taste buds when giving bad-tasting drugs 14. When possible, give bad-tasting drugs first followed by pleasant tasting liquids 15. Assist patient to appropriate position 16. Provide only amounts and kinds of liquids allowed on diet 17. Stay with patient until medications are taken 18. Administer no more than 2.5 to 3 mL of solution intramuscularly at one site. Infants receive no more than 1 mL at one site and no more than 1 mL subcutaneously 19. When administering drugs scheduled at the same time to a group of patients, give drugs last to patients who need extra assistance. 20. Discard needles and syringes in appropriate containers 21. Drug disposal is dependent on agency policy and state law. 22. Discard unused solutions from ampules 23. Appropriately store unused stable solutions from open vials 24. Write date and time opened and your initials on the label 25. Keep narcotics in a double-locked drawer or closet. Medication carts must be locked at all times without a nurse 26. Keys to the opoids drawer must be kept by the nurse and not stored in a drawer or closet 27. Keep opoids in a safe place, out of reach of children and others 28. Avoid contamination of one's own skin or inhalation to minimize chances of allergy or sensitivity development Recording 29. Report drug error immediately to patient's health care provider and to the nurse manager 30. Complete an incident report 31. Charting: record drug given, dose, time, route, and your initials 32. Record drugs promptly after given, especially STAT doses 33. Record effectiveness and results of medication administered, especially PRN medications 34. Report to the patient's health care provider and record drugs that were refused with the reason for refusal 35. Record amount of fluid taken with medications on input and output chart

Explain the equipment and technique in parenteral therapy

Properly disposed of used needles in sharps container after administering medication Sterile technique or surgical asepsis is required for parenteral routes.

Define the terms protein-bound drugs, half-life, therapeutic index, therapeutic drug range, side effects, adverse reaction and drug toxicity

Protein-bound drugs - portion of the drug that is bound to the protein and inactive Half-life - Time it takes for 1/2 of the drug concentration to be eliminated (t1/2) Therapeutic index - estimates the margin of safety of a drug through the use of a ratio that measures the effective, or therapeutic dose (ED50) in 50% of people to the lethal dose (LD50) in 50% of people. The closer this ratio is to 1, the greater the danger of drug toxicity. Therapeutic drug range - in plasma, the level of drug between the minimum effective concentration for obtaining the desired drug action and the minimum toxic concentration Side Effects - physiological effects not related to the desired drug effects; may be desirable or undesirable. Adverse reaction - more severe than side effects such as anaphylaxis which are always undesirable drug toxicity - identified by monitoring plasma therapeutic range of drug; toxic effects that result from overdosing or drug accumulation

Explain the method for charting medications

Record 1. The name of the drug 2. dose 3. route (with injection site if applicable) 4. time and date 5. nurses initials or signature. Documentation of patient's response is required for: 1. Opioids 2. non-opioid analgesics 3. sedatives 4. antiemetics 5. Unexpected reactions to the medication

Blood & blood products

Whole blood products = packed RBCs, plasma, platelets & albumin

Electrolytes

potassium, sodium, calcium, magnesium and chloride and phosphurus

Explain the nurse's role related to drug therapy plans

the nurse provides education, medication administration, patient care and other interventions to help patient accomplish durg therapy goals. Administration and assessment of drug effectiveness are very important nursing responsibilities