Lehne's Pharmacology for Nursing Care 10TH EDITION Chapter 2

Preadministration Assessment (Application of Pharmacology in Patient Care)

(1) collecting baseline data needed to evaluate therapeutic and adverse (i.e., undesired) responses, (2) identifying high-risk patients, and (3) assessing the patient's capacity for self-care.

Dosage and Administration (Patient Education) Promoting Therapeutic Effects

-nature and time course of expected beneficial effects -recognizing treatment failure, allow for timely alternative therapy implementation

Dosage and Administration (Patient Education) Patient Adherence

Adherence—also known as compliance or concordance—may be defined as the extent to which a patient's behavior coincides with medical advice.

Collecting Baseline Data (Preadministration Assessment)

Baseline data are needed to evaluate both therapeutic and adverse drug responses. Without these data, we would have no way of determining the effectiveness of our drug.

Dosage and Administration (Patient Education) Drug Storage

Certain medications are chemically unstable and deteriorate rapidly if stored improperly. Patients who are using unstable drugs must be taught how to store them correctly (e.g., under refrigeration, in a lightproof container).

Dosage and Administration (Patient Education)

Drug Name Dosage and Schedule of Administration Patient Adherence Technique of Administration Duration of Drug Use Drug Storage

Promoting Therapeutic Effects (Application of Pharmacology in Patient Care)

Drug therapy can often be enhanced by nonpharmacologic measures. Examples include (1) enhancing drug therapy of asthma through breathing exercises, biofeedback, and emotional support; (2) enhancing drug therapy of arthritis through exercise, physical therapy, and rest; and (3) enhancing drug therapy of hypertension through weight reduction, smoking cessation, and sodium restriction.

Evaluating Responses to Medication (Application of Pharmacology in Patient Care)

Evaluation is one of the most important aspects of drug therapy. After all, this is the process that tells us whether a drug is producing a benefit or is causing harm. Because the nurse follows the patient's status most closely, the nurse is in the best position to evaluate therapeutic responses. To make an evaluation, you must know the rationale for treatment and the nature and time course of the intended response. When desired responses do not occur, it may be essential to identify the reason quickly so that timely implementation of alternative therapy may be ordered.

Dosage and Administration (Patient Education) Duration of Drug Use

Just as patients must know when to take their medicine, they must know when to stop. In some cases (e.g., treatment of acute pain), patients should discontinue drug use as soon as symptoms subside. In other cases (e.g., treatment of hypertension), patients should know that therapy will probably continue lifelong

Dosage and Administration (Patient Education) Minimizing Adverse Effects

Knowledge of adverse drug effects will enable the patient to avoid some adverse effects and minimize others through early detection.

Minimizing Adverse Effects (Application of Pharmacology in Patient Care)

Measures to reduce adverse events include identifying high-risk patients, ensuring proper administration, and teaching patients to avoid activities that might precipitate an adverse event.

Identifying High-Risk Patients (Preadministration Assessment)

Multiple factors can predispose an individual to adverse reactions from specific drugs. Important predisposing factors are pathophysiology (especially liver and kidney impairment), genetic factors, drug allergies, and life span considerations such as pregnancy or very young or advanced age.

Modified Nursing Process Format Used for Summaries of Major Nursing Implications

PREADMINISTRATION ASSESSMENT Therapeutic Goal Baseline Data Identifying High-Risk Patients IMPLEMENTATION: ADMINISTRATION Routes Administration IMPLEMENTATION: MEASURES TO ENHANCE THERAPEUTIC EFFECTS ONGOING EVALUATION AND INTERVENTIONS Summary of Monitoring Evaluating Therapeutic Effects Minimizing Adverse Effects Minimizing Adverse Interactions Managing Toxicity

Making PRN Decisions (Application of Pharmacology in Patient Care)

PRN stands for pro re nata, a Latin phrase meaning as needed. A PRN medication order is one in which the nurse has discretion regarding when to give a drug and, in some situations, how much drug to give.

Dosage and Administration (Patient Education) Minimizing Adverse Interactions

Patient education can help avoid hazardous drug-drug and drug-food interactions.

Dosage and Administration (Patient Education) Technique of Administration

Patients must be taught how to administer their drugs. This is especially important for routes that may be unfamiliar (e.g., sublingual for nitroglycerin) and for techniques that can be difficult (e.g., subcutaneous injection of insulin).

Dosage and Administration (Patient Education) Dosage and Schedule of Administration

Patients must be told how much drug to take and when to take it.

Managing Toxicity (Application of Pharmacology in Patient Care)

Some adverse drug reactions are extremely dangerous. If toxicity is not diagnosed early and responded to quickly, irreversible injury or death can result. To minimize harm, you must know the early signs of toxicity and the procedure for toxicity management.

Dosage and Administration (Patient Education) Drug Name

The patient should know the name of the medication he or she is taking. If the drug has been prescribed by brand name, the patient should be given its generic name, too.

Patient Education

This topic does not have a section of its own. Rather, patient education is integrated into the other sections.

(Applying the Nursing Process in Drug Therapy) Analysis and Nursing Diagnoses

With respect to drug therapy, the analysis phase of the nursing process has three objectives. First, you must judge the appropriateness of the prescribed regimen. Second, you must identify potential health problems that the drug might cause. Third, you must determine if your assessment of the patient's capacity for self-care identified an impaired ability for self-care.

(Applying the Nursing Process in Drug Therapy) Planning

defining goals, establishing priorities, identifying specific interventions, and establishing criteria for evaluating success

(Application of Pharmacology in Patient Care)

eight aspects of drug therapy: (1) preadministration assessment, (2) dosage and administration, (3) promoting therapeutic effects, (4) minimizing adverse effects, (5) minimizing adverse interactions, (6) making "as needed" (PRN) decisions, (7) evaluating responses to medication, and (8) managing toxicity.

(Applying the Nursing Process in Drug Therapy) Implementation

four major components: (1) drug administration, (2) patient education, (3) interventions to promote therapeutic effects, and (4) interventions to minimize adverse effects.

Evolution of Nursing Responsibilities Regarding Drugs

give the right drug to the right patient in the right dose by the right route at the right time, right assessment, right documentation, right evaluation, the patient's rights to education, and the patient's right of refusal

(Applying the Nursing Process in Drug Therapy) Preadministration Assessment

• Collection of baseline data needed to evaluate therapeutic effects • Collection of baseline data needed to evaluate adverse effects • Identification of high-risk patients • Assessment of the patient's capacity for self-care

(Application of Pharmacology in Patient Education) Very often, the nurse is responsible for educating patients about medications. In your role as educator, you must give the patient the following information:

• Drug name and therapeutic category (e.g., penicillin: antibiotic) • Dosage • Dosing schedule • Route and technique of administration • Expected therapeutic response and when it should develop • Nondrug measures to enhance therapeutic responses • Duration of treatment • Method of drug storage • Symptoms of major adverse effects, and measures to minimize discomfort and harm • Major adverse drug-drug and drug-food interactions • Whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions

Dosage and Administration (Application of Pharmacology in Patient Care)

• Read the medication order carefully. If the order is unclear, verify it with the prescriber. • Verify the identity of the patient by comparing the name on the wristband with the name on the drug order or medication administration record. • 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. • Verify dosage calculations. • Implement any special handling the drug may require. • Don't administer any drug if you don't understand the reason for its use.

To help reduce adverse effects, you must know the following about the drugs you administer: (Minimizing Adverse Effects)

• The major adverse effects the drug can produce • When these reactions are likely to occur • Early signs that an adverse reaction is developing • Interventions that can minimize discomfort and harm

Key Points

■ Nursing responsibilities with regard to drugs extend far beyond the Rights of Drug Administration. ■ You are the patient's last line of defense against medication errors. ■ Your knowledge of pharmacology has a wide variety of practical applications in patient care and patient education. ■ By applying your knowledge of pharmacology, you will make a large contribution to achieving the therapeutic objective of maximum benefit with minimum harm. ■ Application of the nursing process in drug therapy is directed at individualizing treatment, which is critical to achieving the therapeutic objective. ■ The goal of preadministration assessment is to gather data needed for (1) evaluation of therapeutic and adverse effects, (2) identification of high-risk patients, and (3) assessment of the patient's capacity for self-care. ■ The analysis and diagnosis phase of treatment is directed at (1) judging the appropriateness of the prescribed therapy, (2) identifying potential health problems treatment might cause, and (3) characterizing the patient's capacity for self-care. ■ Planning is directed at (1) defining goals, (2) establishing priorities, and (3) establishing criteria for evaluating success. ■ In the evaluation stage, the objective is to evaluate (1) therapeutic responses, (2) adverse reactions and interactions, (3) patient adherence, and (4) patient satisfaction with treatment.