Chapter 4 assessment: information gathering regarding the current status of a particular patient, including evaluation of past history and physical examination; provides a baseline of information and clues to effectiveness of therapy evaluation: part of the nursing process; determining the effects of the interventions that were instituted for the patient and leading to further assessment and intervention implementation: actions undertaken to meet a patient’s needs, such as administration of drugs, comfort measures, or patient teaching nursing: the art of nurturing and administering to the sick, combined with the scientific application of chemistry, anatomy, physiology, biology, nutrition, psychology, and pharmacology to the particular clinical situation nursing diagnosis: statement of an actual or potential problem, based on the assessment of a particular clinical situation, which directs needed nursing interventions nursing process: the problem-solving process used to provide efficient nursing care; it involves gathering information, formulating a nursing diagnosis statement, prioritizing the diagnoses, developing goals and desired outcomes for the patient, carrying out interventions, and evaluating the process planning: the process of prioritizing the information gathered in assessment and, using the established nursing diagnoses, to develop goals and desired outcomes for the patient Assessment (gathering information) is the first step of the nursing process. EX: history ( chronic conditions, drug use, allergies,etc) Assessment #2: physical examination ( weight, age, drug effects) Planning (goal setting, minimizing adverse effects, understanding drug regiment A nursing diagnosis is simply a statement of the patient’s status from a nursing perspective Implementation involves nursing interventions aimed at achieving the goals of outcomes determined in the planning phase. 1. Drug administration 2. Provision of comfort measures 3. patient/family education Comfort measures: Managing adverse effects 1. Environmental control (temp, light. etc) 2. Safety measures (avoiding driving and the sun, using side rails) 3. Physical comfort measures (skin care, laxatives, frequent meals Placebo effect Nurses attitude can be a critical part of drug therapy Lifestyle Adjustment Evaluation: changes in assessment, diagnosis, and intervention Key elements in any drug education program 1. 2. 3. 4. 5. 6. 7. 8. Name,dose, and action of drug Timing of administration Special storage and preparation instructions Specific OTC drugs or alternative therapies to avoid Special comfort measures Safety measures Specific points about drug toxicity Specific warnings about drug discontinuation Chapter 5 : dosage calculations apothecary system: a very old system of measure that was specifically developed for use by apothecaries or pharmacists; it uses the minim as the basic unit of liquid measure and the grain as the basic unit of solid measure Clark rule: a method of determining the correct drug dose for a child based on the known adult dose (assumes that the adult dose is based on a 150-lb person); it states conversion: finding the equivalent values between two systems of measure Fried rule: a method of determining a pediatric drug dose for a child younger than 2 years of age, based on the child’s age and the usual adult dose (assumes that an adult dose would be appropriate for a 12.5-year-old child); it states metric system: the most widely used system of measure, based on the decimal system; all units in the system are determined as multiples of 10 ratio and proportion: an equation in which a ratio containing two known equivalent amounts is on one side and a ratio containing the amount desired to convert and its unknown equivalent is on the other side Young rule: a method for determining pediatric drug dose based on the child’s age and the usual adult dose; it states ● ● ● ● ● ● ● ● ● ● 1 Kg = 1,000 g 1 Kg = 2.2 lbs. 1 L = 1,000 mL 1 g = 1,000 mg 1 mg = 1,000 mcg 1 gr = 60 mg 1 oz. = 30 g or 30 mL 1 tsp = 5 mL 1 lb. = 454 g 1 tbsp. = 15 mL Measuring systems - Metric system - Apothecary system - Household system - Avoirdupois system - Other systems Metric system Solid measure= Gram (g) 1 milligram (mg)= 0.001 g 1 microgram (mcg)= 0.000001 1 kilogram (kg)= 1,000g Liquid Measure= Liter (L) 1 milililiter (mL) = 0.001L 1 mL= 1 cubic centimeter= 1cc Apothecary Solid measure= Grain (gr) 60 gr= 1 dram (dr) 8 dr= 1 ounce (oz) Liquid measure= Minim (min) 60 min= 1 fluidram (fl dr) 8 fl dr= 1 fluid ounce (fl oz) Household Solid Pound (lb) 1 lb= 16 ounces (oz) Liquid measure: Pint (pt) 2 pt= 1 quart (qt) 4qt= 1 gallon (gal) 16oz= 1 pt= 2 cups (c) 32 tablespoons (tbsp)= 1 pt 3 teaspoons (tbsp) = 1 tbsp 60 drp[s (gtt)= 1 tsp The avoirdupois system is a system of measurement that use ounces and grains ( older system) Calculating dose: oral drugs Calculating dose: parenteral drugs Calculating Dose: Intravenous Solutions Pediatric dosage calculation - Fried rule - Young rule - Clark rule - Body surface area : most accurate Fried rule For children <2 years of age, this rule assumes that an adult dose would be appropriate for a child who is 12.5 years (150 months) old Young rule Children 1-12 years of age Clark rule For infants under 1 year, uses child’s weight to calculate the appropriate dose and assumes that the adult dose is based on a 150-lb person Surface Area Calculation #1 Determine the child’s surface area with the use of a nomogram (the height and weight of the child are taken into consideration in this chart) Chapter 6: Challenges to effective drug therapy alternative therapy: includes herbs and other “natural” products as often found in ancient records; these products are not controlled or tested by the U.S. Food and Drug Administration and are considered to be dietary supplements; however, they are often the basis for discovery of an active ingredient that is later developed into a regulated medication biological weapons: so-called germ warfare; the use of bacteria, viruses, and parasites on a large scale to incapacitate or destroy a population cost comparison: a comparison of the relative cost of the same drug provided by different manufacturers to determine the costs to the consumer internet: the worldwide digital information system accessed through computer systems off-label uses: uses of a drug that are not part of the stated therapeutic indications for which the drug was approved by the FDA; off-label uses may lead to new indications for a drug self-care: patients self-diagnosing and determining their own treatment needs street drugs: nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure Media influence - 1990s: legal to advertise prescription drugs directly to the public - Federal guidelines: When the advertisement states the indication, it must also include: - Contraindications - Adverse effects - Precautions -Herbal medications of alternative therapies are not controlled or tested by the FDA. Off-Label uses Definition The use of a drug for an indication not approved by the FDA Occurrence -Commonly done for groups of patients for which there is little premarketing testing -Used with pediatric and geriatric population -May lead to discovery of new use for a drug -Liability issues are fuzzy
