Data collection Medication history Physical assessment Data analysis Judgment or conclusion about the need or problem of the patient Based upon an accurate assessment NANDA format Identification of goals and outcome criteria Prioritization Time frame Objective, measurable, realistic Time frame specified Specific standards of measure Patient oriented Initiation and completion of the nursing care plan as defined by the nursing diagnoses and outcome criteria Follows the 12 rights of medication administration Also termed as patient education One of the most important roles of the nurse Carries legal implications for those who fail to provide and document education All significant caregivers should be included in the patient teaching (must also be documented) a.c. ad lib bid NPO p. c. p. r. n. p. o. qd qid tid OD ANST Applied directlt to skin, tissue, or mucous membranes Given by routes that allow the drug to be absorbed and distributed into the bloodstream When preparing to administer drug, pay close attention to Deciding how the patient is responding to the interventions in relation to the stated goals and expected outcomes The 5 rights The 6 rights The 12 rights of drug administration Check the name on the order and the patient Use 2 identifiers Ask the patient to identify himself or herself When available, use technology like the barcode system Check the medication label Rx (at the beginning of every prescription) Contains the name of the drug, the dosage strength and the drug form Begins with either symbol # or with N which stands for number Beginning with the abbreviation Sig.; contains directions to the patient how to use the medication Protocols derived from guidelines created by healthcare providers for use in specific settings, for treating certain diseases or sets of symptoms May be an ongoing order, may be given for a specific number of doses or days This order may include prn orders Given once and usually at a specific time Given at the client’s request and nurses’ judgment concerning need and safety Give once immediately Refers to the dose prescribed for a particular client Be familiar with the various measurement system and the conversion from one system to another Measuring devices Always use the appropriate measuring device and read it correctly Shake all suspensions and emulsions How to hold the dropper Where to measure the volume of a liquid medication Can you divide unscored tablet Confirm appropriateness of the dose using a current drug reference Calculate the dose and have another calculate the dose as well Check the order and appropriateness of the route ordered Confirm that the patient can take or receive the medication by the ordered route Check the frequency of the ordered medication Double-check that you are giving the ordered dose at the correct time Confirm when the last dose was given When to document the administration of medication Chart the time, route, and other specific information as necessary. For example: the site of an injection or any lab value or vital sign that needed to be checked before giving the drug Confirm the rationale for the ordered medication Revisit the reasons for long term medication use Make sure that the drug led to the desired effect Be sure to document your monitoring of the patient and any other nursing interventions that are applicable A critical element of drug administration is Nursing practice law The policy of the state to safeguard the integrity of its territory and wellbeing of its citizenry particularly the youth, from the harmful effects of dangerous drugs on their physical and mental wellbeing and to defend the same against acts or omissions detrimental to their development and preservation Registered nurses have to gain knowledge and understanding of man’s cultural, social, spiritual, physiological, psychological, and ecological aspects of illness, utilizing the therapeutic process. Cultural diversity and political and socio-economic status are inherent factors to effective nursing care nurses must consider the individuality and totality of patients when they administer care registered nurses must respect the spiritual beliefs and practices of patients regarding diet and treatment RN must uphold the rights of individuals Registered nurses must take into consideration the culture and values of patients in providing nursing care. However, in the event of conflicts, their welfare and safety must take precedence Nurses must respect the patients bill of rights Assess the influence of a patient’s cultural beliefs, values, and customs Drug polymorphism Compliance level with therapy Environmental considerations Genetic factors Varying responses to specific agents Health beliefs and practices Past uses of medicine Folk remedies Home remedies Use of nonprescription drugs and herbal medicines OTC treatments Usual response to treatment Responsiveness to medical treatment Religious practices and beliefs Dietary habits Two types of Adverse Drug Reactions (ADRs) Unique, strange, or unpredicted reaction to a drug Hypersensitivity to drug that occurs after previous exposure How to clarify verbal or telephone orders What to do if the tablet is unscored How to round your answers when preparing a dose When to recheck calculations What unit is used in INSULIN AND HEPARIN What unit is used for mL What unit is used for IV pumps If number of tablets is asked write “ “ Leading zeros Trailing zeros When to get the signature from the doctor with telephone order USPMERP ISMP This may cause possible consequences to nurses How to report and respond to medication errors Involve medications that are visually similar in physical appearance or packaging and names of medications that have spelling similarities and/or similar phonetics The means by which drug molecules are delivered to sites of action within the body Route of administration Physical forms The need for dosage forms A hard, compressed medication in round, oval or square shape Give examples of excipients Excipients used to ensure efficient tableting Excipient used to ensure that the tablet breaks up in the digestive tract Excipient used to mask the taste of bad tasting active ingredients Excipients to make uncoated tablets visually attractive Importance of coating in tablets Tablets covered with one or more layers of mixtures of various substances with the intention of conferring benefits and properties to the dosage form over the uncoated one Drug release over a sustained period but not at a constant rate IR SR XL Released more slowly in the body, remaining in the system longer Extended release works within ____ and when does it reach its peak This is the barrier applied to oral medication that controls the location in the digestive system where it is absorbed This refers to small intestine This is used for drugs that are unstable and irritating to the stomach Compressed tablets may be coated with a colored or an uncolored sugar layer An elegant, glossy, easy-to-swallow tablet dosage form They permit separation of incompatible ingredients between coating and core, and utilized in preparing many multivitamin and multivitamin mineral combinations These are an alternative to to sugarcoated tablets in which drug is not required in the coating Continuous release of small doses of the drug over an extended time period to increase duration of action, decrease dosing frequency and increase compliance Designed to achieve prolonged therapeutic effect Uncoated tablets that generally contain acid substances and carbonates or bicarbonates and which react rapidly in the presence of water by releasing carbon dioxide They are intended to be dissolved or dispersed in water before use They are tablets that chewed prior to swallowing They are designed for administration to children A medication in a gelatin container Capsule that is normally used for dry and powdered ingredients Capsule that is primarily used for oils and for active ingredients that are dissolved or suspended in oil These are also known as lozenges Generally, disc-shaped and are dissolved slowly in the mouth Usually designed to release medication that exerts an antiseptics or anesthetic effect on the tissues of the mouth or throat A solid preparation consisting of sugar and gum, the latter giving strength and cohesiveness to the lozenge and facilitating slow release of the medicament It is used to medicate the mouth and throat for the slow administration of indigestion or cough remedies Solid medicated preparations designed to dissolve slowly in the mouth Softer than lozenges and their bases are either glycerol and gelatin, or acacia and sugar Two kinds of powder intended for internal use These are multidose preparations consisting of solid, loose, dry particles of varying degrees of fineness Usually contain non-potent medications such as antacids since the patient measures a dose by colume using a 5mL medicine spoon. The powder is then usually dispersed in water or in the case of effervescent powders, dissolved before taking These are single dose presentations of powder that are intended to be issued to the patient as such, to be taken in or with water Clear liquid preparations for oral use containing one or more active ingredients in a suitable vehicle Stabilized oil in water dispersions, either or both phases of which may contain dissolved solids Liquid preparations for oral use containing one or more active ingredients suspended in a suitable vehicle May show sediment which is readily dispersed on shaking to give a uniform suspension which remains sufficiently stable to enable the correct dose to be delivered Classes of suspension What does the particles in suspensions for injection exhibit The product must have the ability to be successfully administered by a syringe and appropriate needle Particle size must not exceed 10 microns Fine particles are desired to avoid grittiness when applied to the skin The smaller the particle size, the greater the covering and protective power of the preparation Barium sulfate for suspension A concentrated aqueous solution of a sugar, usually sucrose It is pleasantly flavored clear liquid oral preparation for potent or nauseous drug The vehicle of this liquid oral preparation may contain a high proportion or ethanol or sucrose together with antimicrobial preservatives which confers to the stability of the preparation Viscous, liquid oral preparations that are usually prescribed for the relief of cough Contain a high proportion of syrup and glycerol which have a demulcent effect on the membranes of the throat What is the dose volume of linctuses and how should they be taken, diluted or undiluted Liquid preparations for oral use that are intended to be administered in small volumes with the aid of a suitable measuring device Aqueous solutions used in prevention or treatment of throat infections Usually they are prepared in a concentrated solution with directions for the patient to dilute with warm water before use These are similar to gargles but used for oral hygiene and to treat infections in the mouth Semi-solid, greasy preparations for application to the skin, rectum, or nasal mucosa The base is usually anhydrous and immiscible with skin secretions May be used as emollients or to apply suspended or dissolved medicaments to the skin Semisolid emulsions that is mixtures of oil and water Two types of creams Composed of small droplets of oil dispersed in a continuous aqueous phase These creams are more comfortable and cosmetically acceptable as they are less greasy and more easily washed off using water Composed of small droplets of water dispersed in a continuous oily phase Hydrophobic and will be released more readily. More moisturizing as they provide an oily barrier which reduces water loss from the stratum corneum Semisolid system constrained within a 3D polymeric matrix Used for lubrication A soft, viscous, pasty prepararion for external use. Applied to skin while they are hot. Basically ointments into which a high percentage of insoluble solid has been added Less penetrating, less macerating, and less heating than ointment Medicated adhesive that is placed on the skin to deliver specific dose of medication through the skin and into the bloodstream Fluid, semifluid, or occasionally semi solid preparations intended for application to the skin This should not be applied to broken skin. These are massaged into the skin These are fluid preparations for external application without friction Either dabbed on the skin or applied on a suitable dressing and covered with a waterproof dressing top reduce evaporation Volatile solvents that evaporates quickly to leave a dry resinous film of medicament More viscous due to a high content of glycerol, designed to prolong contact of the medicament with the affected site Small solid medicated mass usually cone-shaped that is inserted either into the rectum or vagina where it melts at body temperature A procedure of introducing liquids into the rectum and colon via the anus Used as a bowel stimulant to treat constipation An infusion method of putting liquid into the body with a hollow needle and a syringe pierced through the skin to a sufficient depth for the material to be forced into the body Liquid administered directly into the bloodstream via a vein The injection of a substance directly into a muscle Site of intramuscular injections Injections given by injecting a fluid into the sub cutis – layer of the skin directly below the dermis and epidermis Solutions, suspensions, or emulsion of drugs in a mixture of inert propellants held under pressure in an aerosol dispenser Saline containing drops used as a vehicle to administer medication in the eye Sterile semi solid preparation intended for application to the conjunctiva and eyelid margin Drugs in solution may be instilled into the nose Solutions, suspensions, or emulsions of drugs that are instilled into the ear with a dropper How many times to check medications What are the first pass route What are the non first pass route The metabolism of a drug and its passage from the liver into the circulation What route has a high first pass effect This is the easiest and most commonly used route This route has a slower onset of action, more prolonged effect, preferred by clients This route involves sublingual and buccal administration Injecting a medication into body tissues Should we recap a used needle How to recap an unused needle What method to use for IM injections What is the preferred site for IM injections How to pull the pinna for children younger than 3 years old Can a medication be part of more than one class? Ways in which a drug can produce a therapeutic effect The reactive site on a cell or tissue The degree to which a drug binds with a receptor Drugs that bind to the receptor with response Drugs that binds to the receptor, has no response and prevent binding of agonists Substances that catalyze nearly every biochemical reaction in a cell The expected or predictable physiological response a medication causes Unintended secondary effects a medication predictably will cause; may be harmless or serious Undesirable response of a medication Unexpected effects of drug not related to therapeutic effects This may develop after prolonged intake or when a medicine accumulates in the blood because of impaired metabolism or excretion or excessive amount taken What can toxic levels of opioids can cause Unpredictable effects overreacts or under reacts to a medication or has reaction different from normal Genetically determined abnormal response Usually caused by abnormal levels of drug-metabolizing enzymes Makes up greater than 10 percent of all medication reactions Structural effect in unborn fetus Causes cancer Changes genetic composition Occurs when one medication modifies the action of another Unintentional adverse effects that occur during therapy Effect of 2 medications combined is greater than medications given separately Time it takes for excretion processes to lover the medication concentration by ½ The time it takes for one half of the original amount of a drug in the body to be removed A measure of the rate at which drugs are removed from the body The time it takes for the drug to elicit a therapeutic response The time it takes for a drug to reach its maximum therapeutic response The time a drug concentration is sufficient to elicit a therapeutic response The ration between a drug’s therapeutic benefits and its toxic effects A decreasing response to repetitive drug doses A physiologic or psychological need for a drug The study of poisons and unwanted responses to therapeutic agents
