Chapter 2

1. Chapter 2 Application of Pharmacology in Nursing Practice

2. Why Should a Student Nurse Learn About Drugs? • Motivation for studying Pharmacology • Essential for nursing practice • Worthwhile investment • Much more required than the Six Rights • Right drug, patient, dose, route, time, documentation

3. Evolution of Nursing Responsibilities Regarding Drugs • Correct administration, without additional interventions, cannot ensure that treatment will result in the therapeutic objective. • Proper delivery is only the beginning of a nurse’s responsibility.

4. Evolution of Nursing Responsibilities Regarding Drugs • Nurses + physicians + pharmacists participate in a system of checks and balances designed to promote beneficial effects and to minimize harm.

5. Evolution of Nursing Responsibilities Regarding Drugs • The nurse must know • What medications are appropriate for the patient • What drugs are contraindicated for the patient • The probable consequences of the interaction between drug and patient

6. Evolution of Nursing Responsibilities Regarding Drugs • The nurse’s role as advocate • Follows the patient’s status most closely • Detect mistakes made by pharmacists and prescribers • First member of the health care team to observe and evaluate drug responses and intervene if required • Must know the response that a medication is likely to elicit

7. Evolution of Nursing Responsibilities Regarding Drugs • The nurse’s role as advocate • Last line of defense for the patient • Ethically and legally unacceptable to administer a drug that is harmful to the patient—even though the medication has been prescribed by a licensed prescriber and dispensed by a licensed pharmacist

8. Application of Pharmacology in Patient Care • Two major areas in which pharmacologic knowledge can be applied: • Patient care • Patient education

9. Application of Pharmacology in Patient Care • Preadministration assessment • Dosage and administration • Evaluating and promoting therapeutic effects • Minimizing adverse effects • Minimizing adverse interactions • Making PRN decisions • Managing toxicity

10. Preadministration Assessment • Collecting baseline data • Needed to evaluate therapeutic responses and adverse effects • Identifying high-risk patients • Liver and kidney impairment • Genetic factors • Drug allergies • Pregnancy • Elderly and pediatric • Tools: patient history, physical examination, and laboratory results

11. Dosage and Administration • Certain drugs have more than one indication. • Dosage may differ depending on which indication the drug is used for. • Many drugs can be administered by more than one route. • Dosage may differ depending on the route selected. • Certain IV agents can cause severe local injury if IV extravasates.

12. Dosage and Administration • Read the medication order carefully. • Verify the identity of the patient. • Read the medication label carefully. • 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.

13. Evaluating and Promoting Therapeutic Effects • Evaluating therapeutic responses: • One of the most important aspects of drug therapy • Must know the rationale for treatment and the nature and time course of the intended response • Cannot effectively evaluate a drug with multiple applications if the intended use is not known

14. Evaluating and Promoting Therapeutic Effects • Promoting patient adherence • Also known as compliance or concordance • Extent to which a patient’s behavior coincides with medical advice • Implementing nondrug measures • Drug therapy can often be enhanced by nondrug measures. • Biofeedback, emotional support, weight reduction, smoking cessation, sodium restriction, etc.

15. Minimizing Adverse Effects • All drugs have the potential to produce undesired effects. • Always know the following: • The major adverse effects the drug can produce • The time when these reactions are likely to occur • Early signs that an adverse reaction is developing • Interventions that can minimize discomfort and harm

16. Minimizing Adverse Interactions • Take a thorough drug history. • Advise the patient to avoid OTC drugs that can interact with the prescribed medication. • Monitor for adverse interactions known to occur. • Be alert for as-yet unknown interactions.

17. Making PRN Decisions • PRN: pro re nata, meaning “as needed” • Nurse has discretion regarding how much drug to give and when to give it. • Know the reason for drug use. • Be able to assess the patient’s medication needs.

18. Managing Toxicity • Early identification makes early intervention possible. • Know the early signs of toxicity. • Know the procedure for toxicity management.

19. Application of Pharmacology in Patient Education • Drug name and therapeutic category • Dosage size • Dosing schedule • Route and technique of administration • Expected therapeutic response and when it should develop • Nondrug measures to enhance therapeutic responses

20. Application of Pharmacology in Patient Education • 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

21. Teaching Dosage and Administration • Give patient the following information: • Name of drug • Dosage and schedule of administration • Technique of administration • Duration of drug use • Storage of drug

22. Application of Pharmacology in Patient Education • Promoting therapeutic effects • Nature and time course of expected beneficial effects • Recognizing treatment failure, allow for timely alternative therapy implementation • Minimizing adverse effects • Insulin overdose • Anticancer and infection • Some side effects are benign but disturbing, especially if unknown to the patient.

23. Minimizing Adverse Interactions • Educate patient about hazardous drug-drug and drug-food interactions. • Example: phenelzine and amphetamines or figs

24. Application of the Nursing Process in Drug Therapy • Application of the nursing process conceptual framework in drug therapy • Use of a modified nursing process format to summarize nursing implications in this text

25. Review of the Nursing Process • Assessment • Analysis: nursing diagnoses • Planning • Implementation (intervention) • Evaluation

26. Applying the Nursing Process in Drug Therapy • Preadministration assessment • Analysis and nursing diagnoses • Planning • Implementation • Evaluation

27. Preadministration Assessment • Collection of baseline data to evaluate therapeutic effects • Collection of baseline data to evaluate adverse effects • Identification of high-risk patients • Assessment of the patient’s capacity for self-care

28. Analysis and Nursing Diagnoses • Three objectives: • Judge the appropriateness of the prescribed regimen. • Identify potential health problems that the drug might cause. • Determine the patient’s capacity for self-care.

29. Planning • Defining goals • Setting priorities • Identifying specific interventions • Drug administration • Interventions to enhance therapeutic effects • Interventions to minimize adverse effects • Patient education • Establishing objective criteria for evaluation

30. Implementation • Drug administration • Patient education • Interventions to promote therapeutic effects • Interventions to minimize adverse effects

31. Evaluation • Therapeutic responses • Adverse drug reactions and interactions • Adherence to the prescribed regimen • Satisfaction with treatment

32. Modified Nursing Process Format to Summarize Nursing Implications (see Table 2-2) • Preadministration assessment • Implementation: administration • Implementation: measures to enhance therapeutic effects • Ongoing evaluation and interventions • Patient education • What about diagnosis and planning?