Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 2 Application of...

Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Chapter 2

Application of Pharmacology in Nursing Practice

2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

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


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.


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.


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


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


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


Application of Pharmacology in Patient Care

Two major areas in which pharmacologic knowledge can be applied:1. Patient care2. Patient education


Application of Pharmacology in Patient Care

1. Preadministration assessment2. Dosage and administration3. Evaluating and promoting therapeutic effects4. Minimizing adverse effects5. Minimizing adverse interactions6. Making PRN decisions7. Managing toxicity


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


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.


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.


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


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.


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


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.


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.


Managing Toxicity

Early identification makes early intervention possible.

Know the early signs of toxicity. Know the procedure for toxicity management.


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



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


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



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.


Minimizing Adverse Interactions

Educate patient about hazardous drug-drug and drug-food interactions. Example: phenelzine and amphetamines or figs


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


Review of the Nursing Process

Assessment Analysis: nursing diagnoses Planning Implementation (intervention) Evaluation


Applying the Nursing Process in Drug Therapy

Preadministration assessment Analysis and nursing diagnoses Planning Implementation Evaluation


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


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.


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


Implementation

Drug administration Patient education Interventions to promote therapeutic effects Interventions to minimize adverse effects


Evaluation

Therapeutic responses Adverse drug reactions and interactions Adherence to the prescribed regimen Satisfaction with treatment


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?

Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 2 Application of...

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