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

3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Application of Pharmacology in Patient Care  Two major areas in which pharmacologic knowledge can be applied: 1.Patient care 2.Patient education

9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Application of Pharmacology in Patient Care 1.Preadministration assessment 2.Dosage and administration 3.Evaluating and promoting therapeutic effects 4.Minimizing adverse effects 5.Minimizing adverse interactions 6.Making PRN decisions 7.Managing toxicity

10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

15Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

16Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

17Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

18Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Managing Toxicity  Early identification makes early intervention possible.  Know the early signs of toxicity.  Know the procedure for toxicity management.

19Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

20Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

21Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

22Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

23Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Minimizing Adverse Interactions  Educate patient about hazardous drug-drug and drug-food interactions.  Example: phenelzine and amphetamines or figs

24Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

25Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Review of the Nursing Process  Assessment  Analysis: nursing diagnoses  Planning  Implementation (intervention)  Evaluation

26Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Applying the Nursing Process in Drug Therapy  Preadministration assessment  Analysis and nursing diagnoses  Planning  Implementation  Evaluation

27Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

28Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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.

29Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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

30Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Implementation  Drug administration  Patient education  Interventions to promote therapeutic effects  Interventions to minimize adverse effects

31Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Evaluation  Therapeutic responses  Adverse drug reactions and interactions  Adherence to the prescribed regimen  Satisfaction with treatment

32Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Modified Nursing Process Format to Summarize Nursing Implications (see Table 2-2) 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?