Chapter 2 - Application of Pharmacology in Nursing Practice

‭1 - Preadministration Assessment‬ ‭●‬ ‭Gather‬‭baseline data‬‭for evaluating responses‬ ‭○‬ ‭Ex. BP, liver function‬ ‭●‬ ‭Identify‬‭high-risk pts‬‭/factors‬ ‭○‬ ‭Ex. Pathophysiology, genetics, drug allergies, young/advanced age, pregnancy‬ ‭●‬ ‭Assess pt’s capacity for self-care‬ ‭2 - Dosage and Administration‬ ‭●‬ ‭Dosages can differ depending on drug indication‬ ‭●‬ ‭Drugs can be administered by multiple routes, and dosage can differ for each‬ ‭●‬ ‭Certain IV agents can cause local injury if the drug extravasates‬ ‭3 - Promoting Therapeutic Effects‬ ‭●‬ ‭Nonpharmacologic measures:‬ ‭○‬ ‭Breathing exercises for asthma‬ ‭○‬ ‭Exercise and physical therapy for arthritis‬ ‭●‬ ‭Short-term interventions:‬ ‭○‬ ‭Careful positioning for maximum comfort‬ ‭○‬ ‭Stimulating environment for a pediatric pt‬ ‭4 - Minimizing Adverse Effects‬ ‭●‬ ‭Identify high-risk pts‬ ‭●‬ ‭Ensure proper‬‭administration‬ ‭●‬ ‭Teach pts to avoid activities with‬‭adverse interactions‬ ‭●‬ ‭Timely intervention‬ ‭5 - Minimizing Adverse Interactions‬ ‭●‬ ‭Thorough drug‬‭history‬ ‭●‬ ‭Have the pt avoid‬‭OTC‬‭drugs that can interact‬ ‭●‬ ‭Monitor for adverse interactions‬ ‭●‬ ‭Be alert to presently unknown interactions‬ ‭6 - Making PRN Decisions‬ ‭●‬ ‭PRN: Pro re nata, as needed‬ ‭●‬ ‭The nurse has discretion for when to give a drug or how much to give‬ ‭●‬ ‭Common for drugs to promote sleep, relieve pain, and reduce anxiety‬ ‭7 - Evaluating Medication Responses‬ ‭●‬ ‭Know the‬‭rationale‬‭for tx and the‬‭nature/time course‬‭of the intended response‬ ‭●‬ ‭Identify why desired responses may not occur and implement alternative therapy‬ ‭8 - Managing Toxicity‬ ‭●‬ ‭Know the early signs and procedure for management‬ ‭●‬ ‭Early/quick dx and response‬ ‭Patient Education‬ ‭●‬ ‭Drug name and therapeutic category (ex. antibiotic)‬ ‭●‬ ‭Dosage‬ ‭○‬ ‭May need to be adjusted‬ ‭●‬ ‭Dosing schedule‬ ‭○‬ ‭PRN medications do not have a fixed schedule‬ ‭○‬ ‭What to do if a dose is missed‬ ‭●‬ ‭Route and technique of administration‬ ‭○‬ ‭Unfamiliar/difficult (sublingual/subcutaneous)‬ ‭○‬ ‭Special instructions (not to be chewed/crushed, with fluids, with meals, not to be‬ ‭taken on an empty stomach)‬ ‭●‬ ‭Expected therapeutic response and onset‬ ‭●‬ ‭Nondrug measures to enhance therapeutic responses‬ ‭●‬ ‭Tx duration‬ ‭○‬ ‭Discontinued when symptoms subside (ex. acute pain)‬ ‭○‬ ‭Continue lifelong (ex. HTN)‬ ‭○‬ ‭Specific time interval (ex. Gastric ulcers)‬ ‭●‬ ‭Method of drug storage‬ ‭●‬ ‭Symptoms of adverse effects‬ ‭●‬ ‭Measures to minimize discomfort/harm‬ ‭●‬ ‭Major adverse drug-drug and drug-food interactions‬ ‭●‬ ‭Whom to contact in the case of therapeutic failure or severe adverse reactions/interactions‬ ‭●‬ ‭Adherence:‬‭Extent to which a pt’s behavior coincides‬‭with medical advice‬ ‭Nursing Process‬ ‭●‬ ‭Assessment: Collecting data about the patient‬ ‭●‬ ‭Analysis: Analyzing information to determine actual/potential health problems‬ ‭○‬ ‭Nursing diagnosis: Includes statement of pt’s health problem, problem’s probable‬ ‭cause or risk factors, and the s/s or other evidence of the problem‬ ‭○‬ ‭Judging the appropriateness of the prescribed therapy‬ ‭○‬ ‭Identifying potential health problems tx may cause‬ ‭○‬ ‭Characterizing the pt’s capacity for self-care‬ ‭●‬ ‭Planning: Delineating specific interventions to solve/prevent the problems identified‬ ‭○‬ ‭Defining goals‬ ‭○‬ ‭Establishing priorities‬ ‭○‬ ‭Establishing criteria for evaluating success‬ ‭ ‬ I‭ mplementation: Carrying out the interventions made‬ ● ‭●‬ ‭Evaluation: Determining the degree to which tx has succeeded‬ ‭○‬ ‭Helps to identify what should be continued, discontinued, and newly implemented‬ ‭○‬ ‭Therapeutic responses‬ ‭○‬ ‭Adverse reactions/interactions‬ ‭○‬ ‭Pt adherence‬ ‭○‬ ‭Pt satisfaction with treatment‬