Pharm unit 1

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Khristovo
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Pharm unit 1
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2012-09-14 00:17:00
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Pharm unit 1
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  1. assessment -
    a process tht helps you gain information about a patient,the patient's problem, and anyhthing that may effect the choice of drug given to a patient
  2. Auscultation:
    listening with a setthoscope
  3. Database
    a record
  4. Diagnosis
    a conclusion aabout the patients problems; the physician will decide the medical diagnosis, the nurse will decide the nursing diagosis.
  5. Evaluation
    is the process of looking at what happens once a care plan is implamented ((requires a nurse to watch for a patients response to drugs, noteing both the expected, and unexpected findings))
  6. Implamentation
    following the care planand giving the medication accurately to a patient
  7. inspection
    a close observation
  8. nursing porcess
    a plan developed over the years that and coordinates a nurses actavities. its five major parts are assessment, diagnosis, planning, evaluation. (adpie)
  9. Objective data;
    • any observed and/or measureable information obtained from documentation that patients may bring with them, such as electrodiagrams,  x-rays, of information that can be directly observed during aphysical examination
    • or obtained during a laboritory test, and diagnostic procedures.
  10. Palpation
    is feeling, or touching
  11. percussion
    is detecting differences in vibrations through skin
  12. Six "rights" of medication administration:
    are the six points to check when administering a drug. these include five pints to check before administering medication. (the righ drug, the right time, the righ dose, the right patient, the right rout.) and one more point to check rite after administeration; (the right documentation)
  13. Subjective data
    infromattion supplied by the patient family, it may be felt or known only by the patient, and not detectanble to anyone else.
  14. Therapeutic effects
    when a drug produces the intened reaction and the theraputic goal is met.
  15. What .. Pray tell .. is ADPIE ?
    • ADPIE is the acronym used for the nursing process; the five logical steps in the nursing plan.
    • 1 Assessment - interview, get history, and physical exam from the patient./
    • 2 Diagnosis you, as a nurse make a nursing diagnosis by finding the problems a patient has.
    • 3 Planning - you set the thereputic goals with your patient, gain, share knowleges of you patients medications with the patient; get special needs equipment for your patient,and teach your patient at their learning levels.
    • 4 Implementation you make sure you have the right drug, the right time, the righ tdose right patient , right rough and right documentation.
    • 5 Evaluation: Document the patients theraputic effects, adverse effects, and allergies to the medications
  16. Using the six rights, we learn the proper administration of medications; What part of this does the right drug play?
    • Chech the right drug label at least 3 times:
    • 1 - before taking the drug from the unit dose cart or shelf
    • 2 - before preparing or measureing the prescribed dose of medication.
    • 3 - before putting the medication back on the shelf or just before opening the medication at the time you give it to the patient.
  17. Using the six rights, we learn the proper administration of medications; What part of this does the right Time play?
    check the right time by paying close attention to special dietary restrictions; one-time-only, as needed (“pnr”) or “stat” on medications.
  18. Using the six rights, we learn the proper administration of medications; What part of this does the right dose play?
    Check to make sure the dose is correct. Pay close attention to doseespecially with infants, children, older adults, and obese people
  19. Using the six rights, we learn the proper administration of medications; What part of this does the right patient play?
    Make sure you have the right patient by looking at their identification bracelets, and ask them their name and date of birth.
  20. Using the six rights, we learn the proper administration of medications; What part of this does the right rout play?
    Make sure you give the medication the route the       physician ordered the medication to be given.
  21. Using the six rights, we learn the proper administration of medications; What part of this does the right drug play?
    For right documentation note how and when you gave the drug
  22. Using the six rights, we learn the proper administration of medications; What part of this does the right documentation play?
    Chart the drug given, the dose, and the time the drug       was actually given (not the time it was supposed to be given).
  23. When, and where is it okay to give medications prepared by another nurse?
    NEVER!
  24. How do you insure that a medication order is accurate?
    • The right drug
    • the Drug must be varified 3 times:
    • 1.      Before taking the drug from the unit dose cart or shelf
    • 2.      Before preparing the prescribed dose
    • 3.      Before replacing the medication on the shelf or before administering it to the patient
  25. what are four reasons (judgements) given by the book that if true, should result in the nurse withholding the medications and making a call to the phisician?
    • (1) any part of theorder is incorrect or unclear,
    • (2) the patient’s condition would be made worseby the medication,
    • (3) the physician may not have had all the informationneeded about the patient when drug therapy was planned, 
    • (4) there has been achange in the patient’s condition and a question has arisen about whether themedication should be given
  26. Evaluating (as it applies to drug administration)
    the process of looking atwhat happens when the care plan is implemented. Evaluation requires the nurseto watch for the patient’s response to a drug, noting both expected andunexpected findings.
  27. TherapeuticEffects
     are seen when the drug does what it was supposed to do. If you understand why the medication is being given, you will be able to decide whether or not that goal is being met.
  28. Adverseor side effects
     are seen when patients do not respond to their medications in the way they should or develop new signs or symptoms.
  29. generic vs. brand name and sound alike drugs
    • Generic Names – same in all countries and is not capitalized
    • Trade names have the r symbol. They are catchy and capitalized
    • Sound alike drugs, drugs whos names look, and/or sound alike EX. Novolog and Novolin
  30. Compliant
    a patient follows a prescribed plan of care
  31. Noncompliant
    when a patient doesn’t follow a prescribed planof care.
  32. Literacy
    the ability to read, write, and speak English,do math and solve problems at the level necessary to function on the job and insociety.
  33. Health literacy:
     the ability to understand and use information that is important in keeping them healthy
  34. Health disparity
     a person with a low literacy level is often at a higher risk for disease and disability. They may die of disease than someone with higher literacy.
  35. How to implament a teaching plan
    • Teaching should be offered systematically to decrease stress for the patient.
    • Teaching should be done in a timely way and in a quiet unhurried setting so the patient has a chance to ask questions
    • Offer 3 major pieces of information in the order they need to be remembered.
  36. How do you implament a teaching Plan
    • Teaching should be offered systematically to decrease stress for the patient.
    • Teaching should be done in a timely way and in a quiet unhurried setting so the patient has a chance to ask questions.
    • Offer 3 major pieces of information in the order they need to be remembered
  37. what are some examples of ways to teach a patient?
    • Verbal Education:
    • direct teaching with the nurse telling the patient information, and then giving the patient a chance to ask questions
    • Written information
    • this can incluse, special lables for perscription bottles, materials inserted in the drug packet, booklets that accompany the booklet
    • Audiovisual resources: slide tape programs, videocasettes, and CD-ROMs
    • Nurse and patient use on the internet
  38. Why do we teach about medications to our patients?
    • So the Pt. understands why they are taking the medications, So that the Pt. continues to take the medication, and so the patient knows the risks and the allergic reaction of the medication.
    •  THE NURSE MAY BE HELD LEGALLY RESPONSIBLE FOR FAILURE TO TEACH THE PATIENT THIS INFORMATION.
  39. What should you do after teaching?
    a.       EVALUATION OF LEARNINGb.      Throughout the teaching process it is important for the nurse to summarize, repeat, and keep in simpleCheck for understanding as the teaching continues by having the patient repeat back the important points.  It is important not to create fear or stress when quizzing patients on information that has been discussed.  Not in the patient's record what has been taught.  This not should list the important topics covered, state what material was given to the patient, and provide your view of the patient's level of understanding.  And list anything that has made you believe that the patient is willing to carry out the treatment plan.
  40. Controlled substance:
    a category of drugs that are most heavily regulated by US federal legislation because of their high potential for abuse. includes major pain killers (narcotics) and some sedatives, or tranquilizers.
  41. Prescription or legend drugs
    a category of drugs created by the US govvernment, because they are dangerous, and their use must be controled. maybe purchased only when prescribed by an othorized perscriber. Examples are antibiotics and oral birth control.
  42. Over the counter drugs
    acategory of drugs identified by federal legislation as having low risk to patients and may be purchased without a perscription
  43. Engineering controls
    Built-in safety features to reduce risk of infection and other hazards in health care institutions
  44. Physical dependance
    refers to a physiologic need for medication to relieve shaking, pain, or other symptoms
  45. Physhological dependance
    refers to  anxiety, stress, or tension that is felt if the patient does not have the medication. one type of dependance often leads to another, both types of dependance are often found together in the same individual.
  46. Problem-oriented medical record (POMR)
    a list of nimbered patinent problems as an index to the chart.
  47. Professional responsibility
    a nurses responsability for dilivering meds appropriately, ethicaly, and to the best of her ability.
  48. Legal responsability
    a nursrs responsability for good judgement, and actions while carrying out professional duties
  49. Scheduled Drugs
    controlled substances that are highly regulated because they commmonly abused
  50. Schedule I drugs
    • High potential for abuse,  (no currently accepted medical use) lack of acceptable safety for use under medical supervision.
    • EX. hashish, heroin, lysergic acid diethylamide (LSD), marajuana, peyote, 2,5-diemethylmidemethenphedamine (STP)
  51. Schedule II drugs
    • High potential for abuse, may lead to savier psychologic or physical dependance.
    • EX. amphedamines, meperidine, methadone, methaqulone, morphine, pentobarbitol, oxycodone, (percocet), secobarbitol.
  52. Schedule III drugs
    • Potential for abuse that may lead to moderate to low physical dependance, and psychological dependance.
    • EX glutethimide, asprin with codine, (Emprine with Codine), asprin with bubitol and caffine (Fiorinol), methaprylone, paregoric, acetaminiphine with codine,
  53. Schedile IV drugs
    • Abuse potential may lead to limited physical or psychological dependance
    • EX. lorazapam  (Ativan), Diazapam (Valium)
  54. Schedule V drugs
    • Abuse potential may lead to limited physical or psychological dependance
    • EX. diphenoxlate, with trophine sulphate, (lomotil) ,guaifenesin with codine sulfate antitussives
  55. OTC med rules
    Even though perscription drugs do not requre a perscripton for purchase, a physitians order is nessisary before thy can be given at the hospital. --- even OTC meds carried in by the patients themselves can only be taken with a physicians order.
  56. Wasteing meds
    a.       If a dose is ordered that is smaller than that provided (so that some medication must be discarded), or if the medication is accidentally dropped, contaminated, spilled, or otherwise made unusable and unreturnable, two nurses must sign the inventory report and describe the situation. The medication given should be noted in the patient’s chart, and there should also be a follow-up note about the patient’s response to the medication.   
  57. ad lib
    as desired
  58. cap
    capsule
  59. comp
    compound
  60. D
    day or give
  61. dil
    dilute
  62. div
    divide
  63. dos
    dose
  64. dr
    drain
  65. elix
    elixer
  66. ext
    extract
  67. m
    minim
  68. PR
    per rectum
  69. Rx
    take
  70. S
    mark
  71. sig
    mark or write on the lable
  72. ss
    one half
  73. tab
    tablet
  74. tid
    three times a day
  75. tinct
    tincture
  76. ung
    ointment
  77. 3*
    dram
  78. looks like 3*, BUT with an extra bump on the three
    ounce
  79. occasionaly, when the count in the drawer dont add up..
    it is hunted down, all nurses with a key have to be questoined, all pt charts have to be searched, if it cant be reconsiled, it has to notified to administration, and pharmacy BIG errors cet a call to the cops
  80. medication errors
    a.       When it's discovered that an error has been made, the nurse should immediately check the patient. (Giving to much insulin?)  If the error poses a risk to the patient's condition... the physician should be notified promptly, and orders from the physician should be followed.  Continue watching the patient's condition through measuring vs., drawing blood for tests, etc...The nurse should also notify charge nurse, record in the pt's chart exactly what happened and fill out incident report. Half of the adverse medical events occurring each year are because of medical errors that could be prevented.
  81. Know types of order
    • -Standing order- Indicates that the drug is to be administered until discontinued or for a certain number of doses. Hospital policy dictates that most standing orders expire after a certain number of days.  A renewal order must by written by the physician before the drug may be continued.
    • Stat order- One time order to be given immediately
    •  Single order -one time order to be given at specified time.PRN order -Given as needed based on nurse's judgment of safety and pt need
  82. Absorption
     involves the way a drug enters the body and passes into the body fluids and tissues
  83.  Additive effect
    two drugs are given together and the combined effect of the drugs is equal to either that of the most active drug or the sum of the effects of the individual drugs
  84. Adverse reactions –
       or adverse effects, usually imply more severe symptoms or problems that develop because of the drug
  85. Agonists –
     some drugs attach at the receptor site and activate the receptor, producing an action similar to that of the body’s own chemicals
  86.  Allergy
    – sensitivity caused by antibody response to a drug
  87. Anaphylactic reaction
          – occasionally, the allergic reaction is so severe that the patient has trouble breathing, and rarely the heart may stop
  88. Antagonistic effect
    a.       – described as, if one drug interferes with the action of another drug
  89.   Bioequivalent
    a.     – Products that chemically identical
  90. Biotransformation
    a.       – Medication that have to be broken down into smaller usable parts, primarily in the liver, through a series of complex chemical reactions until they become chemically inactive
  91. Chemical name
    a.       – are often the most difficult to remember, because they include the chemicals that make up the drug.
  92. Desired action
    the expected response of the medication
  93. Displacement
    – at times, one drug may replace another at a receptor site, increasing the effect of the first drug
  94. Distribution 
    a.       - refers to the ways that drugs move by means of circulating body fluids to their sites of action in the body
  95.  Drug interaction
    a.      – when one drug changes the action of another drug
  96. Enteral (route)
    a.       Enteral – directly into the gastrointestinal tract through oral, nasogastric tube, or rectal administration
  97. Excretion
    a.       –All inactive chemicals chemical by-products are waste finally break down through metabolism and are removed from the body
  98.  First-pass (effect)
    a.       – when most of a medication goes very quickly to the liver, a lot of medication is inactivated and can’t be distributed to other parts of the body
  99. Generic name
    a.       – most common drug name. this is the name the drug manufacturer uses a drug and it is the same in all countries
  100. Half-life
    a.        – the time it takes the body to remove 50%
  101. Hepatotoxic
    a.       – damage to the liver by a drug
  102. Hypersensitivity
    a.       – an increase reaction to the drug
  103.    Idiosyncratic response
    a.    – strange, unique, or unpredicted response
  104. Incompatibility
    a.       – occurs when drugs do not mix well chemically
  105. Interference
    a.       – is seen when one drug promotes the rapid excretion of another drug, thus reducing its activity
  106.     Official name
    a.    – the name that is given by the Food and Drug Administration.
  107. Parenteral (route
    a.       ) – directly into dermal, subcutaneous, or intramuscular tissue, epidurally into the cerebrospinal fluid, or into the bloodstream through intravenous injections
  108. Percutaneous route
    a.       (route) – through topical
  109. a.       Pharmacodynamics –
     what the drug does to the body
  110. Pharmacokinetics
    a.       – what the body does to the drug
  111.     Receptor site
    a.   – drugs most commonly forms a chemical bond at a specific site in the body
  112. Trade name
    a.        – or brand name. this name is often followed by the symbol R, which indicates that the name is registered to a specific drug maker or owner and no one else can use it
  113. a.       Partial agonists
    • i.      Other drugs attach at the receptor site.                                                           
    •   ii.      no new chemical reaction                                                        
    •   iii.      prevent activation of the receptor, stopping other reactions from occurring

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