Ppt chapter 01-1

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 1

Nursing Management of Drug Therapy


Question

• ______________ are the changes that occur to the drug while it is inside the body.

– A. Pharmacotherapeutics

– B. Pharmacokinetics

– C. Pharmacodynamics


Answer

• B. Pharmacokinetics

• Rationale: Pharmacokinetics are the changes that occur to the drug while in the body.


Core Drug Knowledge

• Pharmacotherapeutics: the desired, therapeutic effect of the drug

• Pharmacokinetics: the changes that occur to the drug while it is inside the body

• Pharmacodynamics: the effects of the drug on the body


Core Drug Knowledge (cont.)

• Contraindications and precautions: the conditions under which the drug should not be used or must be used carefully with monitoring

• Adverse effects: the unintended and usually undesired effects that may occur with the use of the drug

• Drug interactions: the effects that may occur when the drug is given along with another drug, food, or substance


Core Patient Variables

• Health status: overall health of the patient

• Life span and gender: age and gender

• Lifestyle, diet, and habits: occupation, finances, substance use, exercise

• Environment: where will the drug be administered

• Culture and inherited traits: cultural beliefs


Nursing Management of Drug Therapy

• Maximize the therapeutic effects of a drug

• Minimize the adverse effects of a drug

• Provide patient and family education


Management of Drug Therapies


Health Care Settings

• Hospitals

• Long-term care facilities

• Outpatient centers and clinics

• Health care providers’ offices

• Patients’ homes


Managing Drug Therapy Using the Nursing Process


Question

• What percentage of the population in the United States takes at least one medication in a month?

– A. 10%

– B. 25%

– C. 33%

– D. 45%


Answer

• D. 45%

• Rationale: In any given month, almost 45% of the U.S. population will receive one prescription drug. This percentage is higher in the aging population.


Drug Usage in the United States

• Approximately 45% of the population receives one drug in any given month.

• Prescription drug use increases with each age group.

• Approximately 85% of adults aged 65 and older are receiving one prescription per month.

• Almost 50% of adults aged 65 and older are receiving three or more prescriptions a month.


Assessment: Core Drug Knowledge

• Current medications a patient is taking

• Interaction between medications

• Use of resources to identify drugs that are unfamiliar

• Use of prototype drugs to increase understanding of different medications


Prototype Drug

• Typical of a medication within a drug class

• Typically the first drug of a class

• Drug has similar characteristics to all drugs in a class of drugs

• Provides a systematic way to increase knowledge of medications


Three Sources of Assessment Data

• The patient interview and history

• The physical examination

• The medical record


Patient Interview and History

• Health status

– Assess functioning of body systems and organs

• Life span and gender

– Needed to plan patient education on drug therapy

• Lifestyle, diet, and habits

– Can cause potential effect on drug therapy


Patient Interview and History (cont.)

• Environment

– The patient’s adherence to the drug regimen

– Potential risks from the therapy where the drug will be administered

• Culture and inherited traits

– Affect the patient’s acceptance of prescribed drug therapy


Question

• Objective data are the data collected from the patient’s story.

– A. True

– B. False


Answer

• B. False

• Rationale: Subjective data are what the patient tells the nurse; objective data are the data the nurse collects by completing a physical examination of the patient.


Physical Examination

• Focus on health status, life span, and gender

• Comprehensive

• Physical assessment of each body system

• Vital signs

• Height and weight


Medical Record

• The medical record provides information about the patient’s health status, lifestyle, diet, habits, and environment.

• Laboratory test and diagnostic test results

• Drug history


Purpose of Data Collection

• Interpretation of data based on their relevance to drug therapy

• The nurse uses the drug knowledge and patient variables to determine any significant drug interactions.


Nursing Diagnosis

• North America Nursing Diagnosis Association (NANDA)

• Reflect a current, actual problem or the risk for developing a problem related to drug therapy

• Diagnoses may reflect effects of drugs.

• Nursing diagnoses are highly individualized.


Nursing Outcomes

• Outcomes determine the desired results.

• Outcomes are based on data collected.

• Outcomes are specific to the patient’s drug regimen.


Maximizing Therapeutic Effects

• Administer the drug in a manner that will promote its absorption

• Administer the drug at the appropriate time

• Monitor laboratory values


Minimizing Adverse Effects

• Verify the patient’s allergies

• Assess for contraindication for the drug therapy

• Administer the drug in a manner consistent with standard safety protocols

• Monitor the patient and relevant laboratory findings

• Discontinue or withhold a drug based on assessment or laboratory findings


Minimizing Adverse Effects (cont.)

• Report evidence of adverse effects to the prescriber

• Modify administration techniques, when appropriate

• Implement appropriate assessment for certain drugs to detect the onset of adverse effects


Core Drug Knowledge

• Understand the drug’s response

• Basics of teaching patient and family about drug therapy

– Name of the drug

– Reason the drug was prescribed (pharmacotherapeutics)

– Intended effect of the drug (pharmacodynamics)

– Important adverse effects that may occur


Core Patient Variables

• Health status

– Activities that must be performed while the patient receives the drug

• Life span and gender

– Adverse effects on a developing fetus

– Used for patient education


Core Patient Variables (cont.)

• Lifestyle, diet, and habits

– Changes the patient may need to make during drug therapy

• Environment

– To promote effective self-managed drug therapy

• Culture and inherited traits

– Consider cultural issues and modify content or presentation accordingly


Evaluation

• Measures the patient’s progress

• Consider whether the drug achieved the desired effect

• Outcomes that are not achieved

– Reassess to identify barriers to success

• Must identify the reason behind any treatment failure

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