lOMoARcPSD|11700591
The Nursing Process o An organizational framework for the practice of nursing. Steps: Assessment Data collection, review & analysis Medication profile Diagnosis Used to communicate and share info about the patient and the patient experience Common diagnoses: Deficient knowledge Risk for injury noncompliance Planning Goals - objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria Outcome Criteria - concrete description of patient goals Implementation Initiation and completion of specific nursing actions as defined by the nursing diagnoses, goals and outcome criteria Follow the 6 rights of med administration Right drug, dose, time, route, patient & documentation Evaluation Ongoing part of the nursing process Determining the status of the goals and outcomes of care Monitor the patients response to drug therapy
Subjective Data o Includes all spoken information shared by the patient o Such as: Complaints Problems Or stated needs
Objective Data o Includes information available through senses, such as what is seen, felt, heard, and smelled. o Among the sources of data are: The chart Lab results Report of diagnostic procedures Physical assessment Examination findings o Examples: Age Height
lOMoARcPSD|11700591
Weight Allergies Med profile Health history
Pharmacokinetics - the study of what the body does to the drug (think MOVEMENT) o Four major pharmacokinetic processes Absorption Bioavailability First pass effect - the initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream Different routes Distribution Transport of a drug by the bloodstream to its site of action Albumin is the most common blood protein & carries the majority of protein-bound drug molecules Metabolism (Biotransformation) Biochemical alteration of a drug into an inactive metabolite, more soluble compound, more potent active metabolite, or a less active metabolite. Excretion Elimination of drugs from body Renal Excretion - Kidneys are a primary source of excretion o Half-life - time required for 50% of a given drug to be removed from body
Pharmacodynamics - the study of what the drug does to the body o Mechanism of drug actions in living tissues o Therapeutic effect o Mechanism of action (MOA)
Lifespan Considerations o Fetus Drugs cross the placenta by diffusion FDA has implemented pregnancy safety categories o Infants (Neonatal & Pediatric) Breastfed infants are at risk for exposure to drugs consumed by the mother Consider risk-benefit ratio Pharmacokinetics Absorption Gastric pH less acidic until 1-2 yr old Gastric emptying slowed IM absorption faster & irregular Distribution Greater total body water = lower fat content Decreased level of protein binding Immature BBB - more drugs enter brain Metabolism
lOMoARcPSD|11700591
o
Immature liver - doesn’t produce enough microsomal enzymes Older children may have increased metabolism, requiring higher doses than infants Excretion Kidney immaturity affects glomerular filtration rate and tubular secretion Decreased perfusion rate of the kidneys may reduce excretion of drugs Skin is thin & permeable Stomach lacks acid to kill bacteria Lungs have weaker mucus barriers Body temps less regulated - dehydration easily Liver & kidneys immature, impairing drug metabolism & excretion Older Adults High use of meds Polypharmacy Noncompliance/nonadherence Increased incidence of chronic illnesses Sensory and motor deficits Pharmacokinetics Absorption Gastric pH less acidic Gastric emptying slowed Movement through GI slowed bc of decreased muscle tone and activity Blood flow to GI tract reduced Absorptive surface of GI slowed Distribution Lower total body water percentages Increased fat content Decreased production of proteins by liver = decreased protein binding of drugs Metabolism Aging liver produces fewer enzymes Reduced blood flow to liver Excretion Decreased glomerular filtration rate Decreased number of nephrons
Cultural Considerations o Influence of ethnicity on genetics and drug response o Varying drug responses in different racial or ethnic groups o Health beliefs and practices o Barriers to adequate health care for the culturally diverse US pop Language, poverty, access, pride, and beliefs regarding med practices Medications may also have a different meaning to different cultures