Lect10 Med Admin- Regulatory Needs

8/12/2019 Lect10 Med Admin- Regulatory Needs

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Nursing Management of

Clients with StressorsRequiring Medication

AdministrationRegulatory NeedsPharmacology Principles

The Nurses Role NUR101 Fall 2008

K. BurgerLecture # 10

PPP by:Sharon Niggemeier RN, MS(J. Garnar & R.Kolk)Revised 1006,1007 KBurger


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PharmacologyPharmacology : is the study of chemicals/drugs and

their effects on living organisms. Drugs (legal and illegal) are chemicals intended

to elicit a specific effect . Drugs alter physiological functions in the body,

they do not create a new function in a tissue or

organ. Drugs also create unwanted effects in addition

to the desired effect.


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Terminology Pharmacotherapeutics : use of drugs to treat or

prevent disease. It can be preventative, palliative, orrestorative. Why a drug is prescribed.

Pharmacokinetics

: (means "drug movement") thestudy of the concentration of a drug during the processesof absorption, distribution, biotransformation(metabolism), and excretion of a drug. What the

body does to the drug Pharmacodynamics : study of the mechanism ofdrug action on living tissue at the cellular level . Whatthe drug does to the body


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NCLEX Time

A nurse administering medications has many responsibilities.Among these responsibilities is a knowledge of

pharmacokinetics. Which statement is the best description of

pharmacokinetics? A.The passage of medication molecules into the blood from

the site of administration B.The degree to which medications bind to serum proteins,

which affects distribution C. The study of how medications enter the body, reach their

site of action, metabolize, and exit the body D.The method by which a medication, after absorption, is

moved within the body to tissues, organs, and specific sites ofaction


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Nursing Responsibilities:

Remember that drugs can helpor harm

Nurses are liable for their actions ,omissions, and for those duties they maydelegate to others.

They are personally responsiblelegally,morally and ethicallyfor every drug theyadminister.


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Nursing Responsibilities

Obtaining current knowledge base of drugs Referring to authoritative sources in professional

literature (PDR, journals, etc.) (less than 5yrs old) Questioning a drug order that is unclear or that

appears to contain an error Refusing to administer a drug if there is a reason to

believe it will be harmful.

Performing correct techniques and precautions Monitoring client response and documenting drug

effects Patient and family education


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Nursing Process & Drug Administration

ASSESSMENT Thorough collection of data I nf ormation about the medication Action side effects appropriate doseAge specific considerations routes

I nf ormation about the cl ientWhat other medications are they takingAllergies or other problems w/ medsGag reflex Impaired swallowingDietary and/or Fluid restrictionsCultural and/or religious influencesGenetic factorsVital signsLab values renal & liver function / protein & albuminAgePregnant/breast feeding


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Nursing Process & Drug Administration

Assessment: Pt needs to take meds, cantswallow

The result of this assessment is theNURSING DIAGNOSIS

PLANNING: include goals that directly

relate to the nursing diagnosis and specificoutcome criteria (goals)


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Nursing Process & DrugAdministration

IMPLEMENTATION Using correct techniques of preparation and

administration to deliver medications safely. Monitoring the client for therapeutic and non-therapeutic

effects of the drug Client education for safe and accurate self-administration

of the drug.

EVALUATION of the nursing care provided based on the

level of achievement of the outcome criteria.


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Critical ThinkingThe nurse is preparing to administer prescribedantibiotics to an adult hospitalized client sufferingfrom a wound infection. When the nurse offers the

oral medication to the client, he says Im nottaking those. Pills make me gag and throw up.Write a nursing diagnosis that addresses this

problem.

Impaired swallowing R/T sensitive gag reflexAEB client reports gagging and vomiting when

attempting to take oral medications


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Critical Thinking

Write an outcome statement for yourdiagnosis.

Client will receive appropriate medicationtherapy without discomfort or vomiting.


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Critical Thinking

What are some interventions for this problem?

Determine availability of alternate oral forms:liquid

If not contraindicated, crush medications andmix with applesauce for administration


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Critical Thinking

How will you evaluate this process?

Is client able to take medications in liquidor crushed form without discomfort?

Is the therapeutic effect of the medication

evident ( ie: C & S -, no S/S of infection)?Has the client experienced any adverseeffects of the medication?


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Legal Aspects of Pharmacology

Purpose and Scope of Legal Controls:

Protect public health and safety Laws govern testing, production,

distribution, prescription and theadministration of drugs.


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Federal Medication Laws

1906 Pure Food & Drug Act Disclosure of dangerous ingredients

1912 Sherley Amendment No fraudulent claims of action

1914 Harrison Narcotic Act Established regulations for narcotics

1938 Food,Drug,CosmeticAct Drugs must be tested and proved safe

1952 DurhamHumphrey Amendment Established list of drugs needing RX

1962 Kefauver-Harris Amendment Drugs must be proven effective1970 Controlled Substances Act Strict controls on distribution

1978 Drug Regulation Reform Act Shortened drug investigation time


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Controlled Substance Act Designed to promote treatment and prevention of drugdependence Established controls such as:

-Prescribers are registered with the DEA. A registry

number is issued to each person and is renewedannually.-Complete written records of all drugs prescribedmust be kept for two years. Pharmacists record eachsale in triplicate. Schedule II drug prescriptionscannot be renewed.-DEA (Drug Enforcement Agency) monitoring


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-Health care agencies must establish policies to complywith Federal law.-All units have a record of every controlled drug on theunit and two nurses at the change of every shift count alldrugs.-All controlled drugs are stored using a double locksystem. Keys to medication areas are under the control ofnurses on the unit.

-Discarding of controlled substances must be witnessed byanother nurse-Written renewal orders are required every 72 hours fornarcotics and schedule II & III drugs.

Controlled Substance Act - continued


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Control Schedule

Drugs with a significant potential for abuseare classified into 5 categories or schedules:Schedule I: highest potential for abuse

Illicit drugs (Heroin, LSD, Marijuana)Schedule II: (Morphine, Dilaudid)Schedule III: (Vicodin, Meperidine)

Schedule IV: (Valium, Xanax)Schedule V: lowest potential for abuse

(OTC cough suppresant w/codeine)


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Drug Information Resources The United States Pharmacopoeia ( USP)

and the National F ormulary(NF ) arehighly recommended for use in agencies forall health care professionals to use as a

resource. Agency pharmacists are an appropriateresource for obtaining drug information onthe job.

Nur sing drug handbooks : contain druginformation along with nursingconsiderations.


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Drug Information Resources -continued

Physician' s Desk Reference (PDR)Contains manufacturer's descriptions(package inserts) which are written usingFDA standards, but may be slanted in favor

of the drug being described. Package I nser ts : Required by law for

insertion with each new drug and must

include a description, indications, precautions, dosage, and contraindications. Electronic databases and I nternet
http://www.drugguide.com/http://www.drugguide.com/


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Medication Orders

Two ways to obtain legal drugs: Prescription ( Rx )- order written authorizing

patient to receive medication.Prescriptionstaken to pharmacy whereby the pharmacistdispenses the drug.

Over the counter ( OTC )- patient treats selfand doesnt need a prescribers order. Buysmedications where ever they are available(Walmart, 7-11, etc.)


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Prescriptions

Written, legible prescribers order includes: Patient name

Drug name Dose Route

Frequency Date Signature


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Types of Medication Orders

STAT order : needed immediately Single order : given only once PRN order : given as needed Routine orders : given within 2 hours of

being written and carried out on schedule Standing order : written in advance carried

out under specific circumstances.


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Drug Nomenclature Chemical name: Precisely describes the chemical

& molecular structure of the drug.

Generic name: Pharmaceutical name given by theUS Adopted Names Council. This name is the samefor every drug company.

eg. ibuprofen Proprietary or Trade or Brand name:can be

copyrighted,popular name of the drug supplied bythe manufacturer, easy to pronounce and easy torecognize.

eg. Advil, Motrin


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Look at your drug guide sample

What is the generic name? What are the various trade names ? What do you think about this drug's various

trade names?


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Example for the drug Demerol

Chemical name: N-methyl 4 carboxypiperidinehydrochloride Generic name: Meperidine Trade name: Demerol

Brand name versus generic drug:Is the drug effect identical?????????


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Drug Classifications

Drugs can be classified various ways:

Therapeutic: categorizes drugs by the disease statethey are used to treat.

Pharmacologic: categorizes drugs by theirmechanism of action

Controlled Substance Schedule Pregnancy Schedule


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Example

Drug ClassificationsTherapeutic ClassificationsAnti-hypertensivesAnalgesics

Pharmacologic ClassificationsDiureticsBeta-blockersVaso-dilators

Non-opioidsOpioids

Non-steroidal anti-inflammatory agents


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Look at your drug guide example

What is the Therapeutic classification?

What is the Pharmacologic classification?

Is it a controlled substance?

What is the Pregnancy category?


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Standards for Drugs

Purity : Must be physically pure in that it onlycontains the ingredients stated.(very few drugs are available in a truly pure state THINKwhat impact might this have on drugadministration?)

Potency : Strength of the drug, measured bystandardization of weight of ingredients.

Bioavailability : The degree to which a drug canreach its site of action in the body.


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Standards for Drugs

Efficacy : The effectiveness of the drug inachieving the desired biological change.

Safety : The frequency and severity of

adverse drug reactions (ADR) determinessafety. No chemical is free of adverseeffects.

Investigational drugs : chemicals testedwhich may have potential as a new drug.


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Drug Approval Process

Pre-clinical testing on cells an animals Clinical testing in (4) phases

I small # of healthy peopleII small # of people with the diseaseIII large # of people with the disease

(marketing can occur after phase III)(new expedited process allows after phase II)IV post marketing; voluntary


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Types of Drug Preparations Drugs are prepared in several drug forms

depending on the route of administration orthe use that will be made of the drug.

A variety of drug forms provide someflexibility in the administration of drugs.Examples: capsules, elixir, tablets, gel caps,

powders, solutions, ointments, sprays,etc.

E ti l El t f D g


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Essential Elements of DrugKnowledge for Nurses

drug name (s): Locate in drug reference books,call pharmacist to clarify when a multitude ofnames for drugs causes confusion.

drug classif ication : Note the classification it provides a general view of drug as an indicatorof specific drug traits. i.e. Antipsychotics

indications : why is this drug given? pain relief?tachycardia? combat infection?


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Knowledge Guidelines drug action : what is the drug supposed to do?

usual dose : range will vary with age, weight,gender and method of administration.

route of administration : what is the preferred

route desired effects : what is the therapeutic effect side ef fects : predictable symptoms that occur as a

consequence of overall drug effects in the body.Can be mild (nausea, rash) or severe/lifethreatening (liver toxicity, blood dyscrasias)


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Knowledge Guidelines untoward ef fects

: dose related symptoms occur asdose is too high = Adverse Drug Event (ADE); oridiosyncratic symptoms opposite of therapeuticeffect.

interactions with other drugs : do they potentiatedrug action (additive effect) or inhibit drug action(antagonistic effect) or otherwise incompatible

interactions with food : may delay absorption, maycombine with active ingredient and inactivate it.

precautions : when does a special condition affect thedecision to use the drug?


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Knowledge Guidelines

contraindications : what conditions areadversely affected by this drug? nursing implications : . List assessments to

be made and guidelines to be taken pregnancy safety : pregnancy risk

categories have been established to identifythe risk to the fetus (teratogenic effect).The categories range from A(no risk), B, C,D, or X (should not be used ever).


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Knowledge Guidelines patient/f amil y education : teach patient necessary

information related to medication administration Be sure to answer questions and emphasize

important points! Some health care facilities have computer printout

on drugs that can be given to patients beforedischarge.

MOST ESSENTIAL:Why does this patientneed this drug?


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Use your drug guide sample

to evaluate this Case StudyYour 72 y.o. client, who was admitted fordizziness leading to a fall, has been diagnosedwith hypertension. The MD has added Lasix 40

mg p.o. b.i.d. as well as Calan SR ( antihypertensive )120 mg p.o. daily to the clients originalmedication regimen of Digoxin 0.125 mg p.o.daily.

What therapeutic effect is the MD expecting from the Lasix?What, if any, precautions should the nurse be aware of regardingadministration of Lasix to this client?Is this an appropriate dosage?What are the important nursing implications assessment,

implementation, client teaching for administration of this drug?


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Rights of Drug Administration

The (5)? Rights offer guidelines for safe drugadministration:

Right patient Right medication Right dose Right route

Right time Right documentation Right REASON

Right of client to refuse


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Standard Abbreviations

CHECK JCAHO Official Do Not Use List@ www.jcaho.org

Review SCCC NUR101 Lab Worksheet CHECK ISMP List of Error-Prone

Abbreviations, Symbols and Dose Designations@ www.ismp.org


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Incorporating Lab Values

Medications may be prescribed based on labresults

Medications may alter body functioning andlab values may denote this

Nursing responsibility includes

incorporating lab data with medicationadministration


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Some beginning Normal Lab Values to KNOW

Fasting Blood Glucose 60-110 Potassium (K) 3.5-5.0 Albumin 3.5 5 WBC 5000 10,000 BUN 10-20 Creatinine 0.5 1.2


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The Case Study - continued

Prior to administering the Lasix, the nursechecks the lab values of the client which are:

K 3.7 / Albumin 3.0 / BUN 28 / Creatinine 0.4

What is the NEXT action the nurse should take?

Why?


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Drug Calculations

Unit dose system, less need for calculations,still may need to calculate the number oftablets.

Infusions ( such as IV) calculate drops perminute

Conversions within the metric system Rarely need to calculate from apothecary

system. Drug calculations will be covered in

NR20Lab


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Drug Supply & Storage

Obtained from pharmacy dept. Individual Pt. Supply UNIT DOSE Stock supply tylenol, ASA Dispensing systems medication carts,

computerized systems, ID bracelet scanning


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Drug Abuse by Licensed

Professional

Need to report suspect of abuseGatekeeper role of a professional nurse

Potential loss of nursing license Assistance for licensed professional through

PAP (Professional Assistance Program) NYS Education Department
http://www.op.nysed.gov/pap.htmhttp://www.op.nysed.gov/pap.htm


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Lect10 Med Admin- Regulatory Needs