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Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 1
Nursing Management of Drug Therapy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• ______________ are the changes that occur to the drug while it is inside the body.
– A. Pharmacotherapeutics
– B. Pharmacokinetics
– C. Pharmacodynamics
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• B. Pharmacokinetics
• Rationale: Pharmacokinetics are the changes that occur to the drug while in the body.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Management of Drug Therapy
• Maximize the therapeutic effects of a drug
• Minimize the adverse effects of a drug
• Provide patient and family education
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Management of Drug Therapies
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Health Care Settings
• Hospitals
• Long-term care facilities
• Outpatient centers and clinics
• Health care providers’ offices
• Patients’ homes
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Managing Drug Therapy Using the Nursing Process
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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%
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Three Sources of Assessment Data
• The patient interview and history
• The physical examination
• The medical record
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Objective data are the data collected from the patient’s story.
– A. True
– B. False
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Examination
• Focus on health status, life span, and gender
• Comprehensive
• Physical assessment of each body system
• Vital signs
• Height and weight
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Outcomes
• Outcomes determine the desired results.
• Outcomes are based on data collected.
• Outcomes are specific to the patient’s drug regimen.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Maximizing Therapeutic Effects
• Administer the drug in a manner that will promote its absorption
• Administer the drug at the appropriate time
• Monitor laboratory values
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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