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48 Cards in this Set
- Front
- Back
Nursing Process 5 steps:
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Assessment
Nursing Diagnosis Planning Implementing Evaluating |
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Assessment includes:
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Physical exam
Health history Diagnostic tests/Lab values Medication history |
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Nursing diagnosis includes:
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North American Nursing Diagnosis Association
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Planning includes:
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Identification of significant interactions between core drug knowledge and patient variables.
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Implementation includes (aka: Intervention):
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Maximizing theraputic effects
Minimizing adverse effects Patient and Family Education |
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Evaluation includes:
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Evaluate the outcome, change implementations as needed.
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6 RIGHTS:
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Right Drug
Right Dose Right Time Right Route Right Patient Right Documentation |
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Pharmacokinetics:
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How the body effects the drug.
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4 phases of Pharmacokinetics:
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1. Absorption
2. Distribution 3. Metabolism 4. Excretion |
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Absorption:
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The movement of the drug from the site of administration to the bloodstream.
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Aborbtion sites slowest to quickest:
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Oral
SQ IM IV |
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3 Influential factors of Distribution:
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Blood flow to the tissues
Drug's ability to leave the blood Drug's ability to enter the cell (must be lipophilic) |
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Drug ditribution works off of:
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Protein binding
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If a drug binds easily to protein the patient will receive?
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Less of the drug/Increased dosage is needed.
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To cross the BBB drugs must be?
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Lipophilic or have a transport system.
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Metabolism primarily occurs where?
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The Liver (Can also occur in GI tract, lungs, kidney, skin
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Metabolism of a drug is?
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Conversion of the drug into another substance. Lipophilic to hydrophilic.
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First Pass Effect:
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% of drug that is metabolized by the liver with each pass through the portal vein.
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What percent of cardiac output is sent to the liver?
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25%
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Excretion;
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Removal of the drug or metabolites from the body.
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Excretion usually occurs through:
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Urine (also bile, exhaled air, breast milk, sweat, saliva)
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What is a drug?
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Any chemical that can affect living processes.
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Three factors of Renal Excretion:
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1. Glomerular filtration
2. Passive tubular reabsorption 3. Active tubular reabsorption |
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Glomerular Filtration:
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Drugs enter capillaries surrounding Bowmans capsule. Most drugs filter easily through capillary walls and into proximal tubule (urine). Proteins do not pass
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Passive Tubular Reabsorption:
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Drug tries to move down concentration gradient.
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Precautions of Active Tubular secretion:
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If several drugs need active transport one drug will have to wait to be excreted.
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Pharmacodynamics:
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How the drug affects the body.
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Drugs cannot create new responses in the body, they?
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Turn on/off, promote or block responses.
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Pharmacotherapeutics:
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Desired therapeutic goal/effect/outcome
Why we are giving the drug. |
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Effective Dose=
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dose required to produce a therapeutic response in 50% of population. Becomes standard dose.
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Lethal Dose=
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Dose would be fatal in 50% of population.
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Therapeutic Index:
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relationship between Effective and Lethal doses. If margin is narrow, patient must be monitored closely.
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Drugs come from:
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animals
plants-Alkaloids (end in -ine, nicotine), glycosides (end in -in, digoxin), gums synthetic |
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Pure Food and Drug Act 1906
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Designated Uonited States Pharmacopeia and National Formulary as the official standards and empowered Fed Gov to enforce standards.
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Federal Food, Drug, and Cosmetics Act 1938:
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Established the FDA (Drugs must be labeled)
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Durham-Humphrey Amendment:
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Defined 2 categories for drugs; Prescription and OTC
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Clinical trials have how many phases?
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4
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Clinical trial phase 1:
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20-80 healthy volunteers to est. a drug's safety. About 1 year.
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Clinical trial phase 2:
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100-300 patient volunteers to assess the drug's effectiveness. (about 2 years)
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Clinical trial phase 3:
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1000-3000 patients in clinics and hospitals who are monitored carefully to determine effectiveness and identify adverse reactions. (about 3 years)
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Clinical trial Phase 4
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After final approval, drug available for physicians to prescribe. Drug co. will continue to report cases of adverse reactions and other data to FDA.
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Additional safeguards for drugs:
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MedWatch
Practitioners Reporting Network Medication Error Index |
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Process of new drug developement takes?
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Aprox 12 years and $350 Billion
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Controlled Substances
Category C-I: |
High abuse pot.
Severe Dep liability Heroin, hashish, LSD, GHB No medical use/research only |
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Controlled Substances
Category C-2: |
High abuse pot.
Severe Dep liability Amphetamines, some opioid narcotics, dronabinol. Requires specific type of prescription No phone orders Refills require new prescription |
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Controlled Substances
Category C-3: |
Moderate abuse pot.
Moderate Dependence Some opioid narcotics (codeine, hydrocodone), some CNS stim and anabolic steroids. Written or phone order accep. May be refilled 5 x's in 6 mos.from date of issue. |
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Controlled Substances
Category C-4: |
Low abuse pot.
Limited dep liability Benzodiazepine anxiolytics, anticonvulsants, muscle relaxants, Some opioid narcotics such as propoxyphene or pentazocine. Written or phone order accep. May be refilled 5 x's in 6 mos.from date of issue. (same as C-3) |
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Controlled Substances
Category C-5: |
Limited abuse pot.
Lowest dep liability Antidiarrheal, small amounts of narcotics such as codeine used as antitussives. Many of these may be obtained w/o prescription. |