NR565 Midterm Study
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Prescriptive authority for nurse practitioners also regulates prescribing
rights beyond medications and controlled substances. These rights
include therapeutic devices and services and are outlined in state
practice laws and regulations and include Durable Medical Equipment
(DME) such as wheelchairs, power scooters, hospital beds, portable
oxygen equipment, handicap placards, etc. and medical services such
as Physical Therapy (PT), Occupational Therapy (OT), home health
services, etc. Prescriptive authority encompasses more than writing a
prescription correctly. It requires adherence to ethical guidelines to
APRN prescribing role
ensure that patients are safeguarded from harm. Ethical prescribing
starts with being well-informed about medications. Mechanism of
action, efficacy, and safety are important considerations, as are a
patient's distinct needs and circumstances, including the number of
medications prescribed (Mitchell & Oliphant, 2016). Most patients
receiving a prescription are taking other medications, whether
prescription or over-the-counter. Appropriate selection, dosing, and
duration of pharmaceutical agents are key to maximizing outcomes
and minimizing adverse effects
, Nurse practitioners have the autonomy to evaluate patients, diagnose,
order and interpret tests, initiate and manage treatments and prescribe
benefits of full practice authority
medications, including controlled substances without physician
oversight
Administering medications and prescribing medications are two
distinct processes. Prescription writing requires prudent and deliberate
decision-making processes to maintain patient safety and reduce
liability, including:
*documentation of a provider-patient relationship for the recipient of
the prescribed medications
*documentation of a thorough history and physical examination for the
recipient
*documentation of discussions regarding risk factors, side effects, or
promoting positive outcomes therapy options
through prudent prescribing
practices *documentation of drug monitoring or titration plan, if applicable
*documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
Rational drug selection requires a logical approach that includes the
formulation of a diagnosis based on clinical reasoning and the
selection and monitoring of the most appropriate pharmacological
treatment
Considerations include: Cost, guidelines, availability, interactions, side
effects, allergies, hepatic/renal functions, need for monitoring, &
special populations
identifies drugs with a high likelihood of causing adverse effects in
older adults. Accordingly, drugs on this list should generally be
Beer's Criteria
avoided in adults older than 65 years except when the benefits are
significantly greater than the risks.
the study of the biochemical and physiologic effects of drugs on the
Pharmacodynamics body and the molecular mechanisms by which those effects are
produced
Pharmacokinetics the study of drug movement throughout the body
the study of how genes affect a person's response to drugs. The
purpose of this is to combine the sciences of genomics and
Pharmacogenomics
pharmacology to provide individualized, targeted, safe drug therapies
to patients