NURSING
NURS 311 Clinical Nursing Skills Exam 3
Generic - -is the name that is listed in official publications such as the United States
Pharmacopeia (USP).
Many companies names that are easy to remember and can be very similar, which
contributes to medication errors. Are often prescribed as a more cost-efficient
substitution for brand-name medications. However, there may be dramatic differences
in appearance of drugs, depending on the manufacturer.
Trade name - -has the symbol™ at the upper right of the name, indicating a
manufacturer trademark of the name (e.g., Panadol™, Tempra™, Tylenol™).
Many companies choose names that are easy to remember and can be very similar,
which contributes to medication errors. May look different from generic.
Therapeutic range - --The minimum effective concentration (MEC) is the plasma level of
the medication below which the effect of the medication does not occur. The toxic
concentration is the level at which toxic effects occur. Is between the MEC and the toxic
concentration.
-ratio of the Lethal Dose in 50% of the population to the Effective Dose in 50% of the
population
-= LD50 / ED50
-a very low value means that there is a small difference between the doses of a drug
Which produce therapeutic vs. lethal effects
Guidelines for administering controlled substances - -•All are stored in a securely
locked, substantially constructed cabinet (i.e., automated medication dispensing system
[AMDS]) or a locked room.
•Authorized nurses carry a set of keys or an individual computer entry code for the
AMDS.
•An inventory record is used each time one is dispensed. Records are often kept
electronically and provide an accurate ongoing account of the medications used,
wasted, and remaining. If you find a discrepancy, correct and report it immediately.
•Use a special inventory record to document a patient's name, date, name of
medication, dose, time of medication administration, and signature of nurse dispensing
the medication.
•A second nurse witnesses disposal of the unused part if a nurse gives only part of a
dose of one. Computerized systems record the nurses' names electronically. If paper
records are kept, both nurses sign their names on the form. Follow agency policy for
appropriate waste of them. Do not place wasted part of medications in sharps
containers.
Absorption - -Is the passage of medication molecules into the blood from the site of
administration. Factors that influence the rate of it include the administration route,
NURSING
,NURSING
ability of a medication to dissolve, blood flow to the administration site, body surface
area, and lipid solubility of a medication
Distribution - -After a medication is absorbed, it is passed out to tissues and organs and
finally to the site of drug action. The rate and extent of it depends on circulation, cell
membrane permeability, and protein binding. Poor perfusion (e.g., heart failure) alters it.
A medication must pass through biological membranes to reach certain organs. Some
membranes are barriers to the passage of medications. For example, the blood-brain
barrier allows only fat-soluble medications to pass into the brain and cerebrospinal fluid.
The degree to which medications bind to serum proteins such as albumin affects it.
Most medications bind to albumin to some extent. When this happens, they are unable
to exert pharmacological activity. Only the unbound, or "free," medication is active.
Older adults and patients with liver disease or malnutrition have reduced albumin, which
increases their risk for medication toxicity.
metabolism - -After a medication reaches its site of action, it is processed into a less
active or inactive form. Biotransformation occurs under the influence of enzymes that
detoxify, degrade (break down), and remove biologically active chemicals. Most
biotransformation occurs in the liver; although the lungs, kidneys, blood, and intestines
also play a role. Patients (e.g., older adults and those with chronic disease) are at risk
for medication toxicity if their organs cannot process medications effectively.
excretion - -The final aspect of pharmacokinetics is this, the process by which
medications exit the body through the lungs, exocrine glands, bowel, kidneys, and liver.
The chemical makeup of a medication determines the organ of exit. For example,
gaseous and volatile compounds such as alcohol and nitrous oxide exit through the
lungs. The site of it poses implications for nursing care. For example, when medications
exit through sweat glands, you provide skin care to reduce irritation. You must know if a
drug exits through the intestines because the administration of laxatives or enemas
increases peristalsis, accelerates it, and thus lessens the time for drug effects. When
patients have reduced renal function, they are at risk for medication toxicity since
kidneys are the main organs for medication exit.
Therapeutic effects - -the intended or desired physiological response of a medication
side effects - -Every medication has the potential for harm. No medication is totally safe
and absolutely free of nontherapeutic effects. Are predictable and often unavoidable
secondary effects produced at a usual therapeutic drug dose. They are either harmless
or cause injury. The intensity of side effects is often dose dependent. If they are serious
enough to outweigh the benefits of the therapeutic action of a medication, the health
care provider will likely discontinue the medication. Patients commonly stop taking
medications because of ones such as anorexia, nausea, vomiting, dizziness,
drowsiness, dry mouth, constipation, and diarrhea. Report any to the health care
provider to ensure that it is not incorrectly interpreted as a more serious adverse
medication reaction.
NURSING
, NURSING
Adverse effects (AEDs) - -Are unintended, undesirable, and often unpredictable.
Although sometimes they are apparent immediately, unfortunately they often take
weeks or months to develop. Early clinical recognition of them is the important first step
in identification. Range from mild (e.g., rashes or photosensitivity to light) to potentially
fatal (anaphylaxis). Prompt recognition and reporting of them prevent serious injury to
patients. Always assess patients who may be at high risk for one such as pregnant
women and patients with chronic disorders (e.g., hypertension, epilepsy, heart disease,
psychoses). Health care providers report them to the Food and Drug Administration
(FDA) using the MedWatch program.
Toxic effects - -Develop after prolonged intake of a medication or when a medication
accumulates in the blood because of impaired metabolism or excretion. Excess
amounts of a medication within the body sometimes have lethal effects, depending on
the action of the medication. For example, high levels of morphine, an opioid, cause
severe respiratory depression and death. Antidotes are available to treat specific types
of medication toxicity.
Idiosyncratic reactions - -A reaction is an unpredictable effect in which a patient
overreacts or underreacts to a medication or has a reaction different from normal.
Predicting which patients will have this response is impossible. For example, lorazepam
is an antianxiety medication that may cause agitation and delirium when given to an
older adult.
Allergic reactions - -Also are adverse unpredictable responses to a medication.
Exposure to an initial dose of a medication causes a patient to become sensitized
immunologically. The medication acts as an antigen, which causes antibodies to be
produced. With repeated administration a patient develops one to the drug, its chemical
preservatives, or a metabolite. Ranges from mild to severe, depending on the patient
and the medication. Among the different classes of medications, antibiotics cause a
high incidence of them. Severe or anaphylactic reactions, which are life threatening, are
characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and
larynx, severe wheezing, and shortness of breath. Some patients become severely
hypotensive, necessitating emergency resuscitation measures.
It is common practice for hospitalized patients with them to have their allergy
information recorded in a clearly identifiable place.
Absorption rate factors - --From fastest to slowest IV, IM, SubQ, Oral
-Topical applications on skin absorb slowly.
-Medications applied to mucous membranes and respiratory airways absorb quickly.
-Oral medications pass through the gastrointestinal tract and absorb slowly.
-The intravenous route produces the most rapid absorption because the medication is
available immediately when it enters the systemic circulation.
-Solutions and liquid suspensions absorb more readily than tablets or capsules.
-Acidic medications pass through the gastric mucosa rapidly and absorb rapidly,
whereas basic medications (pH greater than 7.0) do not absorb before reaching the
small intestine.
NURSING
NURS 311 Clinical Nursing Skills Exam 3
Generic - -is the name that is listed in official publications such as the United States
Pharmacopeia (USP).
Many companies names that are easy to remember and can be very similar, which
contributes to medication errors. Are often prescribed as a more cost-efficient
substitution for brand-name medications. However, there may be dramatic differences
in appearance of drugs, depending on the manufacturer.
Trade name - -has the symbol™ at the upper right of the name, indicating a
manufacturer trademark of the name (e.g., Panadol™, Tempra™, Tylenol™).
Many companies choose names that are easy to remember and can be very similar,
which contributes to medication errors. May look different from generic.
Therapeutic range - --The minimum effective concentration (MEC) is the plasma level of
the medication below which the effect of the medication does not occur. The toxic
concentration is the level at which toxic effects occur. Is between the MEC and the toxic
concentration.
-ratio of the Lethal Dose in 50% of the population to the Effective Dose in 50% of the
population
-= LD50 / ED50
-a very low value means that there is a small difference between the doses of a drug
Which produce therapeutic vs. lethal effects
Guidelines for administering controlled substances - -•All are stored in a securely
locked, substantially constructed cabinet (i.e., automated medication dispensing system
[AMDS]) or a locked room.
•Authorized nurses carry a set of keys or an individual computer entry code for the
AMDS.
•An inventory record is used each time one is dispensed. Records are often kept
electronically and provide an accurate ongoing account of the medications used,
wasted, and remaining. If you find a discrepancy, correct and report it immediately.
•Use a special inventory record to document a patient's name, date, name of
medication, dose, time of medication administration, and signature of nurse dispensing
the medication.
•A second nurse witnesses disposal of the unused part if a nurse gives only part of a
dose of one. Computerized systems record the nurses' names electronically. If paper
records are kept, both nurses sign their names on the form. Follow agency policy for
appropriate waste of them. Do not place wasted part of medications in sharps
containers.
Absorption - -Is the passage of medication molecules into the blood from the site of
administration. Factors that influence the rate of it include the administration route,
NURSING
,NURSING
ability of a medication to dissolve, blood flow to the administration site, body surface
area, and lipid solubility of a medication
Distribution - -After a medication is absorbed, it is passed out to tissues and organs and
finally to the site of drug action. The rate and extent of it depends on circulation, cell
membrane permeability, and protein binding. Poor perfusion (e.g., heart failure) alters it.
A medication must pass through biological membranes to reach certain organs. Some
membranes are barriers to the passage of medications. For example, the blood-brain
barrier allows only fat-soluble medications to pass into the brain and cerebrospinal fluid.
The degree to which medications bind to serum proteins such as albumin affects it.
Most medications bind to albumin to some extent. When this happens, they are unable
to exert pharmacological activity. Only the unbound, or "free," medication is active.
Older adults and patients with liver disease or malnutrition have reduced albumin, which
increases their risk for medication toxicity.
metabolism - -After a medication reaches its site of action, it is processed into a less
active or inactive form. Biotransformation occurs under the influence of enzymes that
detoxify, degrade (break down), and remove biologically active chemicals. Most
biotransformation occurs in the liver; although the lungs, kidneys, blood, and intestines
also play a role. Patients (e.g., older adults and those with chronic disease) are at risk
for medication toxicity if their organs cannot process medications effectively.
excretion - -The final aspect of pharmacokinetics is this, the process by which
medications exit the body through the lungs, exocrine glands, bowel, kidneys, and liver.
The chemical makeup of a medication determines the organ of exit. For example,
gaseous and volatile compounds such as alcohol and nitrous oxide exit through the
lungs. The site of it poses implications for nursing care. For example, when medications
exit through sweat glands, you provide skin care to reduce irritation. You must know if a
drug exits through the intestines because the administration of laxatives or enemas
increases peristalsis, accelerates it, and thus lessens the time for drug effects. When
patients have reduced renal function, they are at risk for medication toxicity since
kidneys are the main organs for medication exit.
Therapeutic effects - -the intended or desired physiological response of a medication
side effects - -Every medication has the potential for harm. No medication is totally safe
and absolutely free of nontherapeutic effects. Are predictable and often unavoidable
secondary effects produced at a usual therapeutic drug dose. They are either harmless
or cause injury. The intensity of side effects is often dose dependent. If they are serious
enough to outweigh the benefits of the therapeutic action of a medication, the health
care provider will likely discontinue the medication. Patients commonly stop taking
medications because of ones such as anorexia, nausea, vomiting, dizziness,
drowsiness, dry mouth, constipation, and diarrhea. Report any to the health care
provider to ensure that it is not incorrectly interpreted as a more serious adverse
medication reaction.
NURSING
, NURSING
Adverse effects (AEDs) - -Are unintended, undesirable, and often unpredictable.
Although sometimes they are apparent immediately, unfortunately they often take
weeks or months to develop. Early clinical recognition of them is the important first step
in identification. Range from mild (e.g., rashes or photosensitivity to light) to potentially
fatal (anaphylaxis). Prompt recognition and reporting of them prevent serious injury to
patients. Always assess patients who may be at high risk for one such as pregnant
women and patients with chronic disorders (e.g., hypertension, epilepsy, heart disease,
psychoses). Health care providers report them to the Food and Drug Administration
(FDA) using the MedWatch program.
Toxic effects - -Develop after prolonged intake of a medication or when a medication
accumulates in the blood because of impaired metabolism or excretion. Excess
amounts of a medication within the body sometimes have lethal effects, depending on
the action of the medication. For example, high levels of morphine, an opioid, cause
severe respiratory depression and death. Antidotes are available to treat specific types
of medication toxicity.
Idiosyncratic reactions - -A reaction is an unpredictable effect in which a patient
overreacts or underreacts to a medication or has a reaction different from normal.
Predicting which patients will have this response is impossible. For example, lorazepam
is an antianxiety medication that may cause agitation and delirium when given to an
older adult.
Allergic reactions - -Also are adverse unpredictable responses to a medication.
Exposure to an initial dose of a medication causes a patient to become sensitized
immunologically. The medication acts as an antigen, which causes antibodies to be
produced. With repeated administration a patient develops one to the drug, its chemical
preservatives, or a metabolite. Ranges from mild to severe, depending on the patient
and the medication. Among the different classes of medications, antibiotics cause a
high incidence of them. Severe or anaphylactic reactions, which are life threatening, are
characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and
larynx, severe wheezing, and shortness of breath. Some patients become severely
hypotensive, necessitating emergency resuscitation measures.
It is common practice for hospitalized patients with them to have their allergy
information recorded in a clearly identifiable place.
Absorption rate factors - --From fastest to slowest IV, IM, SubQ, Oral
-Topical applications on skin absorb slowly.
-Medications applied to mucous membranes and respiratory airways absorb quickly.
-Oral medications pass through the gastrointestinal tract and absorb slowly.
-The intravenous route produces the most rapid absorption because the medication is
available immediately when it enters the systemic circulation.
-Solutions and liquid suspensions absorb more readily than tablets or capsules.
-Acidic medications pass through the gastric mucosa rapidly and absorb rapidly,
whereas basic medications (pH greater than 7.0) do not absorb before reaching the
small intestine.
NURSING
