PHARMACOLOGY MIDTERMS  Objective, measurable, realistic

 Time frame specified

THE NURSING PROCESS  Patient-centered
 An organizational framework for the practice of nursing
 Orderly, systematic OUTCOME CRITERIA
 Central to all nursing care  Specified standard(s) of measure
 Encompasses all steps taken by the nurse in caring for a patient  Patient oriented
 Flexibility is important
 ADPIE IMPLEMENTATION
 Assessment  Initiation and completion of the nursing care plan as defined by the
 Nursing Diagnosis nursing diagnoses and outcome criteria
 Planning (with outcome criteria)  Follow the “12 rights” of medication administration
 Evaluation
EVALUATION
FIVE NURSING PROCESS (ADPIE)  Deciding how the patient is responding to the interventions in
relation to the stand goals and expected outcomes
ASSESSMENT
 Data collection PATIENT TEACHING
 Subjective, objective
 Data collected on the patient, drug and environment HEALTH EDUCATION
 Medication History  Also termed as patient education
 Physical Assessment  One of the most important roles of the nurse
 Data Analysis  Carries legal implications for those who fail to provide and
document education
NURSING DIAGNOSIS  All significant caregivers should be included in the patient teaching
 Judgment or conclusion about the need/problem (actual or at risk) of (must also be documented)
the patient
 Bases upon an accurate assessment COMMON PHARMACOLOGY ABBREVIATIONS
 NANDA format  a.c = before meals
 ad lib = as desired
PLANNING  b.i.d. = twice a day
 Identification of goals and outcome criteria  NPO = nothing by mouth
 Prioritization  p.c. = after meals
 Includes the family and the patient  p.r.n. = as needed
 Time frame  p.o = by mouth
 qd = every day
GOALS  q.i.d. = four times a day

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  t.i.d. = three times a day  Right documentation
 IVP = intravenous push
 ANST = after negative skin test
 OD = once a day
 1/2 glass = 120 mL 12 Rights of Drug Administration
 1 tsp = 5 mL a. Right Client
 1 tbsp = 15 mL b. Right Drug
c. Right dose
Preparing to Administer a Drug d. Right route
e. Right time
Rules for Drug administration f. Right Assessment
 Drugs g. Right motivation/ approach
-Local effect- applied directly to skin, tissue or mucous membranes h. Right of the client to refuse
-Systemic effect- given by routes that allow the drug to be absorbed i. Right of the client to know the reason for the drug
or distributes into the bloodstream j. Right evaluation
 Pay close attention k. Right documentation
 Dose route l. Right drug preparation
 Form of medication
1. Right patient
Preparing to Administer a Drug (con’t)  Check the name on the order and the patient
 Use 2 identifiers (Id bracelets, Ask what the patient name (e.g.
 Rules for administration Ano po ang pangalan nila), ask relatives what is the patient
 Give only drugs the doctor orders- use drugs reference, if name.)
necessary  Ask patient to identify himself/herself
 Wash your hands  When available, use technology (for example, bar-code
 Prepare in a well-lit area system)
 Focus on task; avoid distraction
 Calculate the dose carefully 2. Right medication
 Do not leave a prepared drug unattended- never give a drug that  Check the medication label
someone else has prepared  Check the order

The Six rights Prescription

 Right Drug  Superscription- Rx (at the beginning of every prescription)
 Right dose  Inscription- contains the name of the drug, the dosage
 Right time strength and the drug form.
 Right route  Subscription- begins with either the symbol # or with N,
 Right patient which stands for number

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  Signature- beginning with the abbreviation Sig,; contains  When measuring drops of medication with a dropper, always
directions to the patient how to use the medication. hold the dropper vertically and close to the medication cup
 Do not attempt to devide unscored tablets and do not
Categories of Drugs Orders administer tablets which have been broken unevenly along the
 Standing Order- protocols derived from guidelines created by scoring.
healthcare provider for use in specific setting for treating certain 
diseases or sets o symptoms
 Standard Order- may be an ongoing order, may be given for a RIGHT DOSE
specific number of doses or days. May include prn orders  Check the order
 One time or Single order- given once and usually at a specific time  Confirm appropriateness of the dose using a current drug reference.
 PRN Orders- given at the time client’s request and nurse’s judgment  If necessary, calculate the dose and have another nurse calculate the dose
concerning need and safety as well.
 Stat Orders- given once immediately
RIGHT ROUTE
Right Dose  Again, check the order and appropriateness of the route ordered
 Refers to the dose prescribed for a particular client  Confirm that the patient can take or receive the medication by the
ordered route.
Nursing Implication:
 Be familiar with the various measurement system and the RIGHT TIME
conversion from one system to another.  Check the frequency of the ordered medication
 Double-check that you are giving the ordered dose at the correct time
Measuring Devices:  Confirm when the last dose was given
 Medication cups
 Dropper RIGHT DOCUMENTATION
 Syringe  Document administration AFTER giving the ordered medication
 Tuberculin  Chart the time, route, and any other specific information as necessary.
 Insulin For example, the site of an injection or any laboratory value or vital sign
 General purpose that needed to be checked before giving the drug.
 For use in administering .50-50ml of medication
RIGHT REASON
Nursing Implication:  Confirm the rationale for the ordered medication. What is the patient’s
 Always use the appropriate measuring device and read it history? Why is he/she taking this medication?
correctly  Revisit the reasons for long-term medication use.
 Always measure the volume of a liquid medication at the
lowest point of the meniscus RIGHT RESPONSE
 Shake all suspension and emulsion

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  Make sure that the drug led to the desired effect. If an anti hypertensive -Cultural diversity and political and socio- economic status and inherent
was given, has his/her blood pressure improved? Does the patient factors to effective nursing care.
verbalize improvement in depression while on an antidepressant?
 Be sure to document your monitoring of the patient and any other
nursing interventions that are applicable. Code of Ethics for Filipino Nurses
-Section 5
Legal, Ethical, and Cultural Considerations -Registered nurses must
-consider the individuality and totality of patients when they administer care.
"The very first requirement in a hospital is that it should do the sick no -respect the spiritual beliefs and practices of patients regarding diet and
harm." -Florence Nightingale RA 9173 treatment.
-uphold the rights of individuals.
Article VI: Nursing practice -take into consideration the culture and values of patients in providing
-Philippine Nursing Act of 2002 nursing care. However, in the event of conflicts, their welfare and safety must
-section 28a take precedence.
-Provide nursing care through the utilization of the nursing process. -Respect the Patient's Bill of Rights (Section 8)
- Nursing care includes, but not limited to, traditional and innovative
approaches, therapeutic use of self, executing health care techniques and Cultural Considerations
procedures, essential primary health care, comfort measures, health teachings 1. Assess the influence of a patient's cultural beliefs, values, and customs.
and administration of written prescription for treatment, therapies, oral 2. Drug polymorphism
topical and parenteral medications, internal examination during labor in the 3. Compliance level with therapy
absence of antenatal bleeding and delivery. 4. Environmental considerations
-In case of suturing of perineal laceration, special training shall be provided 5. Genetic factors
according to protocol established. 6. Varying, responses to specific agents

Republic Act No. 9165 Cultural Assessment

-Comprehensive Dangerous Act 2002 1. Health beliefs and practices
-It is the policy of the state to safeguard the integrity of its territory and the 2. Past uses of medicine
well-being of its citizenry particularly the youth, from the harmful effects of 3. Folk remedies
dangerous drugs on their physical and mental well-being, and to defend the 4. Home remedies
same against acts or omissions detrimental to their development and 5. Use of nonprescription drugs and herbal remedies
preservation. 6. OTC treatments

Code of Ethics for Nurses Cultural Assessment (cont'd)

-Registered nurses have to gain knowledge and understanding of man's 1. Usual response to treatment
cultural, social, spiritual, physiological, psychological, and ecological aspects 2. Responsiveness to medical treatment
of illness, utilizing the therapeutic process. 3. Religious practices and beliefs
4. 4. Dietary habits

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  If a tablet is unscored, call the pharmacy.
 Recheck calculations if the dose is more than 1 or tablets.

Medication errors: preventing and responding LABELING

 Always label your answer with appropriate unit injection
Medication Misadventures (cont'd)  use "ml", but, INSULIN AND HEPARIN use "units"
 by definition, all ADRs are also ADEs  use if IV pumps- "ml/hr"
 But all ADEs are not ADRs  if number of tablets is asked write "tablet"

Two types of ADRs LEADING ZEROS

 allergic reactions  Always use a "leading zero" for decimal dosages
 idiosyncratic reactions  Do not use .25 mg; use 0.25 mg
 .25 mg may be misread as 25 mg
PREVENTING MEDICATION ERRORS  ".25" is sometimes called a "naked decimal"
 minimize verbal or telephone orders  0.05 is CORRECT
 repeat order to prescriber  .05 is INCORRECT
 spell drug name aloud
 speak slowly and clearly TRAILING ZEROS
 list indication next to each order  Never use "trailing zeros" with medication orders
 avoid medical shorthand, including abbreviations and acronyms  Do not use 1.0 mg; use 1 mg
 1.0 mg could be misread as 10 mg, resulting in a tenfold dose increase
PREVENTING MEDICATION ERRORS (cont'd)  3 is CORRECT
 Never assume anything, about items not specified in a drug, order (i.e.,  3.0 is INCORRECT
route)
 Do not hesitate to question a medication order for any reason when in  Check medication order and what is available while using the "12 rights"
doubt.  Take time to learn special administration techniques of certain dosage
 Do not try to decipher illegibly written orders; contact prescriber for forms.
clarification.
 Always listen to and honor any concerns expressed by patients regarding
ROUNDING medications.
 Always round your answers to the nearest dose that is measurable, after  Check patient allergies and identification
verifying, that the dose is correct for that patient.
 if a tablet is scored, you may round to the nearest half tablet  Medication
 1.8 tabs, give 2 tabs  Reconciliation
 1.2 tabs, give 1 tab

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 - advise client not to use more doses than ordered
- explain to client which type of medication is for long-term control and
which one is for short-term responses
- teach client the correct use of inhalation
PULMONARY DRUGS Devices
ANTIHISTAMINES Asthma- Albuterol (Proventil)
USES: Emphysema- Terbutaline Sulfate
- prevent and treat allergies and allergic reactions (Brethine)
- allergic transfusion reactions COPD- Salmeterol (Serevent)
- decrease itching and pruritus
- may be used with epinephrine in the management of anaphylaxis ANTITUSSIVES, EXPECTORANTS, MUCOLYTICS
Antitussives act either centrally or locally to inhibit cough response receptors
SIDE EFFECTS: in the medulla or at the site of irritation to decrease frequency and intensity.
- Benadryl- dry mouth, drowsiness Expectorants decrease thickness of sputum for a productive cough.
- Vistaril- drowsiness, dry mouth Mucolytics disrupt the bond between proteins in respiratory secretions to
- Zyrtec- dry mouth and membranes, headache, dizziness liquify mucus.

NURSING IMPLICATIONS: ANTITUSSIVES, EXPECTORANTS, MUCOLYTICS

- for motion sickness, administer 30 minutes before motion USES:
- caution client about drowsiness because of safety concerns - antitussives suppress persistent or nonproductive cough
- expectorants decrease viscosity and promote more productive cough
BRONCHODILATORS - mucolytics act directly on mucus to break it down and make cough more
USES: productive
- short-acting preparations to treat acute exacerbations of asthma
- short-term relief of bronchoconstriction caused by bronchitis and SIDE EFFECTS:
emphysema -minimal, but side effects may occur with overdose
- long-term control of chronic airway problems - antitussive: codeine-drowsiness, constipation, GI upset
- expectorants- nausea and vomiting, GI upset
SIDE EFFECTS: - mucolytics- nausea, bronchospasms, dizziness, rhinorrhea
- tachycardia
- headche NURSING IMPLICATIONS:
- irritability - evaluate client’s respiratory status
- anginal pain - warn client to avoid driving and operating machinery when taking codeine
- anxiety and tremors cough suppressant
- teach client to read labels
NURSING IMPLICATIONS:
- evaluate client’s respiratory status and vital signs GASTROINTESTINAL DRUGS

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 H2- BLOCKERS
RANITIDINE (ZANTAC) PROTON PUMP INHIBITORS
CIMETIDINE (TAGAMET) Omeprazole (Prilosec)
Esomeprazole ( Nexium)
USES: Lanzoprazole (Prevacid)
- gastric and duodenal ulcer therapy Pantoprazole ( Protonix)
- heartburn, acid indigestion, and gastroesophageal reflux disease
- upper gastrointestinal bleeding USES:
- short-term (4-8 weeks): duodenal ulcers, gastric ulcers, gastro-esophageal
SIDE EFFECTS: reflux disease
- diarrhea - long-term: hypersecretory conditions
- older adults: confusion, agitation
- Cimetidine: dysrhythmias, hypotension when given IV SIDE EFFECTS:
- Cimetidine: may bind with androgens to cause gynecomastia and impotence - headache
- decrease in stomach acid may increase growth of Candida and bacteria in - diarrhea
the stomach, pneumonia - nausea and vomiting

NURSING IMPLICATIONS: NURSING IMPLICATIONS:

- give oral drug before eating or with food; give at bedtime for adequate - instruct client to avoid opening, chewing or crushing capsules
coverage - instruct client to return for follow-up if symptoms are unresolved after 4-8
- teach to avoid alcohol weeks of therapy
- smoking may decrease effectiveness - should be taken before meals
- notice that the generic names end in
LACTULOSE “zole”
USES:
- treats portal systemic (hepatic) encepalopathy ANTIDIARRHEALS
- treats constipation Loperamide ( Imodium)
Diphenoxylate Hydrocholoride
SIDE EFFECTS: (Lomotil)
- dehydration
- increased thirst USES:
- abdominal discomfort, frequent loose stools - symptomatic relief of acute nonspecific diarrhea
- chronic diarrhea associated with inflammatory bowel disease
NURSING IMPLICATIONS:
- encourage increase fluid intake SIDE EFFECTS:
- monitor bowel activity, may receive dose even with loose stools - drowsiness
- anticipate need for low-protein diet - dizziness

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 - nausea - minimal pharmacologic effects in absence of narcotics
- reversal of analgesia 
NURSING IMPLICATIONS:
- encourage adequate fluid intake, monitor hydration status
- check bowel sounds for peristalsis; discontinue and report abdominal pain NURSING IMPLICATIONS:
and distention - preferred route of administration is intravenously
- do not give in presence of bloody diarrhea - client should be assessed frequently because the narcotic analgesic lasts
longer in the system than the action of the
DRUGS FOR PAINMORPHINE SULFATE
USES: Narcan antagonist - if client has a history of opioid dependency,
- relieves mild to severe pain administration of Narcan may produce symptoms of acute withdrawal - if
- decreases anxiety, therefore decreases myocardial oxygen demands with accidental poisoning or possible narcotic overdose is a concern,
pain from a myocardial infarction Narcan is usually administered - not effective against barbiturates or other
central nervous system depressant medications
SIDE EFFECTS:
- respiratory depression
- urinary retention NONSTEROIDAL
- confusion ANTIINFLAMMATORY
- constipation DRUGS (NSAIDS, NON
- nausea and vomiting ASPIRIN)
- orthostatic hypotension USES:
- tolerance and physical dependency with long-term use - mild to moderate pain relief,
- toxicity arthritis, dysmenorrhea, headache
- reduce imflammation
NURSING IMPLICATIONS: - decrease fever
- perform strict documentation and inventory assessment of narcotic
- assess pain and vital signs before and after the dose. SIDE EFFECTS:
- infants and older adults are very sensitive to depression - dyspepsia
- Naloxone (Narcan) reverses the effect of morphine - anorexia
- nausea and vomiting
NARCOTIC ANTAGONISTS - rash
NALOXONE ( NARCAN) - dizziness
USES: - heartburn
- reverse the opiate effects of narcotic overdose and respiratory depression - GI bleeding

SIDE EFFECTS: NURSING IMPLICATIONS:

- too rapid reversal of narcotic depression - take with food or milk to reduce GI distress

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 - instruct client to use correct concentrations for age groups (infants,
children)
- do not crush or chew enteric coated tablets- teach client to avoid alcohol
and aspirin products while taking NAIDs
- client should avoid all NSAIDs for at least 1 week before surgery or
invasive diagnostics

ACETYLSALICYLIC ACID
( ASPIRIN, ASA)
USES;
- relieves low to moderate pain
- decreases inflammation in conditions: SLE, rheumatoid
arthritis, osteoarthritis, bursitis and tendonitis
- prophylaxis against or reduction of the recurrence of transient ischemic
attack and myocardial infarction

Anti- inflammatory
Anti- pain (mild to moderate)
Anti-pyretic
Anti-platelet aggregation

SIDE EFFECTS:
- decreases platelet aggregation
- increase bleeding potential
- epigastric distress
- heartburn and nausea
- aspirin overdose or toxicitytinnitus

NURSING IMPLICATIONS:
- give with milk or full glass of water to decrease gastric irritation
- teach safety measures to parents regarding medications at home
- the potential for toxicity is high in older adults and children
- teach to avoid concurrent use of alcohol to decrease GI irritation
- client should not take aspirin for one week before surgery
- evaluate client to determine the purpose of medication- pain, inflammation,
or anti-platelet action

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