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Adverse Effects, High Risk Meds, Dosage Calc

What are the 6 Rights of Drug Administration? Right Drug, Right Patient, Right Dose, Right Route, Right Time and Right Documentation
What are the 3 basic goals of a pre-administration assessment? 1. Collecting baseline data 2. Identifying high-risk patients 3. Assessing the patient's capacity for self-care
How do you identify high-risk patients? patient history, physical examination and laboratory data
What topics should you cover when educating your patient about their medication? The drug name (medical and generic), dosage size and schedule of administration, technique or administration, duration of drug use and drug storage
What are the 5 steps in the nursing process? Assessment, Analysis (including nursing diagnosis), Planning, Implementation and Evaluation
When interviewing a patient, the drug history should include... prescription drugs, over-the-counter drugs, herbal remedies, and drugs taken for nonmedical purposes (alcohol, nicotine, caffeine, illicit drugs).
What factors can increase a patient's risk of adverse reactions to a particular drug? Age, ethnicity (genetic variations), comorbidities, drug-drug reactions, and food-drug reactions
Elaborate on how age can be a major risk factor in adverse drug reactions. Infants and elderly are the most sensitive when it comes to adverse drug reactions. Infants experience drug sensitivity due to organ immaturity. The elderly experience sensitivity due to organ degeneration.
What factors can cause adverse drug reactions in elderly individuals? increased severity of illness, multiple pathologies and polypharmacy.
Discuss the nurse’s responsibility in identifying adverse drug reactions and medication errors. Minimizing the number of drugs a patient receives and taking a thorough drug history. A nurse should also know when to adjust the dosage and the timing of administration, monitor for signs of toxicity, and be aware of narrow therapeutic ranges.
How could liver disease and kidney disease affect drug response? Liver disease can decrease drug metabolism, kidney disease can decrease drug excretion - both cause drug levels to rise which can lead to toxicity. Drug dosages should be reduced for patients who have either disease.
How could ethnicity cause adverse drug reactions? Genetic variations can modify drug responses by altering drug metabolism or by altering the structure of drug receptors and other target molecules. Genetic variants that affect the immune system can cause hypersensitivity reactions to certain drugs.
How could drug-drug interactions cause adverse drug reactions? Drug-drug reactions can either intensify or reduce the effects of the drug. These interactions can be either direct chemical or physical interactions that render both drugs inactive, pharmacokinetics, pharmacodynamics and combined toxicity.
How could food-drug interactions cause adverse drug reactions? Food-drug reactions can affect absorption rates and amounts, can increase drug toxicity and can affect drug action (Vit K & Wafarin). Special care must be taken to ensure what foods pts should avoid and if meds need to be taken w/ or w/o food.
What is a black box warning? It’s the strongest safety warning a drug can carry and still remain on the market. The medication can cause serious undesirable effects compared to the potential benefit of the drug.
Discuss the signs and symptoms of, appropriate lab work to monitor, and risks of renal decline. Proteinuria, decreased urine output, fluid retention (swelling in legs, ankles or feet). Routine urinalysis, measurement of serum creatinine, periodic tests of creatinine clearance and quantification of protein in the urine.
Discuss the signs and symptoms of, appropriate lab work to monitor, and risks of liver decline. Jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, loss of appetite. Monitor ALT & AST (High ALT & AST = liver injury),LFTs/3months. Combining hepatotoxic drugs increases risk. ex. acetaminophen and alcohol
What is an Adverse Drug Event (ADE)? An injury resulting from the use of a drug.
What is an Adverse Drug Reaction (ADR)? Harm directly caused by a drug at normal doses, during normal use.
What is medication nonadherence? Patients can: delay prescription fills, fail to fill Rx, cut dosages, overdose and reduce the frequency of administration. Factors: manual dexterity, visual acuity, intellectual capacity, psychological state, attitude toward drugs, ability to pay for meds
What is a drug-disease interaction? One or more drugs interacting with each other, either by augmentation or reduction of pharmacological effect.
What is an iatrogenic ADE? An injury resulting from the use of a drug that is caused by the physician or therapy.
What are normal ALT values? 1-45 U/L
What are normal AST values? 1-36 U/L
What are normal creatinine values? 0.6-1.2 mg/dL
What are the 8 categories of high risk medications? Chemotherapy, Metformin, IV Potassium, Saline, Anticoagulants (Heparin), Insulin, Neuromuscular blockers and patient controlled analgesia.
What possible risk does chemotherapy have to the patient? Can be carcinogenic, causes tissue necrosis with extravasation, considered a biohazard spill.
What possible risk does Metformin have to the patient? Lactic acidosis. Contraindications: significant renal and hepatic disease, alcoholism, conditions associated w/hypoxia. Other risk factors: sepsis, dehydratioin, high dosages and increasing age. 2 day window for x-rays.
What possible risk does IV Potassium have to the patient? Risk of overdose which can lead to life threatening dysrhythmias.
What possible risk does Saline have to the patient? High risk for injury caused by severe fluid shift.
What possible risk does Heparin have to the patient? Blood thinner often confused with Insulin – similar packaging, both high use meds, dosed in units and often given as continuous IV’s.
What possible risk does Insulin have to the patient? Often confused with Heparin - similar packaging, both high use meds, dosed in units and often given as continuous IV’s.
What possible risk do neuromuscular blockers have to the patient? Causes complete paralysis, including respiratory muscles. Pt. will experience respiratory arrest if without mechanical ventilation.
What possible risk does patient controlled analgesia have to the patient? Can cause severe respiratory depression or ineffective pain control.
Created by: kdanielah



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