Pediatric Nurse Practitioner Final Exam Guide 2020 | PNP301 Final Exam Guide
WEEK 1: Nursing Practice in Canada & Drug Therapy
Nursing
... [Show More] Process
• research-based organizational framework
• central to all nursing care
• Encompasses all steps taken by the nurse in caring for a patient
• Uses a flexible, adaptable, and adjustable process to develop effective solutions to meet patient needs
• Involves critical thinking, knowledge, and skill
5 Phases of the Nursing Process
1. Assessment
2. Nursing diagnosis/ NANDA
3. Planning
🞄 Goals
🞄 Outcome criteria
4. Implementation
5. Evaluation
Nursing Process: Assessment
Assessment of patient and drug
🞄 Data collection
🞄 Subjective
🞄 Objective
🞄 Medication profile
🞄 Prescriptions
🞄 Intake of alcohol, tobacco, and caffeine
🞄 Over-the-counter drugs (OTCs)
🞄 Natural health products
🞄 Responses to medications (therapeutic and adverse responses)
The Nursing Process: Planning
🞄 Based on NANDA/ nursing diagnosis
🞄 Identification of goals and outcome criteria
🞄 Must be specific and measurable (SMART)
🞄 Must be patient-centred
🞄 Time frame
🞄 Prioritization
The Nursing Process: Implementation
🞄 Initiate and complete the collaborative plan of care as defined by the nursing diagnoses and outcome criteria
🞄 Interventions may be independent, collaborative, or dependent upon a physician’s order
🞄 Adhere to safe medication administration standards and practices
The 10 Rights of
Medication Administration (Lilley)
🞄 Right drug
🞄 Right dose
🞄 Right time
🞄 Right route
🞄 Right patient
🞄 Right reason
🞄 Right documentation
🞄 Right evaluation (assessment)
🞄 Right patient education
🞄 Right to refuse
Another “Right”:
Constant System Analysis
🞄 Ensures a “double-check”
🞄 Includes the entire “system” of medication administration (ordering, dispensing, preparing, administering, documenting)
🞄 Involves the physician, nurse, nursing unit, and pharmacy department
🞄 Requires educating patients
Other “Rights”
• Proper drug storage
• Accurate dosage calculation
• Accurate dosage preparation
• Careful checking of transcription of orders
• Patient safety
• Close consideration of special situations
• Prevention and reporting of medication errors
• Monitoring for therapeutic effects, adverse effects, toxic effects
6 Elements of a Drug Order
1. Patient's name
2. Date the order is written
3. Name of medication
4. Dosage (includes size, frequency, and number of doses)
5. Route of administration
6. Signature of the prescriber
Components of a Prescription
🞄 Patient’s name, address, health insurance
number (or identification number)
🞄 Date prescription was written
🞄 The Rx symbol, meaning “take thou”
🞄 Medication name, dosage, and strength
🞄 Route of administration
🞄 Dispensing instructions for the pharmacist
🞄 Directions for administration to be given to the patient
🞄 Number of refills
🞄 Signature of the prescriber
Who Can order?
Controlled Act Who can order?
Dispensing a drug Physicians, NP, Dentist
Performing a procedure below the dermis or mucous
membrane Physician , NP, Dentist, Midwife, Chiropodist
Administering a substance by injection/ inhalation Physician , NP, Dentist, Midwife, Chiropodist
Putting an instrument, hand or finger into a specified opening of
the body Physician, NP, Midwife
🞄 Drug
🞂 Any chemical that affects the physiological processes of a living organism
Pharmacology
🞂 The study or science of drugs
🞄 Drug Names
Chemical name
🞄 drug’s chemical composition and molecular
structure
Generic name (nonproprietary name)
🞄 approved by Health Canada under the Food and Drugs Act and Food and Drug Regulations
Trade name (proprietary name)
🞄 registered trademark and its use is restricted by the patent owner (usually the manufacturer)
🞄 Drug Categories
• Over the Counter (OTC)
• Drug that can be purchased without a prescription in which the consumer can diagnose, treat, and evaluate; includes natural health care products
• Prescription
• Drug that requires a prescription to dispense; health care practitioner prescribes and dispensed by pharmacy
• Controlled Substances
• Prescribed medication that has abuse potential; includes narcotics, amphetamines, medical marijuana, benzodiazepines, etc; lists illicit drugs that have risk of abuse
• Pharmacological Principles
🞂 Pharmacokinetics- the movement of drugs within the body
🞂 Pharmacodynamics-mechanism of
interactions of drugs at their sites of activity
🞂 Pharmacotherapeutics-The use of drugs and the clinical indications for administering
drugs to prevent and treat diseases
🞂 Toxicity
🞄 Pharmaceutics
🞄 The study of how various dosage forms influence pharmacokinetic and pharmacodynamic activities
🞄 Dosage form design affects dissolution
🞄 Pharmacokinetics
🞄 The study of what the body does to the drug
🞄 Absorption
🞄 Distribution
🞄 Metabolism
🞄 Excretion
🞄 Pharmacokinetics (cont.)
🞄 Absorption
🞄 Bioavailability
🞄 First-pass effect Avoidance of first-pass effects
🞄 Routes: A drug’s route of (except for rectally administered drugs)
administration affects the rate and 🞄 Topical Application
extent of absorption of that drug 🞄 Transdermal (adhesive drug patches)
🞄 Enteral route 🞄 deliver constant amount of drug
🞄 Sublingual and buccal per unit of time for a specified time
routes period
🞄 Parenteral route: 🞄 Inhalation
intradermally, 🞄 delivered as micrometre-sized drug
subcutaneously, particles
intravenously, 🞄 absorbed quickly through the
intramuscularly, alveoli
intrathecally, intra-
articularly, intra-arterially. 🞄 Factors That Affect Absorption
🞂 movement of a drug from
🞄 Topical route its site of administration
🞄 Transdermal route into the bloodstream for
🞄 🞄 Inhalation route
Enteral Route
🞂 distribution to the tissues
vary according to the dosage form and
🞄 The drug is absorbed into the systemic circulation through the mucosa of the route
🞂
Food or fluids administered with
stomach, small intestine, or large intestine
🞄 Oral 🞂 the drug
Dosage formulation
🞄 Sublingual
🞄 Buccal 🞂
🞂 Status of the absorptive surface Rate of blood flow to the small
🞄 🞄 Rectal (can also be topical)
Parenteral Route
🞂 intestine
pH of the stomach
🞄 Intravenous (fastest delivery into the blood 🞂 GI motility
circulation) 🞄 Biovailability and Bioequivalence
🞄 Intramuscular 🞄 Bioavailability is a measurement of the rate
🞄 Subcutaneous and extent to which a drug reaches the
🞄 Intradermal systemic circulation
🞄 Intra-arterial 🞄 Absolute bioavailability compares the
🞄 Intrathecal- through the theca of the spinal bioavailability of the active drug after non-
cord (spinal canal) into the subarachnoid IV routes(oral, rectal, transdermal, SQ, or
space and subdural space sublingual administration), with the
🞄 Intra-articular bioavailability of the same drug given
🞄 Parenteral Route (cont’d) intravenously.
🞄 Absorption from intramuscular (IM) or 🞄 Bioequivalent pertains to a drug that has
intradermal (ID) sites may be increased by: the same effect on the body as another
🞄 Applying heat to the injection site drug
🞄 Massaging the injection site
🞄 Most IM injected drugs absorbed 🞄
🞂 First-Pass Effect
The metabolism of a drug and its passage
🞄 over several hours
IM Depot drugs are designed for slow from the liver into the circulation
🞂 A drug given via the oral route may
absorption and may be absorbed over a be extensively metabolized by the [Show Less]