NURS 3342 pharmacology Case Study 2021

NURS 3342 CH 4,6, 38-39 1 Chapter 4  Cultural/ legal/ ethical considerations  WHY we do what we do how we do it! 2 Student Centered objectives  Know why we do what we do so you can feel smug and secure!  E ...

NURS 3342 CH 4,6, 38-39 1 Chapter 4  Cultural/ legal/ ethical considerations  WHY we do what we do how we do it! 2 Student Centered objectives  Know why we do what we do so you can feel smug and secure!  Explain to the patient what you know will help them so they will take it to heart and THANK you!  Recall the 2 MAGIC WORDS for pt compliance and the ONE to be avoided!  Read lab reports and be the first to catch when an antibiotic needs to be changed, thus preventing needless suffering and death! 3 Culture  Includes ethnicity PLUS group socialization  CP 450 system affected by ethnicity as well as aging  Culture affects diet, healthcare practices and all aspects of pts lifestyle, “who they are” Q1 How can a patient’s ethnicity change their use of and response to medication? 4  Q2. How do we find out a patient’s “hidden” (unspoken) cultural beliefs? Why is that important?  Q3. How do we handle a patient’s cultural beliefs that are harmless and would not interfere with medication therapy? What if they ARE potentially harmful or might interfere with the needed therapy? 5 Landmark Drug Legislation 6  1906- free of adulterants list addictive substances  1938- regulation of SAFETY  1962- proof of EFFECTIVENESS required  1970- Controlled substances act  1992- “Fast track” (expedited) added (Why?) AIDS  1997- broad overhaul  2002-2003- Pedi research added  1997- Women added-sometimes (Left out?) women were childbearing 6 6 Controlled drugs 7  Schedule C-I- high abuse, no common medical use (Ex?) heroine  C-II- high abuse, severe dependence risk (Ex- Cocaine, methadone- what medical uses?) coming off of heroine  C-III- less abuse and moderate dependence risk (Tylenol #3- contains codeine)  C-IV- less abuse and limited dependence (Benzos)  C-V- limited abuse potential (cough syrup and Antidiarrheals with narcotics)  Determined by FDA, enforced by DEA 7 7 New Drug Development 8  U.S. FDA drug approval process  Preclinical testing- no patients  Clinical studies  Investigational drug studies  Expedited drug approval  NUSRES ARE PATIENT ADVOCATES 9 Stages of New Drug Development  Preclinical testing- “investigational”- lab, animals  (Investigational new drug (IND) application)  Informed consent  Clinical testing  Phase I- healthy volunteers  Phase II and III- may be double-blind/ placebo controlled ***FDA Approval****  Phase IV: Post marketing surveillance This is the only time placebos are used 9 9  Q4. How does the FDA (supposedly) protect us from drugs that are unsafe, impure or otherwise dangerous? How do nurses help in this effort?  Q 5. What do the following terms mean: orphan drug, controlled substances, expedited approval, double-blind study, black box warning, placebo, controlled study? 10 Exercising Discretion 11 Regarding Change: “Be neither the first to adopt the new nor the last to abandon the old.” New drugs are not always better! (But ALWAYS more EXPENSIVE!) 11 11 12 Limitations of the Testing Procedure  Limited information for Women Children Obesity Elderly  Failure to detect all adverse effects 12 12 Ethical Nursing Practice 13  American Nurses Association (ANA) Code of Ethics for Nurses  International Council of Nurses (ICN) Code of Ethics for Nurses  How are ethical principles manifest in patient care, medication use, drug research?  Be patient advocate. Let them know they are in a controlled study. Educate them on how exactly to use their medication. Ethical principles  Autonomy- people are in charge of their own selves  Beneficence- do good  Nonmalficence- do no harm  Justice- be fair  Veracity- don’t lie 14  The patient really needs some experimental chemo treatment or her likelihood of death is 95% in the next 6 months. She is 60 years old and is very afraid of the chemo due to a close friend’s prior experiences. With treatment her chance of 5 year survival is 90%. There is a 50% risk of serious complications with the chemo. The nurse is there helping the patient understand what the physician has told her so she can decide about the chemo. The patient’s adult daughter wants the nurse to “soft peddle” the risks of chemo “to avoid scaring her any worse”. Pt wants to know and decide for herself. 15 Q5.  How is autonomy illustrated?  Beneficence?  Confidentiality?  Nonmaleficence?  Veracity? 16 Chapter7 Patient education and drug therapy 17 The Domains of Learning 18  Affective domain  Cognitive domain  Psychomotor domain  Summary- What you need to be (or feel), know and be able to do  Q6. A patient is newly diagnosed with a sexually transmitted infection and needs to take antibiotics, along with her partner. What needs might the patient have in the following area:  Affective?  Cognitive?  Psychomotor? (prevention) 19  Q7. Give two questions the nurse might ask to assess the patient’s teaching needs before she plans the needed patient education?  How should the nurse use body language, space, touch, eye contact, empathy and a nonjudgmental attitude in teaching this patient? 20 Patient Education: 21 Assessment Psychosocial- Who is this?  Cognitive/ Developmental status  Emotional status it affects their ability to learn and remember what you say to them  Environment: home and work  Financial status  Cultural- Race and/or ethnicity, Religious beliefs, Family relationships understand that different cultures have different ways Patient Education: 22 Assessment (cont’d)  Medical- what do they have to learn (unlearn)?  Past and present health behaviors, Coping mechanisms  Level of knowledge/ Misinformation about current medications  Current medications, including over-the-counter and herbal medications  Past experience with drug regimens and other therapies Patient Education: 23 Assessment (cont’d) How/ when will they (?) best learn this?  Limitations (physical, psychological, cognitive, motor, Sensory impairment)  Language(s) spoken, Level of education/literacy level  Motivation, Self-care ability  Social support/ helpers  Readiness to learn DO NOT USE FAMILY MEMBERS AS TRANSLATORS Patient Education: 24 Nursing Diagnoses Communicate with staff- basis for planning  Deficient knowledge  Ineffective health maintenance  Ineffective therapeutic regimen management  Risk for injury (self) (Ex- sedatives, narcotics)  Impaired memory  Noncompliance (Ex- Rx $$$$$) Patient Education: 25 Planning  Goals and Outcome Criteria- SMART goals! Specific Measurable Actions Realistic Time frame Patient Education: 26 Implementation  Teaching-learning sessions  Consideration of age-related changes  Consideration of language barriers  Safe administration of medications at home  Return demonstration with equipment  For adults, it is recommended that materials be written at an 8th grade level Patient Education: 27 Teaching-Learning Sessions  Individualize the teaching session  Use positive rewards or reinforcement for accurate return demonstration of procedures or technique (Example?) Patient Education: 28 Teaching-Learning Sessions (cont’d)  Use audiovisual aids when appropriate  Involve family members or significant others (Why? How?)  They may be able to understand. They also may not be the one giving the medication  Keep teaching on a level that is meaningful to the patient  Therefore, know THEIR goals Patient Education: 29 Teaching-Learning Sessions (cont’d)  Consider resources when the patient does not speak English  If possible, communicate with the patient in the patient’s native language, esp greetings  Use a translator if necessary  Provide publications in the patient’s native language  Phone translation services (AT &T) Q8. How do we decide when/ how to use direct 1:1 discussion, pamphlets and written materials, internet resources, DVDs, demonstration/ return demonstration or other teaching methods?  Pointers for effective/ appropriate use of a translator? 30 Patient Education: 31 Evaluation  Validate whether learning has occurred  Ask direct questions!  Have the patient provide a return demonstration  Behavior, such as adhering to schedules  Avoidance of noncompliant behaviors Patient Education: 32 Evaluation (cont’d)  Document for team follow up  Develop and implement new plan of teaching as needed for:  Noncompliance  Inadequate levels of learning Sample education planSAFE Meds  Skills  Action  Facts (patho about disease)  Environment, emotional aspects  MEDS- pt education pointers about SE, AE, danger sx, administration, diet/ drug IA, expected benefits and timeline Time may be needed before the medication will work 33  Q9. How can you correct a patient’s misinformation without “putting her down”?  When/ how should the family be included in patient education?  The 2 “magic words” and NEVER word  PLEASE AND THANK YOU!! 34 Dad’s philosophy Life is not meant to be a journey to the grave, with the intention of arriving safely in an attractive and well-preserved body. But rather to slide in sideways, cigar in one hand, favorite drink in the other, body thoroughly used up, totally worn out and screaming- WOO HOO! What a RIDE! Anti-infective Medications ADAPTED FROM: NANCY F. ROGERS PHD, RN, FNP-CS ASSOCIATE PROFESSOR CH 38- 39 36 36 Part I: Terminology  Infectious diseases- Variety of illnesses caused by pathogenic (disease-causing) microorganisms  Antimicrobial- Agent or activity that destroys or prevents development of microorganisms [bacterial, fungal, antiviral, ant parasitic, antiprotozoal, antimycobacterial (TB)]  FACT: one sixth of the TEN MILLION deaths in WWI were from infection! By WWII, antibiotics had decreased this rate tremendously. 37 37 38 38 • Antibiotics (destructive to life/bios)- Natural or synthetic substances produced from various microorganisms that destroy other microorganisms or inhibit growth; used for antimicrobial/anti-infective action to treat infectious diseases • Antibacterial- Agent or activity that interferes with growth & reproduction of bacteria. *Now antibacterials most commonly described as agents used to disinfect surfaces and eliminate potentially harmful bacteria. Unlike antibiotics, they aren’t used as medicines, but are found in cleansers.