Pharmacological Considerations and Nursing Process Application in Patient Care

QUESTION

1. Marsala a 26 year old female, 23 weeks pregnant, presents to her PCP with complaints of morning sickness that has persisted for 8 weeks, she is not gaining weight and requires an infusion of IV fluids to treat dehydration. The provider has decided to place her on medication to treat her symptoms of nausea and vomiting, Ondansetron.

List and describe the consideration regarding THE BIG THREE properties in selecting the ideal drugs

1. Marsala agrees to start on Zofran 4 mg po every 6 hours as need to treat her nausea and vomiting. Zofran is a Pregnancy Category “B.” With 23 weeks of gestation, the provider and patient agree that the benefits outweigh the risks and treating with Zofran would appropriate. Marsala is on a coverage plan that doesn’t cover drugs.

What additional properties of an ideal drug would the provider need to consider when selecting the most appropriate drug. List and describe these concepts in your own words and how this would apply to Marsala.

1. What is pharmacodynamics?
2. What is Pharmacokinetics?
3. What is teratogenic mean?

Any agent that can disturb the development of an embryo or fetus. Teratogens may cause a birth defect in the child. Or a teratogen may halt the pregnancy outright. The classes of teratogens include radiation, maternal infections, chemicals, and drugs.

1. Herb is an 81 year old patient who has a history of diabetes, heart failure and chronic obstructive pulmonary disease. He lives alone and on a fixed income. He is on multiple drugs for all of his condition. How does the concept “ease of administration” apply to him when considering drug selection? What are the benefits of “ease of administration”?
2. Outline the steps of the nursing process in application to a patient admitted with complaints of mid-epigastric/abdominal pain. Pain is rated as a 10 on the pain scale P: Eating, Q: Sharp, R: Radiates to back, S: Severity, T: 2 HOURS. Outline each step of the Nursing Process and what you would do.

Assess:

Diagnosis/Interpret:

Plan:

Intervention:

Evaluate:

1. The patient is transferred to the Med/Surg pending a GI consult. Shortly after the patient arrives to the unit, he complain of worsening pain now scoring a 10, it would be appropriate to treat their pain with drug therapy. What route would you anticipate that you will need to administer drug therapy to alleviate their pain now?
2. What considerations must you consider with pain management as it pertains to the route of administration. Especially if a patient is presenting with a pain level of 10/10.
3. Look-up Hydromorphone in your drug book and answer the following:
   1. Indication:
   2. Side effects:
   3. Administration Assessment:
   4. Priority assessment with administration (Safety):

1. You have treated the patient, and pain is now rated as a “3” on the pain scale. The provider stops by to check up on the patient. She writes an order; it states Morphine 2 mg Q2 prn. What is your assessment of this order and what is your intervention?
2. Define the following terms in your own words:
3. Addiction
4. Tolerance
5. Dependence
6. What is the difference between a side effect and an adverse reaction? Would you continue the medication for either of these scenarios?
7. What is the difference between an intolerance and allergic reaction, and when would hold a drug?
8. If you suspect a patient is experiencing a allergic reaction with administration of drug via infusion, what is your immediate response?
9. You start an infusion and suspect that the patient is experiencing a severe reaction. What is your 1^st response?
10. What does the term half-life mean with regard to medications?
11. Drug X has a half-life of 8 hours. If 800mg is administered at 1:00 a.m, how much of the drug would be eliminated after 24 hours?

Example: After 8 hours: 400 mg

After 16 hours: 200 mg

After 24 hours: 100 mg

1. Drug A has a half-life of 4 hours. If 600mg is administered at 8:00 p.m, how much of the drug would be eliminated after 24 hours.
2. Drug V has a half-life of 2 hours. If 450 mg is administered at 4:00 p.m, at what time will the drug be considered eliminated?
3. Drug B has a half-life of 9 hours. If 300mg is administered at 5:00 p.m, at what amount would the drug be considered to be completely eliminated?
4. Drug S has a half-life of 3 hours. If 425mg is administered at 12:35 p.m, how much would be eliminated after 9 hours?
5. Drug J has a half-life of 5 hours. If 500mg is administered at 8:00 p.m, how much would be eliminated after 15 hours?
6. Drug U has a half-life of 7 hours. If 450mg is administered at 6:00 a.m, how much would be eliminated after 9 hours?
7. Drug G has a half-life of 6 hours. If 700mg is administered at 3:45 a.m, how much would be eliminated after 24 hours?

ANSWER

Pharmacological Considerations and Nursing Process Application in Patient Care

Introduction

In this essay, we will address various pharmacological considerations and apply the nursing process to patient care scenarios. We will discuss the selection of an ideal drug, the concepts of pharmacodynamics, pharmacokinetics, and teratogenicity. Furthermore, we will explore the concept of ease of administration in drug selection for an elderly patient with multiple comorbidities. Lastly, we will examine pain management, drug administration routes, and key terms related to adverse reactions and allergic responses.

Selection of an Ideal Drug: Considerations and Application for Marsala

When selecting an ideal drug for Marsala’s morning sickness, several considerations should be made, including:
Efficacy: The drug should effectively treat nausea and vomiting in pregnancy.
Safety: The drug’s safety profile, especially concerning its effects on the developing fetus, should be considered.
Cost: As Marsala’s drug coverage plan does not cover medications, cost-effectiveness is important.
Accessibility: The availability and convenience of the drug, especially considering her pregnancy, should be taken into account.

Pharmacodynamics and Pharmacokinetics

Pharmacodynamics: Pharmacodynamics refers to how drugs exert their therapeutic effects on the body. In the case of Marsala, understanding how ondansetron interacts with receptors involved in nausea and vomiting would be essential.
Pharmacokinetics: Pharmacokinetics involves the absorption, distribution, metabolism, and excretion of drugs. Considering Marsala’s pregnancy, changes in these processes may occur, affecting drug concentrations and response.

Teratogenicity

Teratogenicity refers to the potential of a substance, such as a drug, to cause abnormalities in fetal development. When selecting a drug for Marsala, its teratogenic potential should be evaluated to ensure the benefits outweigh the risks.

Ease of Administration for Herb

In Herb’s case, ease of administration is crucial due to his multiple comorbidities, fixed income, and living alone. Benefits of easy drug administration include:
Improved Adherence: Simplified medication regimens increase adherence, ensuring Herb receives the necessary medications as prescribed.
Independence: Ease of administration allows Herb to self-administer medications, promoting independence in managing his health.
 Cost-Effectiveness: Minimizing complex administration methods reduces the need for specialized equipment or services, resulting in potential cost savings.

Steps of the Nursing Process: Application to a Patient with Abdominal Pain

Assess:
Gather information on the patient’s medical history, current medications, and nature of pain (location, quality, radiation, severity, timing).
Diagnosis/Interpret:
Analyze the collected data to identify potential causes or contributing factors to the abdominal pain.
Plan:
Collaborate with the healthcare team to establish a plan of care, including pain management, diagnostic tests, and interventions.
Intervention:
Implement the planned interventions, such as administering pain relief medication, providing comfort measures, and scheduling diagnostic tests.
Evaluate:
Assess the effectiveness of interventions, reassess the patient’s pain level, and monitor for any changes or complications.

Pain Management Route for Worsening Pain

With a pain score of 10, it would be appropriate to administer pain relief via an intravenous (IV) route. IV administration allows for faster onset and greater control over the drug’s effects, providing immediate relief.

Considerations for Pain Management Route

When selecting the route of administration for pain management, several considerations must be made, especially with a pain level of 10/10:
Onset and Duration: The chosen route should provide rapid onset and a duration of relief appropriate for the patient’s pain intensity and condition.
Patient’s Condition: Consider the patient’s ability to tolerate oral medications, gastrointestinal function, and any contraindications for certain routes.
Safety and Efficacy: Evaluate the safety and efficacy of the selected route, considering potential adverse effects and drug interactions.

Hydromorphone

a) Indication: Hydromorphone is an opioid analgesic indicated for the management of moderate to severe pain.
b) Side effects: Common side effects include sedation, respiratory depression, constipation, nausea, and dizziness.
c) Administration Assessment: Assess vital signs, pain level, and any contraindications or precautions before administering hydromorphone.
d) Priority assessment with administration (Safety): Monitor respiratory rate, oxygen saturation, level of sedation, and pain relief after administering hydromorphone.

Assessment of Morphine Order and Intervention

The assessment of the morphine order indicates that the provider prescribed 2 mg of morphine every 2 hours as needed (prn). The nurse’s intervention would involve implementing the order as prescribed, assessing the patient’s pain level before administration, and documenting the response to the medication.

Definitions

Addiction: A chronic, relapsing disorder characterized by compulsive drug-seeking behavior and drug use despite negative consequences.
Tolerance: The decreased response to a drug following its repeated administration, requiring higher doses to achieve the same effect.
Dependence: A state in which the body has adapted to the presence of a drug, and its absence results in withdrawal symptoms.

Side Effects vs. Adverse Reactions

Side Effects: Expected and usually manageable effects of a drug that occur at therapeutic doses. They are typically mild and may subside with continued use.
Adverse Reactions: Unexpected or harmful responses to a drug, occurring at normal therapeutic doses. They can be severe, life-threatening, or require medical intervention. Medication continuation depends on the severity and risk-benefit assessment.

Intolerance vs. Allergic Reaction

Intolerance: An adverse reaction to a drug that does not involve the immune system. It may manifest as gastrointestinal disturbances, headache, or other non-immune-mediated symptoms.
Allergic Reaction: An immune system-mediated response to a drug, often involving an allergic antibody response (IgE). It can range from mild skin reactions to severe anaphylaxis. The drug should be immediately discontinued in cases of allergic reactions.

Immediate Response to Suspected Allergic Reaction

If a patient is experiencing a suspected allergic reaction to a drug administered via infusion, the immediate response should involve stopping the infusion, ensuring patent IV access, monitoring vital signs, assessing the patient’s respiratory status, and notifying the healthcare provider.

Immediate Response to Severe Reaction

If a severe reaction is suspected, the nurse’s first response should be to initiate emergency protocols, including calling for assistance, ensuring patient safety, administering prescribed emergency medications (e.g., epinephrine), and promptly notifying the healthcare provider.

Half-Life of Medications

The half-life of a medication refers to the time it takes for the concentration of the drug in the body to decrease by half. It indicates the rate at which the drug is eliminated from the body.

Drug X Half-Life Calculation

If Drug X has a half-life of 8 hours, after 24 hours (three half-lives), approximately 12.5 mg of the drug would be eliminated.

Drug A Half-Life Calculation

If Drug A has a half-life of 4 hours, after 24 hours (six half-lives), approximately 37.5 mg of the drug would be eliminated.

Drug V Half-Life Calculation

If Drug V has a half-life of 2 hours, after