Pharma

• The Nursing Process


  A research-based framework for professional practice<|>Central to all nursing care<|>Ongoing and constantly evolving process that involves critical thinking
• The Nursing Process


  1. Assessment

  2. Nursing Diagnosis

  3. Planning

  4. Implementation

  5. Evaluation
• Assessment


  • Data collection (subjective and objective)
  • Subjective data include information provided verbally by the patient, family members, friends, and other sources
  • Objective data are what the nurse directly observes about the patient's health status
• Nursing Diagnosis


  Is made based on analysis of the assessment data, and it determines the type of care the patient will receive<|>Decision about the need/problem (Actual or at-risk for)<|>Problem<|>Etiology<|>Signs and symptoms
• Planning


  The nurse uses the data collected to set goals or expected outcomes and interventions<|>Goals or expected outcomes should address the problems in the nursing diagnosis<|>Outcome criteria must be SMART (Specific, Measurable, Attainable, Realistic and Time-bound)
• Implementation


  The nurse provides education, drug administration, patient care and other interventions necessary to assist the patient in accomplishing the established goals
• Evaluation


  The nurse determines whether the goals and teaching objectives are being met
• Patient Teaching


  It allows the patient to be informed about his or her health problems and to participate in creating interventions that can lead to good health outcomes<|>Instruct the patient to take the drug as prescribed<|>Provide simple, written instructions to the patient with the doctor and pharmacy names and telephone numbers<|>Give patient instructions that would minimize side effects<|>Perform an ongoing assessment on the patient's motor skills and abilities<|>Provide instructions on diet - what foods to include or to avoid<|>Consider cultural considerations
• The Respiratory tract is divided into two major parts: the Upper Respiratory Tract (everything above the trachea) and the Lower Respiratory Tract
• Ventilation


  The movement of air from the atmosphere through the upper and lower airways to the alveoli
• Respiration


  Process of gas exchange in the alveolar capillary membrane
• Phases of Respiration


  1. Ventilation (Inspiration and Expiration)

  2. Perfusion (blood flow at the alveolar capillary bed)

  3. Diffusion (movement of molecules from higher to lower concentration)
• Matched ventilation and perfusion is known as VQ, ventilation perfusion ratio
• Upper Respiratory Disorders


  • Common Colds
  • Acute rhinitis
  • Sinusitis
  • Acute pharyngitis (Sore throat)
• The group of drugs used to manage cold symptoms

  • Antihistamines (H1 blockers)
  • Decongestants (sympathomimetric amines)
  • Antitussives (anticough)
  • Expectorants
• Antihistamines (H1 blockers or H1 antagonist)


  Suppress the histamine-induced wheal response (swelling) and flare response (vasodilation) by blocking the binding of histamine to its receptors or reducing histamine receptor activity
• First-generation antihistamines


  • Diphenhydramine
  • Chloramphenicol
• Second-generation antihistamines


  Fewer anticholinergic effects and a lower incidence of drowsiness
• Second-generation antihistamines


  • Cetirizine
  • Claritin
• Cholinergic


  Substance capable of producing, altering, or releasing acetylcholine, or butyrylcholine
• Adverse effects of cholinergic substances

  • Dry mouth
  • Blurred vision
  • Dry eyes
  • Constipation
  • Urinary retention
  • Dizziness due to drop in blood pressure on standing up (postural hypotension)
  • Cognitive problems (confusion)
  • Heart rhythm disturbance
• Nasal decongestants


  Stimulate the alpha adrenergic receptors, producing vascular constriction (vasoconstriction) of the capillaries within the nasal mucosa, resulting in shrinking of the nasal mucous membranes and a reduction in fluid secretion
• Systemic decongestants


  • Ephedrine
  • Phenylephrine
  • Oxymetazoline
  • Pseudoephedrine
• Side effects of systemic decongestants

  • Jittery, nervous, or restless (decrease or disappear as the body adjusts to the drug)
  • Rebound nasal congestion
  • Increase blood pressure and glucose level
• Drug interactions of systemic decongestants

  • Pseudoephedrine may decrease the effect of beta blockers
  • Hypertension or cardiac dysrhythmias if take with MAOI's (monoamine oxidase inhibitors)
  • Coffee and tea can increase restlessness and palpitations
• Intranasal glucocorticoids


  • Beclomethasone
  • Budesonide
  • Dexamethasone
  • Flunisolide
  • Fluticasone
  • Mometasone
  • Triamcinolone
• Antitussives


  Act on the cough-control center in the medulla to suppress the cough reflex
• Types of antitussives


  • Non-opioid (Dextromethorphan HBr)
  • Opioid (Codeine)
  • Combination (Paracetamol + Phenylephrine HCl + Dextromethorphan HBr)
• Expectorants


  Stimulate the airways to expel mucus in the respiratory tract
• Examples of expectorants


  • Guaifenesin
• Mucolytics


  Act as detergents to liquefy and loosen thick, mucous secretions so that they can be expectorated
• Examples of mucolytics


  • Carbocisteine
  • Acetylcysteine
  • Bromhexine
• Lower respiratory tract disorders

  • Chronic obstructive pulmonary disease (COPD)
  • Chronic bronchitis
  • Bronchiectasis
  • Emphysema
  • Asthma
• Medications frequently prescribed for COPD

  • Bronchodilators
  • Glucocorticoids (steroids)
  • Leukotriene modifiers
  • Cromolyn
  • Expectorants
  • Antibiotics
• Sympathomimetics: alpha and beta2 adrenergic agents


  • Albuterol
  • Metoproterenol
• Sympathomimetics


  Can be administered orally or by inhalation with a metered-dose inhaler<|>Onset of action: 1 minute by oral inhalation or 5 to 30 minutes by nebulisation, and 15 to 30 minutes when taken orally<|>Excessive use can lead to tolerance and loss of drug effectiveness
• Side effects of sympathomimetics

  • Tremors
  • Headache
  • Nervousness
  • Increased pulse rate
  • Palpitations (high dosage)
• Anticholinergics


  Tiotropium is used for maintenance treatment of bronchospasms and is administered by inhalation only with the HandiHaler
• Antibiotics may be prescribed to prevent serious complications from bacterial infections
• Examples of Sympathomimetics: Alpha and Beta2 Adrenergic Agents

  • Albuterol (more selective for Beta2 receptors)
  • Metoproterenol