ppt chapter 11-1

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 11

Environment: Influences on Drug Therapy


Question

• The core patient variable of environment is important to drug therapy.

– A. True

– B. False


Answer

• A. True

• Rationale: The patient’s environment in which he or she receives medications can lead to adverse effects, and the manner in which a drug is stored and delivered can affect the efficacy of the drug.


Chapter Overview

• Several aspects of environment relate to drug administration:

– Physical setting in which the drug is administered

– Environmental influences that may affect the stability or efficacy of certain drugs or drug classes.


Environmental Factors that Influence Drug Therapy


Acute Care Hospitals

• Certain drugs or drug classes are given in specific areas of these hospitals.

• IV cardiac medications require continuous heart monitoring.

• Inhaled anesthetics are given in the surgical suite.

• Oxytocin (Pitocin) is given in the delivery suite or postpartum unit.

• Specialized training is provided to the nurse who will be administering chemotherapeutic drugs.


Question

• Nurses require additional special training to administer which of the following drug(s) in the hospital setting?

– A. All cardiac medications

– B. Chemotherapy agents

– C. IV pain medications

– D. Psychoactive drugs


Answer

• B. Chemotherapy agents

• Rationale: Chemotherapy agents require nurses to obtain special certification due to high incidence of adverse effects from these medications. Not all cardiac medications require specialized training. Oral medications may be given in a variety of settings. Pain medications and psychoactive drugs do not require special certification for their administration.


Acute Rehabilitative Units

• Rehabilitation units have the ability to deliver drugs via most routes.

• The focus on these units is physical rehabilitation of the patient.

• The patient who needs medication to treat an acute condition may be transferred to an acute care hospital.


Transitional Care Units

• Transitional care units (TCUs) provide care to a patient who is well enough to be discharged from the hospital but has medical needs that cannot be managed at home.

• The patient-to-nurse ratio is higher in the TCU.

• Because of the patient-to-nurse ratio, the type of drug therapy is limited in these units.


Outpatient Units

• Outpatient units include urgent care centers, physicians’ offices, mental health clinics, or outpatient surgical suites.

• Most pharmacotherapy may be administered in outpatient units as long as the particular site has the ability to monitor the patient closely.


Long-Term Care Facilities

• Long-term care facilities generally admit patients who do not require intense observation.

• These patients range from trauma patients to elderly people who will live out the remainder of their lives in the facility.

• The care in any given long-term care institution may be very limited or quite broad.


Home Environment

• Most drug routes are safe for administering medication in the home environment.

• Limiting factors include the need to monitor the patient closely and the need for special monitoring equipment.

• The decision to teach the patient or family to administer drugs is made after a careful evaluation of the home environment by the home health nurse.

• It is necessary to determine whether the patient lives alone or with a caregiver who can help administer the drug therapy.


Medication Reconciliation

• The Institute for Healthcare Improvement (IHI) estimates that as many as 50% of all medication errors in hospitals occur because of poorly communicated medical information.

• Medication reconciliation can decrease the number of medication errors that occur due to poor communication.

• The nurse communicates to the health care provider any discrepancies between home medications and those that have been prescribed.

• The process of medication reconciliation improves patient outcomes, potentially preventing serious effects.


Question

• What is the most important reason for having a system in place for medication reconciliation?

– A. Because medication reconciliation is required by the Joint Commission.

– B. It will prevent medication errors.

– C. It ensures that patients receive appropriate drug therapy.

– D. It ensures that the nurse gives the right medication.


Answer

• C. It ensures that patients receive appropriate drug therapy.

• Rationale: All of these are correct but the most important reason for medication reconciliation is to ensure that the patient is receiving the appropriate drug therapy.


Environmental Influences on Drug Stability and Effects

• Many drugs are sensitive to the physical environment.

• Storage of the drug may affect the drug’s pharmacokinetic and pharmacodynamic processes.

• The environment can also modify drug effects.

• Environmental influences can affect pharmacotherapy in any environmental setting.


Environmental Influences on Adverse Effects and Injury • Environmental chemicals are increasingly being

recognized as agents that cause substantial drug interactions in some people.

• A patient’s environment may also influence the relationship between physiologic function, drug effects, and adverse effects or injury.

• The role of the home health nurse is to assess the physical environment of the patient to determine the limitations for home pharmacotherapy.

• Simple daily activities may also be affected by environmental influences of pharmacotherapy.

• The environment can influence the metabolism of these substances.


Question

• The nurse only needs to be concerned about drug administration in the hospital setting?

– A. True

– B. False


Answer

• B. False

• Rationale: As health care changes, nurses are working in a variety of health care environments. These environments affect how drugs are given and also how the patient will respond to drug therapy.


The Nurse’s Role

• The nurse’s role is extending more frequently beyond inpatient hospital settings.

• The nurse’s role now includes the expanded range of health care concerns of health education.

• People are now being discharged from health care institutions at increasingly early stages in their treatment.

• Nurses monitor drug response and provide patient education about medication in a variety of patient care environments.


Assessment • Environment is an important determinant of drug

response.

• A number of components of the institutional environment are under the control of nursing.

• In the hospital, assess factors that influence drug outcome, such as a new or strange environment; unfamiliar people, noises, and equipment or procedures; and lack of physical activity.

• Controlling the environment after discharge is a much more difficult task for the nurse.

• People may not realize that environmental factors may affect their prescribed drug therapy.


Nursing Diagnoses and Outcomes

• Risk for Injury related to environmental hazards, such as falls from stairs or loose rugs

– Desired outcome: The patient will remain without a fall.

• Risk for Injury related to decreased drug stability stemming from environmental factors

– Desired outcome: The patient will store drugs as directed.

• Impaired Skin Integrity related to environmental exposure to sunlight

– Desired outcome: The patient will take measures to control the amount of direct sunlight to exposed skin and use sunscreen at all times.


Planning and Intervention

• The planning and intervention phases of the nursing process contain short- and long-term goals. Often, these goals are modified as therapy proceeds.

• The nurse’s primary role usually focuses on patient education.

• The rapport established early in the nurse–patient relationship provides the basis for the trust that is needed as the nurse continues to collaborate with the patient.

• The extent of teaching varies, depending on the environment in which the patient will receive the drug.


Ongoing Assessment and Evaluation

• Evaluate the patient for increased or decreased drug effectiveness related to environmental stimuli.

• Assess the patient for signs of adverse effects.

• Review measures to control environmental factors with the patient at each clinic visit.

ppt chapter 11-1

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