Discussion Question 1: What is the nursing process?

Explain its
components.
The nursing process is a comprehensive medical plan that follows a
patient from start to finish, so to say. It is based upon scientific research
and input from the patient, support members, technicians, nurses, and
doctors. More specifically, it is broken down into 5 steps, which include
assessment, nursing diagnoses, planning, implementation, and evaluation.
As soon as the nurse first lays eyes on a patient, without even saying a
word, there is data being collected. Assessment involves any type of
information that can be gathered from sight, smell, touch, or sound. The
nurse usually questions the patient, family, or caregiver to obtain helpful
knowledge about the medical problem, as well as look up any patient history
on file. Additionally, lab tests, radiology procedures, vital signs, medication
lists, and measurements are sometimes requested and reviewed. Once all of
the information is obtained, the nurse needs to analyze it carefully and pin
point the exact problem.
This is called the nursing diagnoses, and it can be selected by observing
the patients reaction to the medical problem, as well as known factors based
upon research. Then the two are compared and other supporting facts are
presented to confirm the nurses claim for that particular diagnoses.
Next, the nurse begins to prepare for the course of treatment. This
includes setting goals and outcome criteria. While goals are specific to the
nursing diagnosis, outcome criteria are specific to a patients behavior and
responses. Any equipment, procedures, or medications that will be needed
should be made available and prioritized.
Now that the resources are available and there is a plan of action, it is
implemented. In relation to medication administration, nurses might need to
give patients medicine on a strict repetitive schedule. Therefore, it is
imperative that the nurse is familiar and aware of a patients 5 rights, which
include administering the correct medication with the proper dose at the
right time in the right route to the right patient. If all things are in check, the
patient will receive effective treatment according to the plan.
How the patient responds to the treatment will be considered in the final
stage of the nursing process, evaluation. This involves closely looking at all
aspects of the treatment process and ensuring that everything is
documented properly. With close monitoring of the patient, the nurse will
evaluate the need for continued treatment or the successful completion of
goals and outcome criteria.
Each of these steps in the nursing process involves critical thinking skills
that are important in ensuring the proper care that a patient deserves.
Although the process is constantly changing, nurses are responsible for using
this guideline and adapting their skills for every individual situation.
Discussion Question 2: List two ethical terms and discuss. Why is it
so important to know your patients cultural values?

Autonomy is the patients ability to make decisions on his or her own in a

mentally alert and capable state, without the influence of someone else or
being under the influence of drugs. Autonomy is absolutely necessary when
obtaining an informed consent before performing any type of specific
procedure or being included in a research study. In reference to cultural
values, it is important to explain all of the steps of the procedure,
implications, or consequences that may occur in a way that they can
understand it, and in their own language if necessary. Also, it is important to
know your patients cultural values so you do not in any way influence them
to do something that they do not want to do, either by lack of explanation or
overstatement of benefits.
Justice is treating all patients fairly and equally. In the ER, we see a lot of
people who abuse the health care system to get what they want (i.e. just a
pregnancy test, pain medicine, narcotics, a meal, a warm place to stay, etc.).
We also see prisoners or drunk drivers, and drug addicts who were the result
of a horrible crime or accident. It is important to overlook all of those things,
and treat the patient fairly. Some people cannot afford health insurance,
others do not have transportation so they do not have any other choice but
to call 911 for an ambulance. Even though we think someone deserves to be
ignored, or not given pain medicine, it is the nurses responsibility to provide
treatment for whatever reason that patient is in his or her care, until they
leave or are discharged. When taking a persons cultural values into
consideration, a nurse can determine what kind of care they need and adapt
his or her resources to meet those needs. For example, pain tolerance is high
in some, low in others. If the patient says they are in pain, and the doctor
ordered pain meds, they should get them, regardless of how little or how
much pain you think they are in.
Discussion Question 2: Give an example of how you considered a
persons culture before taking action.
As a tech in the ER, I see people who are in pain every day. Some are more
animated than others. It can be easy to judge how much someone is really in
pain based upon how they are acting, especially when we see many of the
same patients/patient types on a weekly, sometimes daily basis. However,
some cultures, I have learned, such as the Hispanics and Asians, do not show
a lot of outside signs that they are in pain. Also, it can be very hard for them
to communicate with us in what little broken English they know. So instead of
waiting for an interpreter, which can take up to 15 minutes, I try to get as
much information as I can and use my best judgment to figure out why they
are here and what I can do to get the medical treatment process started.
Another example is sickle cell patients. We see young and old sickle cellers
alike, but just because we cant necessarily see what is causing them pain
doesnt mean that they arent in pain. I try to take each patients cultural
background into consideration and make them feel as comfortable as
possible. Unfortunately, many of these people with cultural differences or

certain diseases get pushed to the back of the line until the interpreter
arrives, or a room becomes available after everyone else with more
emergent conditions have gone back.
Discussion Question 3: Name four ways to prevent medication
errors.
(1)Always identify the patients identity and allergies before giving
medication. This can be done by asking the patient to please state his/her
name and date of birth and asking them what their allergies are. Although
this might be repetitive to a patient receiving frequent meds, you can
explain that these questions are asked simply to provide safety to the
patient and avoid any medication errors. If the patient is not alert or
conscious, an armband can be checked for patient ID and an allergy
wristband should also be on the patient, reminding the nurse to check the
patients chart for allergies.
(2)Do not use abbreviations, synonyms, and short hand. Its hard enough to
accept that not everyone has cursive writing skills like my second grade
teacher or can understand the common abbreviations of a typical teenage
high school student during a short text message conversation. Nurses are
often pressed for time but it is always better to take as much time as
needed to write things out legibly so that there are no questions asked.
(3)Take written orders more often than verbal, but if verbal is necessary
make sure to repeat it back, verifying the correct spelling of the drug by
speaking clearly and slowly, and document it properly on the chart. If a
written order is missing a piece of the puzzle (i.e. route or dose), never
assume what it might be, always contact the ordering physician for
clarification.
(4)Dont use trailing zeroes, for example 1 mg not 1.0 mg, because it can be
easily misinterpreted if the period is not seen, resulting in a 10x increase
that can make a big difference in affecting the patient depending on
which drug it is. Always use leading zeroes when it comes to a medication
order that is less than 1. Again, this can avoid misinterpretation of a
missing period, for example 0.25 not .25. Often it is easy to see how that
little period can blend in with a just a few specks of dust or residual ink
toner.
Discussion Question 4: What is pharmacokinetics? What is
pharmacodynamics? What is pharmacotherapeutics? Why is it
important that a student nurse understand these terms?
Pharmacokinetics is the study of what the body does to the drug; whereas,
pharmacodynamics is the study of what the drug does to the body. Both of
these depend on the pharmaceutics of the drug, and which form of entry and
dose has been selected as the most effective for metabolizing into the body

to achieve the desired effect/treatment. These terms are important for a

student nurse to understand because they are essential to the nursing
process. In relation to pharmacokinetics, a nurse needs to understand how
the patient will metabolize the drug and how long the effects will last given
the patient's age, cultural background, medical history, allergies, and many
other factors. Understanding pharmacodynamics takes it a step further in
detail as to how the drug chemically reacts with the patient, thus causing a
good, bad, or no response. In taking these two terms into consideration and
thoroughly examining the patients medical status, the nurse should be able
to determine the best route and dose of drug to cause a therapeutic reaction.
Discussion Question 4: Give an example of one medication and its
half life. What will a nurse do with the knowledge of a drugs half
life?
One medication that I see given occasionally is epi (epinephrine). Its half life
is 2 minutes (Wikipedia), which makes it very important for the nurse to
know how to best administer the medication, and how long to wait until
administering more without causing toxic effects. Ive seen it used in patients
with cardiac arrest, and the nurse is especially responsible for obtaining IV
access in the antecubital area and observing EKG changes after it is
administered. Since it increases the heart rate, blood flow, and constricts
blood vessels, the patients reaction to the medication should be monitored
closely. If used effectively, epi can aid in making the heart pump again, but if
the patient has been down for too long, there will not be an observable
change.
Discussion Question 4: How and why does a drug-drug interaction
occur?
Drug interactions occur when a patient takes medicine that produces
weakened, strengthened, or no effects. A drug-drug interaction is specifically
between two drugs that are competing with each other during the process
that it is absorbed into the body. Based how each drug is formulated to
interact with the bodys chemicals, the drugs can travel in their own cars
(causing the intended effects), or they can collide with each other (causing
weakened, no effects, or additives that can be either toxic or therapeutic), or
travel in the same car (causing strengthened effects). Sometimes drugdrug interactions are beneficial, as in the case of amoxicillin with probenecid.
The nurse is responsible for determining the appropriate monitoring for every
patient who encounters drug reactions, beneficial and especially harmful.
Discussion Question 5: Give four benefits of good patient teaching.
Good patient teaching helps patients adapt to illness, prevent illness,
maintain wellness, and provide self-care. In doing this, the nurse needs to
adapt to the patients learning level by providing visual aids, speaking in
their native language, taking cultural background into consideration, and/or

teaching as long as it takes for the patient or care providing family

members/staff to understand.
Discussion Question 6: List two pediatrics considerations and two
geriatric considerations when administering medications.
Pediatric Patients:
Organs are immature and still in the process of developing, and receptor
sites vary with age. This can affect the way drugs are absorbed into the body.
Some can be more toxic in children than they are in adults and vice versa.
Also, pediatric patients are more susceptible to drug interactions,
sensitivities, and unusual drug responses. Thus, smaller or larger doses of
drugs are required depending on which drug is used.
There are several pharmacokinetic considerations for the pediatric patient.
For example, water content decreases and fat content increases with age,
which affects the distribution of the drug.
Geriatric Patients:
As opposed to pediatric patients, the organs of geriatric patients are not as
effective at performing their normal functions, which greatly affects drug
administration and pharmacokinetics. For example, because of decreased
muscular tone, the GI tract moves slower and decreases the rate of drug
absorption.
Because of decreased/impaired organ function or chronic diseases, some
geriatric patients take several medications on a daily basis for a long amount
of time. This is especially important to take into consideration when
administering a new drug because of possible drug interactions or
contraindications that may occur.
Discussion Question 7: What does the term opioid tolerance mean?
What is the major side effect of administering an opioid? What are
the nursing implications to consider?
Opioid tolerance describes a situation in which a patient has been
accustomed to receiving what is considered as highly effective prescription
pain medications. The major side effect of administering an opioid is a
change in the patients mental status. Depending on which opioid is used,
the pain can simply be masked so the patient can continue normally with
their daily activities, or it can alter the patients mental status to complete
sedation, as during procedures that require anesthesia. Some nursing
implications to consider would include assessing the patient for respiratory
insufficiency, elevated intracranial pressure, morbid obesity, sleep apnea,
myasthenia gravis, paralytic ileus, and pregnancy. If any of these things

applies to the patient, dosage and use time should be adjusted accordingly,
along with preparation of resuscitation equipment, monitoring, and other
diagnostic equipment. A nurse should use caution when giving any patient
having one of the above listed conditions an opioid medication, as the
chances are greater for something to go wrong.
Discussion Question 8: What are indications for giving antibiotics?
Name three classifications of antibiotics and discuss.
Antibiotics are used when a patient's immune system is weakened due to
infectious bacterial organisms that multiply throughout the body. Symptoms
that the patient is infected include fever, swelling, chills, sweats, pain, etc.
Sometimes prophylactic antibiotic therapy will be given to prevent an
infection from occurring, especially when the body is recovering from a major
procedure.
3 classifications of antibiotics include sulfonamides, penicillins, and
cephalosporins.
Sulfonamides don't actually destroy the infections bacteria, they just prevent
them from growing by affecting the synthesis of the B-vitamin complex that
is required for reproduction. These antibiotics are used to treat both gram
positive and negative bacteria, but are sometimes ineffective in treating
certain antibiotic resistsnt bacteria. Some of the common indications treated
with sulfonamide antibiotics include UTI, ear infections and chronic
bronchitis.
Penicillins are derived from a mold fungus and have the capability of both
inhibiting gram positive (most common use) and negative bacterial growth
as well as destroying it. The penicillin molecules travel to infected areas of
the body via the patient's bloodstream. However, some molecules are too big
to pass through the cell walls and are unable to reach the harmful bacteria.
Indications for using penicillin antibiotics include ear/skin/urinary/respiratory
infections and Salmonella/Streptococcus/Pseudomonas infections.
Cephalosporins are produced by a fungus but synthetically altered to
produce an antibiotic. They are related to penicillins and function in the same
way. Not only can they affect gram positive and negative bacteria, but they
can also affect anaerobic bacteria. However, they are not useful in treating
fungi and viruses. Cephalosporins are specifically used for prophylactic
treatment and indications such as respiratory/skin/ear/bone infections, and
better coverage of gram-negative and anaerobic organisms.
Discussion Question 9: What are indications for giving antifungals?

Depending on the type of drug and infection, there are very specific
indications for giving various antifungals. The most recent drugs have less
severe adverse effects than older ones, and Amphotericin B is the most
commonly used antifungal for systemic infections. Nystatin is similar to
Amphotericin B, but it has more toxic effects and is specifically used to treat
thrush. Other examples are fluconazole and itraconazole, which are specific
to treating infections in CSF and cryptococcal meningitis.