Learn: Pharmacological and Parenteral Therapies - Part 2

Overview

Welcome! In this session, we’ll break down essential concepts in pharmacological and parenteral therapy, all through the lens of real-world nursing scenarios. You’ll learn how to keep medications safe and controlled, manage high-risk drugs, respond to emergencies like adverse drug reactions or air embolisms, and educate patients on safe medication use and disposal. By mastering these principles, you’ll be equipped to deliver safer, more effective care and confidently answer medication-related NCLEX-style questions.

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Concept-by-Concept Deep Dive

1. Medication Reconciliation and Transitions of Care

What it is:
Medication reconciliation is a systematic process ensuring that patients’ medication lists are accurate and complete at every transition in care—admission, transfer, and discharge. It aims to prevent errors such as omissions, duplications, or harmful drug interactions.

Components:

• Comparing Med Lists: Cross-reference patient’s home medications, current orders, and what’s actually being administered.
• Identifying Discrepancies: Watch for duplications, omissions, or drugs with similar effects.
• Addressing Supplements and OTCs: Herbal supplements and over-the-counter (OTC) drugs can interact with prescribed medications, especially around surgery or in polypharmacy.

Step-by-Step:

1. Obtain a complete list from the patient or caregiver, including all prescribed, OTC, and herbal products.
2. Compare this list with the provider’s orders.
3. Clarify any discrepancies with the prescriber and update records.

Common Misconceptions:

• Assuming herbal supplements are “safe” and don’t need to be documented.
• Overlooking changes made during hospitalization when preparing discharge instructions.

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2. High-Alert Medications and Monitoring

What it is:
High-alert medications are drugs with a heightened risk of causing significant harm if used in error. Examples include anticoagulants (like warfarin), chemotherapeutics, lithium, digoxin, and insulin.

Key Subtopics:

a) Laboratory Monitoring

• Anticoagulants: INR for warfarin (therapeutic range is critical).
• Electrolyte-sensitive Drugs: Lithium (affected by sodium levels), digoxin (potassium-sensitive).

b) Dietary Interactions

• Warfarin: Vitamin K intake can alter drug effectiveness.
• Lithium: Sodium intake fluctuations can change blood levels.

Step-by-Step Recipe:

1. Review the latest lab results before administering the drug.
2. Assess for any dietary or supplement changes.
3. Educate patients on consistency in diet and the importance of scheduled labs.

Common Misconceptions:

• Believing all leafy greens must be avoided on warfarin (consistency is key, not total avoidance).
• Not recognizing signs of overdose or toxicity (e.g., bleeding for warfarin, confusion for lithium).

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3. Parenteral Therapies and IV Safety

What it is:
Parenteral therapy involves administering drugs via injection, infusion, or other non-oral routes. IV chemotherapy, vesicant drugs, and central lines require special precautions.

Key Subtopics:

a) Central Venous Catheter (CVC) Care

• Proper needle selection (e.g., non-coring Huber needle for implanted ports).
• Recognizing and responding to complications: air embolism, infection, exudate.

b) Vesicant Administration

• Vesicants can cause tissue necrosis if extravasation occurs (drug leaks into surrounding tissue).
• Monitor closely for burning, swelling, or redness during infusion.

Step-by-Step Recipe:

1. Confirm IV patency and site integrity before administration.
2. Use the correct equipment and follow protocols for high-risk drugs.
3. Respond immediately to any adverse symptoms at the site.

Common Misconceptions:

• Underestimating the risk of giving vesicants through peripheral lines.
• Ignoring minor patient complaints of discomfort during infusion.

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4. Safe Medication and Sharps Disposal

What it is:
Proper disposal of medications and sharps (needles) prevents accidental injury, environmental harm, and drug misuse.

Key Subtopics:

a) Sharps Disposal

• Use FDA-cleared sharps containers or heavy-duty household containers (e.g., a puncture-proof, leak-resistant plastic container with a tight lid).