TABLE OF CONTENTS

CONTENT PAGE
Module 1- Introduction to Nursing Pharmacolog 3
Lesson 1- Introduction to Drugs 4
Lesson 2- Drugs and the Body 13
Lesson 3- Toxic Effects Of Drugs 21
Lesson 4 - Nursing management 27
Lesson 5-Dosage Calculations 32
Module 2 - Chemotherapeutic Agents 40
Lesson 1 - Anti-infective agents 41
Lesson 2 – Antibiotic 46
Lesson 3- Antiviral agents 60
Lesson 4 - Antifungal agents 69
Lesson 5 – Antiprotozoal 75
Lesson 6 - Antihelmintic agents 81
Lesson 7 - Antineoplastic agent 87
 MODULE 1

MISSION AND VISION OF THE ISABELA STATE UNIVERSITY

INTRODUCTION

The Vision and Mission of Isabela State University has a vital role in the
organization. The Mission statement will provide the organization with a clear and
effective guide for making decision and the vision statement ensures that all decision
made are properly aligned with what the Isabela State University wanted to achieve

LEARNING OUTCOME

At the end of the chapter the learner will be able to comprehend the Vision and Mission
and make an opportunity to innovate their output as they finish the course for future
research activity.

LEARNING CONTENT

A. The Mission of the University

B. The Vision of the University
C. The Mission of the College
D. The Vision of the College
E. The Objectives of the College
F. The Program Outcomes of the College

Many of mistakes vision statements for mission statements. Vision describes what the
company/us will become in the future. Mission describes how it will be achieved. The
table below will help us differentiate the two:

Mission Vision

Statement Picture, snapshot

What we are supposed to be doing What it will be in the future

Informs Inspires
 Head Heart

1st 2nd

The first tells about the how, the second about being. A vision should become the
inspiration of the organization and help them feel proud, excited, and part of something
better and bigger in the future, it gives direction to the organization’s future.

The program outcome will give us a picture of what a graduate of the Isabela State
University College of nursing is.

UNIVERSITY

MISSION

The Isabela State University is committed to develop globally competitive human,

technological resources and services through quality instruction, innovative research,
responsive community engagement and viable resource management programs for
inclusive growth and sustainable development.

MISSION – Defines what we do.

VISION

The Isabela State University as a leading Research University in the ASEAN Region

VISION – Is a picture of what will happen if we fulfill our mission.

COLLEGE

VISION

The College of Nursing envisions a nursing student as innovative, competent and

scientifically equipped with skills to face the demands of Nursing Professions in
promoting and maintaining health.

MISSION

The Isabela State University – College of Nursing, commits to;

Provide nursing students with beginning nursing skills competency based in order to
produce quality nursing graduates who are professionally knowledgeable, competent
and dedicated to serve.

PROGRAM OUTCOMES

At the end of their ISU-BSN education, the graduate is expected to be:

I-nnovative

Utilize research outputs or evidence-based practice in the delivery of nursing

care.

S-killfull

Deliver the basic skills expected of a novice nurse.

Participate collaboratively with the different members of the health team

U-pright

Aware of the legal, ethical responsibilities in delivering nursing care to the

patient.

Provide culturally, environmentally and gender acceptable methods of delivering

care.

R-esponsible

Perform the role of client advocate in promoting health, preventing diseases and
restoring health of clients under his/her care.

N-urturing

Provide the possible safe and secure environment that may support every client
to have a better health status and bring the patient to their optimum level of
functioning.

LEARNING ACTIVITIES

Activity 1: Individual output (Answers the following questions individually and submit it
on the following meeting or as the instructor tells so)

1.  UNIVERSITY
MISSION

Question Answer

Name of the Higher Institution:

In one sentence how do you

describe the Mission of the
University.

As a student how will you

achieve the Mission of the
University?

What is the commitment of the

University in its Mission?

What is the concrete evidence

that will tell you that you have
contributed in the achievement
of the Mission?

What is your suggestion in

improving the Mission?

VISION

Question Answer

Name of the Higher Institution:

In one sentence how do you

describe the Vision of the
University.

What is the main Vision of the

University?

As a student how will you

achieve the Vision of the
University?

What is the concrete evidence

that will tell you that you have
contributed in the achievement
of the Vision?

What is your suggestion in

improving the Vision?

2. COLLEGE

MISSION

Question Answer

Name of the Higher Institution:

In one sentence how do you

describe the Mission of the
College.

As a student how will you

achieve the Mission of the
College?

What is the commitment of the

College in its Mission?

What is the concrete evidence

that will tell you that you have
contributed in the achievement
of the Mission?

What is your suggestion in

improving the Mission?

VISION

Question Answer

Name of the Higher Institution:

In one sentence how do you

describe the Vision of the
College.

What is the main Vision of the

College?

As a student how will you

achieve the Vision of the
College?

What is the concrete evidence

that will tell you that you have
contributed in the achievement
of the Vision?

What is your suggestion in

improving the Vision?

3. Draw an output of an ISUan graduate nurse using the program outcome.

FLEXIBLE TEACHING LEARNING MODALITY (FTLM) ADOPTED

Lecture will be Online (synchronous)

Zoom, Edmodo (for those who have internet access)

Remote (asynchronous)

Module discussion (for those who cannot join the zoom discussion)

ASSESSMENT TASK

Name: _____________________________
Section:_____________
INSTRUCTIONS: ANSWER THE FOLLOWING QUESTIONS IN NOT MORE THAN
ONE HUNDRED (75) WORDS PER ITEM.

1. How can you as a student be able to help in the realization of the mission and
vision of the Isabela State University in this time of pandemic in as much that
we are not physically present in our classrooms?

2. What are your expectations in our subject Community Health Nursing?

REFERENCES

https://www.echague-isabela.com/2020/03/mandate-vision-and-mission.html

Global Leadership Training, 2017. Book 4: CCF DNA (2 nd Edition)

 Module 2 Introduction to Nursing Pharmacology

Learning outcomes: OVERVIEW:

At the end of this module, the student shall Pharmacology is crucial for:
be able to: discovering new medicines to help fight
disease, improving the effectiveness of
1. Define pharmacology and its major
subdivisions. medicines and reducing unwanted side
2. List different forms of drug products and effects of medicines. In this time
the routes by which they are administered. wherein COVID-19 is an emerging,
3. Explain the processes of pharmacokinetics rapidly evolving situation and Scientists
of each drug. around the world are working on
4. List several factors of individual variation potential treatments and vaccines.
that can alter drug response.
5. Identify nursing responsibilities,
malpractice or negligence.
6. Solve problems on dosage calculation, IV
flow rate and critical care IV computations
7. Elaborate efficient nursing management in
performing the different routes of
medication administration
 PHARMACOLOGY
comes from the Greek
words pharmakon which
means “drugs”

Lesson 1-Introduction to Drugs

1. A drug company is beginning a new drug trial for a medication that is

used to treat rheumatoid arthritis (RA). Jonna is a 22-year-old female
who has had RA for 2 years and does not feel that she has full relief of
pain from the medications she has taken. She states she has fallen on
hard times since she became ill and the money for the study will also be
beneficial. She wants to participate in the study.
a. Discuss the reason she should not participate in the study. Do
you feel this patient should be allowed to participate?
b. Discuss the role of the Food and Drug Administration (FDA) in
clinical drug testing.
2. In order to safely administer medications, all nurses must understand
how to read a drug label. Discuss the information that is found on a drug
label.
3. The nurse is administering a drug and recognizes it as a controlled
substance. The prescription, distribution, storage, and use of controlled
substances are closely monitored by the DEA in an attempt to decrease
substance abuse of prescribed medications.
a. Describe how the Drug Enforcement Task Force controls on
drugs that have abuse potential.
b. List and discuss the different Schedules of Controlled
Substances.
4. The nurse is teaching a patient about the brand-name drug Coumadin
and observes “dispense as written.” The patient states that generic
medications are less expensive and questions why he cannot have the
generic drug warfarin instead. Explain the possible reasons for this order.

Pharmacology
 Pharmacology is the study of the biological effects of chemicals.
 Drugs are chemicals that are introduced into the body to cause some sort of
change.
 Health care providers focus on how chemicals act on living organisms.
 Nurses deal with pharmacotherapeutics, or clinical pharmacology.
 Some drug effects are therapeutic, or helpful, but others are undesirable or
potentially dangerous (adverse effects)
Nurse’s Responsibility
 Administering drug
 Assessing drug effects
 Intervening to make the drug regimen more tolerable
 Providing patient teachings about drugs and the drug regimen
 Monitoring the overall patient care plan to prevent medication errors
Sources of Drugs
 Natural Sources
o Plants
 Synthetic version of the active chemical found in a plant
 Main component of the growing alternative therapy movement
 o Animal products
 Used to replace human chemicals that are not produced because
of disease or genetic problems
 Genetic engineering
 Many of these preparations are now created synthetically
o Inorganic compounds
 Salts of various elements can have therapeutic effects in the
human body
 Synthetic Sources
o Genetic engineering alter bacteria to produce chemicals that are
therapeutic and effective
o Original prototypes

Drug Evaluation
 Preclinical Trials
o Chemicals tested on laboratory animals
 Phase I Studies
o Chemicals tested on human volunteers
 Phase II Studies
o Drug tried on informed patients with the disease
 Phase III Studies
o Drug used in vast clinical market
 Phase IV Studies
o Continual evaluation of the drug
Legislation
Pregnancy Categories

Controlled Substances
 The Controlled Substances Act of 1970
o Control over the coding of drugs and the enforcement of these codes to
the FDA and the Drug Enforcement Agency (DEA), a part of the U.S.
Department of Justice.
 Prescription, distribution, storage, and use of these drugs are closely monitored.
 Local policies and procedures might be even more rigorous.
Generic Drugs

 Chemicals that are produced by companies involved solely in the manufacturing

of drugs
 Bioavailability of the drug
 “Dispensed as written”
o Important in drugs that have narrow safety margins

Orphan Drugs
  Drugs that have been discovered, but are not financially viable and therefore
have not been “adopted” by any drug company
 The Orphan Drug Act of 1983

Over-the-Counter Drugs

 Products that are available without prescription for self-treatment of a variety of

complaints.
o Some of these agents were approved as prescription drugs.
o Later were found to be very safe and useful for patients (example:
loratidine).
o Many of these drugs were “grandfathered.”
 Nurses should consider several problems related to OTC drug use:
o Taking these drugs could mask the signs and symptoms of underlying
disease, making diagnosis difficult.
o Taking these drugs with prescription medications could result in drug
interactions and interfere with drug therapy.
o Not taking these drugs as directed could result in serious overdoses.
Sources of Drug Information

 Drug Label
o Drug labels have specific information that identifies a specific drug
o Understanding how to read a drug label is essential
 Package Insert
o Prepared by the manufacturer
o Contains all of the chemical and study information that led to the drug’s
approval
o Difficult to understand and read
 Reference Books
o Physician’s Drug Reference (PDR)
o Drug Facts and Comparisons
o AMA Drug Evaluations
o Lippincott’s Nursing Drug Guide (LNDG)
 Journals

 Internet

Flexible Teaching Learning Modality (FTLM)

  Edmodo, google classroom, module, case study, exercises, problem sets

Assessment Task

C H E C K Y O U R U N D E R S TA N D I N G

MULTIPLE CHOICE
Select the best answer to the following.
1. Clinical pharmacology is the study of
a. the biological effects of chemicals.
b. drugs used to treat, prevent, or diagnose disease.
c. plant components that can be used as medicines.
d. binders and other vehicles for delivering medication.
2. Phase I drug studies involve
a. the use of laboratory animals to test chemicals.
b. patients with the disease the drug is designed to treat.
c. mass marketing surveys of drug effects in large numbers of people.
d. healthy human volunteers who are often paid for their participation.
3. The generic name of a drug is
a. the name assigned to the drug by the pharmaceutical company developing it.
b. the chemical name of the drug based on its chemical structure.
c. the original name assigned to the drug at the beginning of the evaluation
process.
d. the name that is often used in advertising campaigns.
4. An orphan drug is a drug that
a. has failed to go through the approval process.
b. is available in a foreign country but not in this country.
c. has been tested but is not considered to be financially viable.
d. is available without a prescription.
5. The Food and Drug Administration (FDA) pregnancy categories
a. indicate a drug’s potential or actual teratogenic effects.
b. are used for research purposes only.
c. list drugs that are more likely to have addicting properties.
d. are tightly regulated by the Drug Enforcement Agency (DEA).
6. The storing, prescribing, and distributing of controlled substances—drugs that are
more apt to be
addictive—are monitored by
a. the FDA.
b. the Department of Commerce.
c. the Federal Bureau of Investigation.
d. the DEA.
7. Healthy young women are not usually involved in phase I studies of drugs because
a. male bodies are more predictable and responsive to chemicals.
b. females are more apt to suffer problems with ova, which are formed only before
birth.
c. males can tolerate the unknown adverse effects of many drugs better than
females.
d. there are no standards to use to evaluate the female response.
8. A patient has been taking fl uoxetine (Prozac) for several years, but when pickin up
the prescription this month, found that the tablets looked different and became
concerned. The nurse, checking with the pharmacist, found that fl uoxetine had just
become available in the generic form and the prescription had been fi lled with the
generic product. The nurse should tell the patient
a. that the new tablet may not work at all and the patient should carefully monitor
response.
b. that generic drugs are available without a prescription and they are just as safe
as the brand-name medication.
c. that the law requires that prescriptions be filled with the generic form if available
to cut down the cost of medications.
d. that the pharmacist fi lled the prescription with the wrong drug and it should be
returned to the pharmacy for a refund.

MULTIPLE RESPONSE
Select all that apply:
1. When teaching a patient about over-the-counter (OTC) drugs, which points should
the nurse include?
a. These drugs are very safe and can be used freely to relieve your complaints.
b. These compounds are called drugs, but they aren’t really drugs.
c. Some of these drugs were once prescription drugs, but are now thought to be
safe when used as directed.
 d. Reading the label of these drugs is very important; the active ingredient is very
prominent; you should always check the ingredient name.
e. It is important to read the label and to see what the recommended dose of the
drug is; some of these drugs can cause serious problems if too much of the drug
is taken.
f. It is important to report the use of any OTC drug to your health care provider
because many of them can interact with drugs that might be prescribed for you.
2. A patient asks what generic drugs are and if he should be using them to treat his
infection. Which of the following statements should be included in the nurse’s
explanation?
a. A generic drug is a drug that is sold by the name of the ingredient, not the brand
name.
b. Generic drugs are always the best drugs to use because they are never any
different from the familiar brand names.
c. Generic drugs are not available until the patent expires on a specific drug.
d. Generic drugs are usually cheaper than the well-known brand names, and some
insurance companies,require that you receive the generic drug if one is available.
e. Generic drugs are forms of a drug that are available over the counter and do not
require a prescription.
f. Your physician may want you to have the brand name of a drug, not the generic
form, and DAW, or “dispense as written,” will be on your prescription form.
g. Generic drugs are less likely to cause adverse effects than brand-name drugs.

Lesson 2- Drugs and the Body

3
Discussion Topics
1. Mr. Rzepka is a 50-year-old male who has just been started on
a new medication for an infection and is very confused about this
medication. During morning rounds, he heard the care team
mention terms including loading dose, half-life, first-pass effect,
and excretion. Mr. Rzepka wants to know what these terms mean
and what they have to do with his new medication.
a. Develop a teaching plan that explains the following
Discussion Topics
terms:
 Half-life
 First-pass effect
 Excretion (including the primary organ
involved)
b. Explain the importance of a loading dose. Why do some
drugs require loading dosing and others do not?
2. Your clinical instructor has assigned you to give medications
during clinical next week. The instructor expects you to be able to
explain the following concepts during postclinical conference.
a. Explain how each of the following factors influences
drug effectiveness:
 Weight
 Age
 Gender
 Genetic differences
b. Explain the concepts of tolerance and cumulation and
what this means for patients.

Pharmacodynamics
 Pharmacodynamics is the science of dealing with interactions between living
organisms and foreign chemicals.
 Each living system has chemical reactions occurring continuously in the body.
 When other chemicals (drugs) are added to the body other effects occur.
Drug Action
 Replace or act as a substitute for missing chemicals
 To increase or stimulate certain cellular activities
 To depress or slow cellular activities
 To interfere with the functioning of foreign cells
Receptor Sites
 Receptor sites react to certain chemicals to cause an effect within the cell.
 Agonists
 Noncompetitive antagonists-
  Competitive antagonists
 Drug- enzyme interactions
 Selective toxicity

Lock and Key

Pharmacokinetics
 The study of absorption, distribution, metabolism (biotransformation), and
excretion of drugs
 Onset of drug action
 Drug half-life
 Timing of the peak effect
 Duration of drug effects
 Metabolism or biotransformation of the drug
 Site of excretion
  Critical Concentration
o The amount of a drug that is needed to cause a therapeutic effect
 Loading Dose
o A higher dose than that usually used for treatment
 Dynamic Equilibrium
o The actual concentration that a drug reaches in the body
Dynamic Equilibrium
 The actual amount of drug that reaches the body results for a dynamic
equilibrium.
 Dynamic equilibrium is affected by:
o Absorption
o Distribution
o Biotransformation
o Excretion
Absorption
 Administration
o Affected by route of administration
o Oral medications affected by presence of food in the stomach
 Passive diffusion
 Active transport
Factors Affecting Absorption

Distribution
The movement of a drug to the body’s tissues
 Drug’s lipid solubility and ionization- blood brain barrier
 Perfusion of the reactive tissue
 Placenta/Breast Milk

Biotransformation
 The liver is the single most important site for biotransformation (metabolism).
 Breaks down medications
 Helps to prevents medications from causing adverse effects on the body
  First pass effect

Excretion
 Removal of drugs from the body
 Kidneys play the most important role in excretion of medication

Half-Life
 Half-life is the time it takes for the amount of drug in the body to decrease to one-
half the peak level.
 Half-life is affected by absorption, distribution, metabolism, and excretion.

Calculating Half-life
Factors Influencing Drugs Effect

 Weight  Genetic Factors

 Age  Immunological Factors
 Psychological Factors
 Gender
 Environmental Factors
 Physiological
 Drug Tolerance
 Pathological  Cumulative Effect

Drug-to-Drug Interactions
 Can occur any time two or more drugs are taken together.
 Can occur at:
o Site of absorption
o During distribution
o During biotransformation
o During excretion
o At the site of action
Drug-Food Interactions
 Certain foods interact with drugs
 In most cases, drugs are best taken on an empty stomach
Drug–Laboratory Test Interactions
 Drugs may alter the results of lab testing.
 Laboratory test may be used to monitor the effects of other medications.

Flexible Teaching Learning Modality (FTLM)

 Edmodo, google classroom, module, case study, exercises, problem sets

Assessment Task
 C H E C K Y O U R U N D E R S TA N D I N G

MULTIPLE CHOICE
Select the best answer to the following.
1. Chemotherapeutic agents are drugs that
a. are used only to treat cancers.
b. replace normal body chemicals that are missing because of disease.
c. interfere with foreign cell functioning, such as invading microorganisms or
neoplasms.
d. stimulate the normal functioning of a cell.
2. Receptor sites
a. are a normal part of enzyme substrates.
b. are protein areas on cell membranes that react with specifi c chemicals.
c. d. are responsible for all drug effects in the body.
3. Selective toxicity is
a. the ability of a drug to seek out a specifi c bacterial species or microorganism.
b. the ability of a drug to cause only specifi c adverseeffects.
c. the ability of a drug to cause fetal damage.
d. the ability of a drug to attack only those systems found in foreign or abnormal
cells.
4. When trying to determine why the desired therapeutic effect is not being seen
with an oral drug, the nurse should consider
a. the blood flow to muscle beds.
b. food altering the makeup of gastric juices.
c. the weight of the patient.
d. the temperature of the peripheral environment.
5. Much of the biotransformation that occurs when a drug is taken occurs as part of
a. the protein-binding effect of the drug.
b. the functioning of the renal system.
c. the fi rst-pass effect through the liver.
d. the distribution of the drug to the reactive tissues.
6. The half-life of a drug
a. is determined by a balance of all pharmacokinetic processes.
b. is a constant factor for all drugs taken by a patient.
c. is infl uenced by the fat distribution of the patient. can be calculated with the
use of a body surface nomogram.
7. Jack B. has Parkinson’s disease that has been controlled for several years with
levodopa. After he begins a health food regimen with lots of vitamin B6, his
tremors return, and he develops a rapid heart rate, hypertension, and anxiety.
The nurse investigating the problem discovers that vitamin B6 can speed the
conversion of levodopa to dopamine in the periphery, leading to these problems.
The nurse would consider this problem
a. a drug–laboratory test interaction.
 b. a drug–drug interaction.
c. a cumulation effect.
d. a sensitivity reaction.

MULTIPLE RESPONSE
Select all that apply.
1. When reviewing a drug to be given, the nurse notes that the drug is excreted in
the urine. What points should be included in the nurse’s assessment of the
patient?
a. The patient’s liver function tests
b. The patient’s bladder tone
c. The patient’s renal function tests
d. The patient’s fluid intake
e. Other drugs being taken that could affect the kidney
f. The patient’s intake and output for the day
2. When considering the pharmacokinetics of a drug, what points would the nurse
need to consider?
a. How the drug will be absorbed
b. The way the drug affects the body
c. Receptor-site activation and suppression
d. How the drug will be excreted
e. How the drug will be metabolized
f. The half-life of the drug
3. Drug–drug interactions are important considerations in clinical practice. When
evaluating a patient for potential drug–drug interactions, what would the nurse
expect to address?
a. Bizarre drug effects on the body
b. The need to adjust drug dose or timing of administration
c. The need for more drugs to balance the effects of the drugs being given
d. A new therapeutic effect not encountered with either drug alone
e. Increased adverse effects
f. The use of herbal or alternative therapies

Lesson 3 - Toxic Effects Of Drugs

Discussion Topics
1. The nurse is preparing to administer medications and
understands the importance of being able to recognize an adverse
drug reaction. When preparing to administer medications to Mrs.
Smith, the patient states she is allergic to diphenhydramine
(Benadryl). In questioning the patient regarding her reaction, she
states that it makes her very sleepy.
a. Explain the reasons for an adverse drug reaction.
b. Is this patient allergic to diphenhydramine? Explain.
c. Discuss the four types of allergic reactions.
2. After receiving her third dose of penicillin, Mrs. Smith became
very anxious and states she is having difficulty breathing. The
nurse recognizes that she is having an anaphylactic reaction.
a. Describe the treatment interventions for an anaphylactic
reaction.
3. Mr. Clayton became confused and was brought to the
emergency room by his family. He is on Lasix therapy and is
admitted with hypokalemia.
a. Explain poisoning by a medication.
b. What assessment findings are frequently seen with
hypokalemia?
c. Describe the nursing interventions for this patient.
4. Your patient is on an antineoplastic drug regimen (drugs to treat
cancer) and is complaining of the following drug-induced effects:
stomatitis, vaginal itching and discharge, sore throat, weakness,
muscle cramps, and extremity numbness and tingling.
a. What are common symptoms and helpful interventions to
treat each adverse effect listed above?
b. Discuss how drug-induced liver and renal dysfunction
causes toxicity. Your answer should include nursing
 Discussion Topics
assessment findings and interventions designed to treat liver
and renal dysfunction.

Adverse Drug Reaction

 Undesired effects that may be unpleasant or even dangerous
 Reasons Adverse Drug Reactions Occur
o The drug may have other effects on the body besides the therapeutic
effect.
o The patient is sensitive to the drug being given.
o The drug’s action on the body causes other responses that are undesired
or unpleasant.
o The patient is taking too much or too little of the drug.
Types of Adverse Reactions
 Primary Actions
o Overdose; extension of the desired effect
 Secondary Actions
o Undesired effects produced in addition to the pharmacologic effect
 Hypersensitivity Reactions
o Excessive response to primary or secondary effect of drug
Types of Drug Allergies
 Anaphylactic Reaction
 Cytotoxic Reaction
 Serum Sickness Reaction
 Delayed Allergic Reaction
Drug-Induced Tissue and Organ Damage

Dermatological Reactions
 Rash/Hives
o Assessment
  Abnormalities in the skin, red area, blisters
o Interventions
 May need to discontinue the medication in severe cases
 Stomatitis
o Assessment
 Inflammation of the mucous membranes
o Interventions
 Frequent mouth care
Drug-Induced Tissue and Organ Damage
 Superinfections — Destruction of the body’s normal flora
o Assessment
 Fever, diarrhea, vaginal discharge
o Interventions
 Supportive care (mouth and skin care), administer antifungal
medications as needed, may also need to stop drug responsible for
the superinfection
 Blood Dyscrasia — Bone marrow suppression
o Assessment
 Fever, chills, weakness
o Interventions
 Monitor blood counts, protective isolation
Toxicity
Affecting the body in a very noxious or toxic way
 Liver- Assessment
 Fever, nausea, jaundice, change in color of urine or stool, elevated
liver enzymes
o Interventions
 Discontinue medication
 Kidney- Assessment
 Change in urinary pattern, elevated BUN and creatinine
o Intervention
 Notify physician, may need to stop medication or decrease the
dosage

Poisoning
 Poisoning occurs when an overdose of a drug damages multiple body systems.
 Damage to multiple systems can lead to a fatal reaction.
 Treatment varies accordingly with drug
Altered Glucose Metabolism
 Hypoglycemia
o Assessment Finding: Low serum blood glucose level
o Intervention: Restore glucose to the body
 Hyperglycemia
o Assessment Finding: High serum glucose level
o Intervention: Administer medications to decrease glucose level
Electrolyte Imbalance
 Hypokalemia
o Assessment Finding: Decrease in serum potassium levels
o Interventions: Replace serum potassium (IV or oral supplement) and
monitor serum levels of potassium
 Hyperkalemia
o Assessment Finding: Increase in serum potassium level
o Interventions: Decrease the serum potassium concentration (Sodium
Polystyrene Sulfonate), monitor serum levels of potassium, and monitor
cardiac rhythm
Sensory Effects
 Ocular Toxicity
o Assessment Findings: Visual changes
o Interventions: Monitor for any visual changes when giving any medication
that is known to cause ocular damage; discontinue medication as
appropriate.
 Auditory Damage
o Assessment Findings: Dizziness, ringing in the ears (tinnitus), loss of
balance, and loss of hearing
o Interventions: Monitor for hearing loss; discontinue medication as
appropriate if a decrease in hearing is noted on assessment.
Neurological Effects
 General Central Nervous System (CNS) Effects
o Assessment Findings: Altered level of consciousness
o Interventions: Prevent injury
 Atropine-like (Anticholinergic) Effects
o Assessment Findings: Dry mouth, urinary retention, blurred vision
o Interventions: Sugarless lozenges to keep mouth moist; have the patient
void before administration of the medication
 Parkinson-like Syndrome
o Assessment Findings: Muscle tremors and changes in gait
o Interventions: Discontinue medication as appropriate
 Neuroleptic Malignant Syndrome
o Assessment Findings: Extrapyramidal symptoms
o Interventions: Discontinue medication as appropriate
Teratogenicity
 Teratogenicity: Any drug that causes harm to the developing fetus or embryo
 Teaching to prevent teratogenicity
o Advise the pregnant woman that any medication may have possible
effects on the baby.
o Weigh the actual benefits against the potential risks.
o Discuss with pregnant women that they should not take medications
without checking with their health care provider first.
Flexible Teaching Learning Modality (FTLM)

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Assessment Task

6
C H E C K Y O U R U N D E R S TA N D I N G

MULTIPLE CHOICE
Select the best answer to the following.
1. An example of a drug allergy is
a. dry mouth occurring with use of an antihistamine.
b. increased urination occurring with use of a thiazide diuretic.
c. breathing difficulty after an injection of penicillin.
d. urinary retention associated with atropine use.
2. A patient taking glyburide (an antidiabetic drug) has his morning dose and then
does not have a chance to eat for several hours. An adverse effect that might be
expected from this would be
a. a teratogenic effect.
b. a skin rash.
c. an anticholinergic effect.
d. hypoglycemia.
3. A patient with a severe infection is given gentamicin, the only antibiotic shown to
be effective in culture and sensitivity tests. A few hours after the drug is started
intravenously, the patient becomes very restless and develops edema. Blood
tests reveal abnormal electrolytes and elevated blood urea nitrogen. This
reaction was most likely caused by
a. an anaphylactic reaction.
b. renal toxicity associated with gentamicin.
c. superinfection related to the antibiotic.
d. hypoglycemia.
4. Patients receiving antineoplastic drugs that disrupt cell function often have
adverse effects involving cells that turn over rapidly in the body. These cells
include
 a. ovarian cells.
b. liver cells.
c. cardiac cells.
d. bone marrow cells.
5. A woman has had repeated bouts of bronchitis throughout the fall and has been
taking antibiotics. She calls the clinic with complaints of vaginal pain and itching.
When she is seen, it is discovered that she has developed a yeast infection. You
would explain to her that
a. her bronchitis has moved to the vaginal area.
b. she has developed a superinfection because the antibiotics kill bacteria that
normally provide protection.
c. she probably has developed a sexually transmitted disease related to her
lifestyle.
d. she will need to take even more antibiotics to treat this new infection.
6. Knowing that a patient is taking a loop diuretic and is at risk for developing
hypokalemia, the nurse would assess the patient for
a. hypertension, headache, and cold and clammy skin.
b. decreased urinary output and yellowing of the sclera.
c. weak pulse, low blood pressure, and muscle cramping.
d. diarrhea and fl atulence.

MULTIPLE RESPONSE
Select all that apply.
1. A patient is taking a drug that is known to be toxic to the liver. The patient is
being discharged to home. What teaching points related to liver toxicity and the
drug should the nurse teach the patient to report to the physician?
a. Fever; changes in the color of urine
b. Changes in the color of stool; malaise
c. Rapid, deep respirations; increased sweating
d. Dizziness; drowsiness; dry mouth
e. Rash, black or hairy tongue; white spots in the mouth or throat
f. Yellowing of the skin or the whites of the eyes
2. Pregnant women should be advised of the potential risk to the fetus any time
they take a drug during pregnancy. What fetal problems can be related to drug
exposure in utero?
a. Fetal death
b. Nervous system disruption
c. Skeletal and limb abnormalities
d. Cardiac defects
e. Low-set ears
f. Deafness
3. A client is experiencing a reaction to the penicillin injection that the nurse
administered approximately ½ hour ago. The nurse is concerned that it might be
an anaphylactic reaction. What signs and symptoms would validate her
suspicion?
a. Rapid heart rate
 b. Diaphoresis
c. Constricted pupils
d. Hypotension
e. Rash
f. Client report of a panic feeling
4. A client is experiencing a serum sickness reaction to a recent rubella vaccination.
Which of the following interventions would be appropriate when caring forthis
client?
a. Administration of epinephrine
b. Cool environment
c. Positioning to provide comfort
d. Ice to joints as needed
e. Administration of anti-infl ammatory agents
f. Administration of topical corticosteroids E C
KYOURUND

Lesson 4 - Nursing management

Discussion Topics

1. A patient is admitted to your institution directly from her

attending physician’s office. The patient has been admitted to your
institution before; however, the previous medical records are not
available.
a. What questions should be asked about medications during
your admission assessment?
b. What objective information is important to document that
will affect this patient’s drug profile?
2. As Dr. Sheila Pearson walks through the third floor nurses’
area, she verbally orders the nurse to “Please start drug X four
times per day to the patient in Room 324; I will write the order
later.”
 Discussion Topics

a. What essential elements are missing from this medication

order?
b. What potential medication errors could occur?
c. How does the nurse effectively address this order?
D
Nursing: Art and Science
 Assuming increasing responsibilities
 Holistic
 Nurse is a key health care provider
 Integrate knowledge of the
o Basic sciences
o Social sciences
o Education
o Other disciplines
 Applying the nursing process

Nursing Process
 Assessment
o Data gathering: history, physical assessment,wholistic
 Nursing Diagnosis
o Drawing a conclusion from the assessment data that was gathered
 Planning/Implementation
o Formulation of a plan of care that includes actions to improve or maintain
the patient’s health
 Evaluations
o Determining if the plan of care was effective at either maintaining or
improving the patient’s health
Assessment
 History
o Chronic Conditions
o Drug Use
o Allergies
o Level of Education and Understanding
o Social Supports
o Financial Supports
o Pattern of Past Health Care
Physical Assessment
 Weight
 Age
 Physical Parameters Related to Disease or Drug Effects
Nursing Diagnosis
Implementation
 Synthesizing information into nursing diagnoses to plan patient care
 Setting goals
 Desired patient outcomes
o Effective response to drug therapy
o Minimization of adverse effects
o Understanding of the drug regimen
Interventions
 Three Types of Nursing Interventions
o Drug administration
o Provision of comfort measures
o Patient/family education
Comfort Measures
 Help the patient cope with the effects of drug therapy
 Nurse is in a unique position for this
 Patient more likely to be compliant
Promoting Drug Therapy
 Placebo Effect
 Managing Adverse Effect
 Lifestyle Adjustment
 Patient and Family Education
 Cornerstone of drug therapy
 Nurses are the primary educators about medications
Evaluation
 Part of the continuing process of patient care
 Leads to changes in assessment, diagnosis, and intervention

Proper Drug Administration

(The Rights of safe administration)
 Patient
 Drug
 Storage
 Route
 Dosage
 Preparation
 Timing
 Documentation

Prevention of Medication Errors

 To Err is Human”
 Drug Regimen Process
 Series of Checks
o Nurse’s Role
o Patient’s Role
 Reporting of Medication Errors

Elements of Patient Teaching

 Name, dose, and action of drug
 Timing of administration
 Special storage and preparation instructions
 Specific OTC drugs or alternative therapies to avoid
 Special comfort or safety measures
 Specific points about drug toxicity
 Specific warnings about drug discontinuation

Flexible Teaching Learning Modality (FTLM)

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Assessment Task

C H E C K Y O U R U N D E R S TA N D I N G

ACTIVITY

A student nurse has received a clinical assignment.

The clinical assignment is to administer medications to
two different patients. The student nurse is preparing to
administer a medication to a patient for the first time. The
student nurse has to prepare a patient and family teaching
guide for the second patient on medication education for
discharge medications.
a. What questions can the nurse ask the patient as
part of the assessment step of the nursing process
as it relates to drug therapy?
b. What are the important points for the nurse to
consider in safe and effective administration of the
drug?
 Lesson 5 - Dosage
Calculations

ACTIVITY 9
Discussion Topics

1. Your clinical instructor has assigned you to present in postclinical

conference about the four measuring systems that can be used in drug
therapy.
a. Briefly describe each system.
b. Which system is best for use by health care professionals? Defend
your answer.
2. James is a 4-year-old who is 35 inches tall and weighs 22 pounds. He
needs to receive an antibiotic for a sinus infection.
a. Describe the three rules for calculating pediatric drug dosages.
b. Use each method to calculate the correct drug dosage for James
based on the following information: penicillin, adult dose 1,000 mg
orally every 12 hours.
c. Discuss the different dosing considerations for pediatric patients
compared to those for adults.
Responsible Parties
 The prescriber who orders the drug
 The pharmacist who dispenses the drug
 The nurse who administers the drug
Dosing Considerations
 Packaging
 Sex
 Weight
 Age
 Physical Condition
 Other drugs that the patient is taking

Measuring Systems
 Metric System
 Apothecary System
 Household System
 Avoirdupois System

Metric System
 Solids: Gram (g)
o 1 milligram (mg) = 0.001 g
o 1 microgram (mcg) = 0.000001 g
o 1 kilogram (kg) = 1000 g
 Liquids: Liter (L)
o 1 milliliter (mL) = 0.001 L
o 1 mL = 1 cubic centimeter = 1 cc

Apothecary System
 Solids: Grain (gr)
o 60 gr = 1 dram (dr)
o 8 dr = 1 ounce (oz)
 Liquids: Minim (min)
o 60 minim = 1 fluid dram (f dr)
o 8 (f dr) = 1 fluid ounce (f oz)

Household System
 Solids: Pound (lb)
o 1 lb = 16 ounces (oz)
 Liquids: Pint (pt)
o 2 pt = 1 quart (qt)
o 4 qt = 1 gallon (gal)
o 16 oz = 1 pt = 2 cups (c)
o 32 tablespoons (tbsp) = 1 pt
 o 3 teaspoons (tsp) = 1 tbsp
o 60 drops (gtt) = 1 tsp

Other Systems
 Avoirdupois System
o Older system
o Ounces and grains
 Other Systems
o Measures may reflect chemical activity or biological equivalence
 Unit
 Milliequivalents
 International units

Calculating Dosage
 Oral Drugs
 Parenteral Drugs
 Intravenous Solutions

Ratio Proportion Conversion Between Systems oral and parental

Example

Calculating IV Drip Rate

Differences Between Children and Adults

 Children absorb, distribute, metabolize, and excrete drugs differently than adults
 Children’s organs are not as developed as an adult’s organs

Pediatric Dosage Calculation

  Fried’s Rule
 Young’s Rule
 Clark’s Rule
 Surface Area Calculation- Most used

Fried’s Rule

This rule assumes that an adult dose would be appropriate for a child who is 12.5
years (150 months) old

Young’s Rule

Clark’s Rule

Uses the child’s weight to calculate the appropriate dose

and assumes that the adult dose is based on a 150-lb
person

Surface Area Calculation

Determine the child’s surface area with the use of a nomogram (the
height and weight of the child are taken into consideration in this chart)
Flexible Teaching Learning Modality (FTLM)

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Assessment Task

C H E C K Y O U R U N D E R S TA N D I N G

ACITIVI
MULTIPLE CHOICE
Select the best answer to the following.
1. Digoxin 0.125 mg is ordered for a patient who is having trouble swallowing. The
bottle of digoxin elixir reads 0.5 mg/2 mL. How much would you give?
a. 5 mL
b. 0.5 mL
 c. 1.5 mL
d. 1 mL
2. The usual adult dose of diphenhydramine (Benadryl) is 50 mg. What would be
the safe dose for a child weighing 27 lb?
a. 0.9 mg
b. 1.8 mg
c. 9.0 mg
d. 18 mg
3. An order is written for 700 mg of ampicillin PO. The drug is supplied in liquid form
as 1 g/3.5 mL. How much of the liquid should be given?
a. 5 mL
b. 2.5 mL
c. 6.2 mL
d. 2.45 mL
4. An order is written for 1,000 mL of normal saline to be administered IV over 10
hours. The drop factor on the IV tubing states 15 drops/mL. What is the IV fl ow
rate?
a. 50 mL/h at 50 drops/min
b. 100 mL/h at 25 drops/min
c. 100 mL/h at 100 drops/min
d. 100 mL/h at 15 drops/min
5. The average adult dose of meperidine is 75 mg. What dose would be appropriate
for a 10-month-old infant?
a. 50 mg
b. 5 mg
c. 25 mg
d. 0.5 mg
6. A patient needs to take 0.75 g of tetracycline PO. The drug comes in 250-mg
tablets. How many tablets should the patient take?
a. 2 tablets
b. 3 tablets
c. 4 tablets
d. 30 tablets
7. Aminophylline is supplied in a 500 mg/2.5 mL solution. How much would be
given if an order were written for 100 mg of aminophylline IV?
a. 5 mL
b. 1.5 mL
c. 2.5 mL
d. 0.5 mL
8. Heparin 800 units is ordered for a patient. The heparin is supplied in a multidose
vial that is labeled 10,000 units/mL. How many milliliters of heparin would be
needed to treat this patient?
a. 0.8 mL
b. 0.08 mL
c. 8.0 mL
d. 0.4 mL
COMPLETE THE FOLLOWING PROBLEMS
1. Change to equivalents within the system:
a. 100 mg = _____ g
b. 1,500 g = _____ kg
c. 0.1 L = _____ mL
d. 500 mL = _____ L
2. Convert to units in the metric system:
a. 150 gr = _____ g
b. gr = _____ mg
c. 45 min = _____ Ml
d. 2 qt = _____ L
3. Convert to units in the household system:
a. 5 mL = _____ tsp
b. 30 mL = _____ tbsp
4. Convert the weights in the following problems:
a. A patient weighs 170 lb. What is the patient’s
weight in kilograms? 170 lb = _____ kg
b. A patient weighs 3,200 g. What is the patient’s weight in pounds? 3,200 g =
_____ lb
5. Robitussin cough syrup 225 mg PO is ordered. The bottle reads: 600 mg in 1 oz.
How much cough syrup should be given? _____ mL.
6. A postoperative order is written for 15 gr of codeine every 4 hours as needed
(PRN) for pain. Each dose given will contain how many milligrams of codeine?
_____ mg.
7. Ordered: 6.5 mg. Available: 10 mg/mL. Proper dose: _____ mL.
8. Ordered: 0.35 mg. Available: 1.2 mg/2 mL. Proper dose: _____ mL.
9. Ordered: 80 mg. Available: 50 mg/mL. Proper dose: _____ mL.
10. Ordered: 150,000 units. Available: 400,000 units/ 5 mL. Proper dose: _____ mL.