Pharm

CNO Principles: Authority, valid order, therapeutic relationship, appropriate scope, Do NOT perform if unclear orders. Competence: Know drug, assess client, educate patient, know limits. Nurse must ensure knowledge, skill, judgement. Safety: Prevent errors, monitor effects, report adverse reactions, ensure storage security. Nurse must act to min harm from errors/reactions. Scope Of Practice: Definition; Nursing=promote health, care, treatment. RPNRN Controlled acts; Injections, INH meds, procedures below dermis, inserting instruments, dispensing drugs. Authorizing mechanisms: Need a order, directive, delegation. Working w/UPC: Teaching, Delegation, Assigning, Supervising. Accountability; Assess client, risk, verify competence, supervise. Communication/Medication Safety; SBAR communication, Reporting refusals/adverse effects, Colabe w/ Pharm&MD.

Medication Groups Antipsychotics: 1,2,3 Gen, Antidepressants, Mood stabilizers. Used for Psychosis, Mood/Anxiety disorders. 1st Gen(Typical) Strong dopamine block, Increased EPS(Extrapyramidal Symptoms) Eg; Haloperidol. 2nd Gen(Atypical) Dopamine+Serotonin, decreased EPS, Increased metabolic risk. Eg; risperidone, clozapine. 3rd Gen; Dopamine stabilizers Eg; Aripiprazole. Anticholinergic Effects "SLOW DRY" Constipation, Urine retention, Dry mouth, Blurred vision, decreased sweating (Common with antipsych/TCAs). Neuroleptic Malignant Syndrome(NMS)**Life Threatening reaction to antipsychotics** Symptoms; High fever, severe muscle rigidity, confusion, autonomic instability. Agranulocytosis ** Abnormal CBC** Decreased WBC, Increased Infection risk. Most associated drug, Clozapine. Monitor CBC/ANC, hold if low. EPS Includes; Dystonia; Muscle contractions causing repetitive movements or postures. Parkinsonism; Slowed movements, tremors, stiffness, rigidity. Akathisia; Difficulty staying still, causing repetitive movements. Often ppl want to crawl out of skin. Types; Acute dystonia, akathisia, pseudo parkinsonism, tardive dyskinesia. Antidepressants; SSRI, SNRI, TCA, MAOI. TCAs: Anticholinergic, cardiac risk. SSRI/SNRIs; Better tolerated, serotonin syndrome. Mood Stabilizers; Bipolar Lithium (0.6-1.2 mmol/L). Live vaccines, who should not receive; Immuno comp, pregnant pt, recent organ donors/stem cell transplant, Pt w/ high dose steroids/chemo. Live Vaxx: MMR, Varicella, LAIV(flu), Rotavirus, Yellow fever. Low immune system; Congenital Immune disorders, Chemo/Rad pt, HIV/AIDS, Post transplant, Leukemia pt. Pregnancy pt avoid: MMR, Varicella, LAIV, yellow. Safe for preg; Influenza, Tdap, Covid, Hep B. Immunization; 2 & 4=Diphtheria pertussis, tetanus, whooping, polio, Haemophiles influ, pnacoccal, rotavirus,  6 mon=Dip, tet, whoop, polio, Hib. 1 yr=pneumococcal conjugate, meingococcal, MMR.