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Expected Actions/Outcomes

by Diana Shenefield, PhD
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    00:01 Today we're going to talk about expected actions and outcomes, and we're talking about pharmacology, which again, is a very big part of NCLEX. My name is Diana Shenefield. So let's dive into this. We're going to talk about a little bit of overview. And again, as I just mentioned, pharmacology is a big part of NCLEX. It's so important that you know common drugs. And so we're going to talk a little bit about what is expected.

    00:24 Again, I want you to read your learning outcomes. If at any point in time you don't feel like that you've met those outcomes or you're confused about those outcomes, make sure you go back to your pharmacology book and review. So we're going to start out with a question just to kind of get your mind thinking about the topic that we're going to talk about. A patient with disseminated herpes zoster is given IV hydrocortisone. We know that's probably Solu-Cortef. Which lab value does the nurse expect to be elevated as a result of this therapy? Again, there are certain drugs that you're going to need to know. There are certain disease processes that are common. And so you're going to want to be able to put this together. So, what do you think? Calcium, glucose, magnesium, or potassium? Hopefully, you picked glucose. Glucose and steroids always go together. So whenever you have a patient that is on a steroid, always be thinking about glucose. Second, a patient with a ventricular septal repair is receiving dopamine, which we know, works on the heart, postoperatively. Which response is expected? Again, you may not know exactly every single drug, but there should be hints in the question, and there should certain things about certain drugs that ring true to you. So should they have a decreased heart rate? Should they have a decreased urine output? Should they have increased cardiac output? Or decreased cardiac contractility? So if you're thinking about a patient that just had heart repair, what are we going to want? Hopefully, you picked C, increased cardiac output. So again, you're going to want to review those common outcomes for certain medications. So, when you're looking at your drugs, you need to know what's expected. We call that the therapeutic effect.

    02:13 What do I want to have happened when this patient takes the medication that I'm giving them? What's the whole purpose? If you don't know the purpose for a medication that you're giving, you need to question the physician, you need to question the patient. There needs to be a purpose. What are your expected outcomes? We know that there are different outcomes. We have side effects, we have adverse effects, but what is the whole reason? Is it to change the way the patient is breathing? Is it to change their pulse rate? Is to help the infection go away? It's really important that when you're studying your medications that you're also looking at what is the purpose, and make sure you're reading through those uses, so that when your patient is on those drugs or when you're answering questions about those drugs that you understand why they're taking it, what signs and symptoms are you trying to treat.

    03:06 So expected outcomes. Again, not only do I need to understand them but I need to make sure that my patient understands them as well. That's where my education comes in. I want my patient to be compliant. And for them to be compliant, they have to know why. Why am I taking this medicine? Why am I going to see as the outcome for that? Again, they only know that for me teaching them, and that's a huge part of my job by giving medications. So, what do I need to review when I'm looking at expected outcomes? Well, one of the things I need to review is my routes of administration. I need to remember that oral meds have to pass through the gut before they are metabolized. So what does that mean as far as how fast it's going to work? I need to understand first pass effect.

    03:52 Remember that's when a lot of the drug is metabolized through the liver and has become inactive, really important to understand that.

    04:01 Sublingual and buccal, remembering, am I putting it in the cheek or under the tongue? Is that faster than swallowing? Yes, because of the capillaries. How about liquids or swallowing a pill, which one is metabolized faster? Or extended release? What happens if a patient chose an extended release or breaks open extended release capsule? If they don't know what the consequences are to that, they're not going to abide by that and they may think it's no big deal. I need to educate them on that and I need to understand that as well. And then remembering that IV is the fastest route of administration. So when I go back and I ask a patient that I've given a pain med too, if I've given an IV, how soon can I expect results? If I've given them a pill, how soon should I expect results and when can I tell the patient that they should be expecting results? These are all things that you need to review. So in closing, make sure you know your drugs. Now I know people are going to say, there is no way I can know every drug in the drug book. And you're right, there is no way. But there is common drugs, in that antibiotics and medicines for blood pressure.

    05:12 So again, what is it about that drug that you're giving it to that patient? What is your expected outcome so that you can document against that and you can also teach that. So again, look at your pharmacology book and answer those questions in your NCLEX book and you'll do fine on the test. This is Diana Shenefield. Good luck.


    About the Lecture

    The lecture Expected Actions/Outcomes by Diana Shenefield, PhD is from the course Physiological Integrity. It contains the following chapters:

    • Expected Actions and Outcomes
    • Routes of Administration

    Included Quiz Questions

    1. Give drug on an empty stomach with a full glass of water
    2. Administer drug with meals
    3. Give drug with a full glass of milk to prevent gastric irritation
    4. Give drug with a glass of orange juice or other source of vitamin C
    1. 1130-1930
    2. 0930-1030
    3. 1130-1430
    4. 1530-1930
    1. “It slows down the motility of the intestine thereby increasing fluid absorption”
    2. “Because of the increased sodium in the stool fluid moves into the bloodstream”
    3. “It increases the bulk in the intestines resulting decreased peristalsis”
    4. “It decreases circulation of blood to the bowels making them less reactive to stimulation.”
    1. Decreased urethral obstruction
    2. Hypotension
    3. Syncope
    4. Decreased urinary frequency
    5. Increased urine flow

    Author of lecture Expected Actions/Outcomes

     Diana Shenefield, PhD

    Diana Shenefield, PhD


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