Nursing and measurements

We use apothecary, household and metric systems of measurement, and we often must convert from
one to another.

Nursing and dosage calculations…

We use math to calculate medication dosages by weight, particularly if we are caring for pediatric
patients.

We use math to calculate the dosages in IVs

The most important thing to learn

. Safety is ALWAYS our priority!

These roman numerals are I, II, III, IV, V, VI, VII, VIII, IX, and X represent 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10
respectively.

Rounding numbers

To round numbers, you need to know the place values of numbers. Here is an example:

362

In this example, the 3 is in the hundreds place, the 6 is in the tens place, and the 2 is in the ones place.

Let's say you are asked to round to the nearest ten. Take a look at what number is in the tens place, and
then take a look at the number directly to the right of it. In this case, the number 6 is in the tens place,
and the number 2 is the number directly to the right of it.

Once you have located these numbers, ask yourself if the number to the right of the tens place is five or
greater, or four or smaller. If the number in the ones place is five or greater, the 6 gets rounded up to a
7. But in this case, the number to the right of the tens place is 2, so the 6 stays the same.

So, if you are rounding 362 to the nearest ten, the answer would be 360. The 3 stays the same because
anything to the left of the place value being rounded stays the same. And the 2 becomes a zero, to
indicate that there is nothing in the ones place.

Decimals and rounding off decimal numbers

Sometimes, decimal numbers are used to be more precise, and to communicate amounts less than one.
For example, consider the number

23.65
The 2 is in the tens place, the 3 is in the ones place, the 6 is in the tenths place and the 5 is in the
hundredths place. Note that for numbers less than one, the place values have "th" added to the end of
them.

Let's say we are asked to round 23.65 to the nearest tenth. As with whole numbers, we look at the
tenth place and see that there is a 6 there. Then we look at the number directly to the right of the 6 and
see a 5. Since we round up for numbers to the right which are five or greater, that 6 becomes a 7, to
make the number 23.7.

Special rules for decimals

In health care, we have special considerations when writing down decimal numbers, because we cannot
risk being misunderstood.

For example, consider the number

0.1

See how there is a zero to the left of the decimal point? We call that a leading zero, and if you are
writing a decimal number that is less than one, you MUST include a leading zero. Why? Imagine that
you are working a night shift, you are tired, and someone didn't do a good job of making the decimal
point clear. You might mistake that number for a 1, and that would mean you might give someone TEN
TIMES the intended dosage! By putting in a leading zero, we tell the reader that they are dealing with a
number less than one.

Now let's consider the number

3.2

Let's say you were rounding that number to the nearest whole number. In this case, even though the 2
becomes zero we NEVER write that zero in, because it would look like 3.0, and someone might mistake it
for 30! That type of zero, the kind that's just hanging around on the end of a number not being
particularly useful, is called a hanging zero.

To summarize:

ALWAYS include a leading zero for numbers less than one.

NEVER include a hanging zero for numbers greater than one. Note also that you don't put a leading zero
for numbers greater than one, because that, too would confuse the reader! Respect the zero and only
include it if the number needs it to make sense! The number 3 makes sense. The number 03 is
confusing!

Fractions

We use fractions less frequently than decimals in health care, but fractions do come up from time to
time, so we need to understand how to use them correctly.

Consider the number 3/4

This number is telling you that it is less than one. The 3 is called a numerator, and it tells you that 3 is
how many pieces you have. The 4 is called a denominator, and it tells you that altogether the number is
divided into 4 parts. If you look at the whole fraction, then, you see that out of 4 possible parts, there
are 3 in this particular number.

In this example, the numerator is smaller than the denominator. That is called a proper fraction. If you
are writing a fraction number that is less than one, then you must put your answer into the form of a
proper fraction.

Sometimes, to perform operations on fractions, we need to temporarily turn fractions into improper
fractions like this:

5/2

Note that in an improper fraction, the numerator (5) is larger than the denominator(2). Once you are
finished writing your answer, you must convert an improper fraction into a mixed number. A mixed
number is a combination of a whole number and a fraction. So, the number above would become

1
2
2
Fractions: Important rules

All fractions must be reduced to their simplest form. Consider the number 2/4.

Both the numerator and the denominator in this number can be divided by 2, resulting in the number
1/2.

We call that the simplest form, or sometimes the lowest form or lowest terms.

Friendly note: When working with fractions, ALL answers must be in simplest form (for numbers less
than one) and in mixed numbers (for fraction numbers greater than one). And if you get a fraction
question on a test, you are expected to give a fraction answer. If you do not follow these rules, you will
get a mark of zero for that question

The important thing to remember is that in this course, you are always being evaluated on your
attention to detail. In the case of operations, it is important that your answers always include whichever
unit is appropriate for the question on which you are working.

example

The practical nurse is tracking the patient's oral fluid intake. According to the PSW's notes, the client's
intake for today has been:

325 mL coffee

250 mL chocolate milk

170 mL juice
95 mL Jello (yes, Jello is considered a fluid!)

400 mL water over the day

185 mL water with evening meds

How many millilitres has the patient taken in today?

To find this out, you just add everything up, and then provide your answer with the appropriate unit. In
this case, your answer would be

1 425 mL

How do you know what the unit is? It is usually the word that comes right after "how much" or "how
many" in a question. You might also be instructed to convert your final answer into a particular unit,
such as millilitres to litres.

It is extremely important that you pay attention to the correct unit when you are doing any calculations
as a nurse. Using an incorrect unit can be dangerous.

Writing large numbers

Place a space for any amount with more than four digits. Do not use a comma, as it could be mistaken
for a one.

10 000 is correct.

10000 is incorrect.

10,000 is incorrect.

Writing units

Do not use a period or an “s” at the end of an abbreviation, as either one could be misinterpreted as a
one. Feel free to use an “s” or a period if you write out the whole word.

5 mg is correct

5 mg. is incorrect

5 mgs is incorrect

To avoid confusion, always use a capital “L” when referring to litres or to millilitres: L or mL, not l or ml.
Use only standard abbreviations for all units.

120 mL is correct

120 ml is incorrect

Make sure there is a space between your number and the unit.

325 mg is correct

325mg is incorrect
The Eleven Commandments of Nursing Math
1. Thou shalt put the number before the unit: 5 g not g 5
2. Thou shalt not use a period in a unit abbreviation: 14 kg not 14 kg.
3. Thou shalt not use an "s" on an abbreviation: 22 lb not 22 lbs
4. Thou shalt separate the number from the unit: 20 mg not 20mg
5. Thou shalt use a space and NEVER a comma for numbers equal to
or greater than one thousand: 3 750 not 3750
6. Thou shalt use decimals, not fractions, in all calculation unless told
otherwise: 0.5 not 1/2
7. Thou shalt employ the leading zero for all amounts less than one:
0.5 not .5
8. Thou shalt not use unnecessary or trailing zeros: 0.5, not 0.50 and 3,
not 03 or 3.0
9. Thou shalt not mu! Use mcg, not µg
10. Thou shalt capitalize the letter L when referring to litres or
millilitres: L and mL, not l and ml
11. Thou shalt always include the correct unit in thy answer
Ratio, Proportion and Percents

Ratio

 A way of expressing a relationship between numbers

– Example: There are forty-two female students for every twenty male students in the PN
program

Percent

 A way to show a fractional relationship out of one hundred

– Example: 91% of dogs have brown eyes

Proportion

 A proportion is also a way to express a relationship between numbers, and can be used as an
equation

– Example: If there are 42 female students for every 20 male students, what percentage
of students is male?

• You can set it up as an equation: 20 = x

62 100 (NB: 62 is the total of all students)

 Nurses need to know how to convert between these systems, because they are useful for many
things, including calculating measurements.

– Example: The baby weighs 6.8 pounds. How many kilograms does the baby weigh?

• Set it up as a proportion: 6.8 lb = 2.2 lb

x kg 1 kg

• Cross multiply: 6.8 x 1 = 2.2x

• Solve for x, rounding as instructed: 3.09

• Give final answer with units: 3.09 kg

– Remember, nurses need to clearly communicate the correct unit, and follow
instructions written into questions!

S.I. METRIC SYSTEM

There are three systems of measurement you are likely to encounter in a clinical setting:

The metric system is the system you will see most commonly. It is the system used in hospitals, medical
offices and long-term care. The metric system is based on a system of units of 10.

The household/imperial system may be used by some of your patients or their families. The metric
system was brought into use in the 1970s in CanadaSome example of household and imperial units
include ounces (oz), teaspoons (tsp), cups (c).
The apothecary system of measurement is a very old system that is not generally used anymore, but we
do still use ounces, which are part of that system.

Common Base Units

 Weight – gram(g): solid medications, body weight

 Length – metre(m): patient's height, circumference

 Volume – litre(L): liquid medications, fluid intake

 Other units you encounter in a clinical setting include mols, milliequivalents, and international
units.

 We use millimols/litre (mmol/L) to measure blood glucose.

 We use milliequivalents (mEq) for some medications, such as some vitamins and potassium.

 We use international units (IU) for some medications, such as some antibiotics, and for insulin.
In the case of insulin, we just use the term unit. Please note that the abbreviations IU and U are
on the ISMP's Do Not Use List
 The three base units for the metric system are the gram, the litre and the metre.
 When we are referring to a multiple or fraction of these units, such as centimetres or millilitres,
we add a prefix to the base unit to indicate what multiple or fraction we mean.
 Kilo- means the base unit is multiplied by 1000.
 Centi- means the base unit is multiplied by 0.01
 Milli- means the base unit is multiplied by 0.001
 Micro- means the base unit is multiplied by 0.000 001

Converting within the metric system

If you want to change from a bigger unit to a smaller unit, do this:
Example: 33.6 kilograms → grams
Note that kilograms are 1 000 times larger than grams.
So, to convert, multiply 33.6 x 1 000.
So, 33.6 kg = 33 600 grams
Take a moment to consider your answer. If you are going from a bigger unit to a smaller unit,
there should be more of it, so if the number you get is smaller, you went the wrong way!
Here's another example, this time going from a smaller unit to a bigger unit:
Convert 550 mcg to mg
Note that micrograms are 1 000 times smaller than milligrams. So, this time, you are going from
a smaller to a bigger unit, and to do this, you divide by 1 000.
550 mcg divided by 1 000 = 0.55
Again, take a moment to consider your answer. You are going from a smaller unit to a bigger
one, so there should be less of it. So, if your number got bigger, you went the wrong way!
Notice, also, that the zero on the end of 550 is useful for the number 550, but it is not useful for
the number 0.55, so we remove it. Remember, nurses must not have any trailing or useless
zeros!
1 g = 1 000 mg
1 kg = 1 000 g
1 L = 1 000 mL
1 m = 1 000 mm
1 mg = 1 000 mcg
1 km = 1 000 m
1 mL= 1 cubic centimetre, which we abbreviate to cc
The last example, going from mL to cc is the easiest, because they are the same! We use cubic
centimetres a lot for liquid medications and intravenous fluids. The unit cc is on the ISMP's Do
Not Use List

Temperature
We use the Centigrade (Celsius) scale to measure temperature, but your patients may only
understand Fahrenheit temperatures.
To convert a temperature from Centigrade to Fahrenheit, use this formula: °C x 1.8 + 32 = °F
To convert a temperature from Fahrenheit to Centigrade, use this formula: (°F - 32) divided by
1.8 = °C
Example: Convert 36°C to Fahrenheit. Round to the nearest degree.
Using the formula, we start by multiplying 36 by 1.8 = 64.8
Then add 32 = 96.8
Remember that the instructions tell you to round to the nearest degree: 97
Don't forget your unit!
97°F (the correct unit for temperature should be written with a degree sign AND the letter to
indicate whether it is Centigrade or Fahrenheit…since that can be tricky on a computer, we will
talk about how to work around this in our synch class)

Measuring time in a healthcare setting

Healthcare is a 7-day-a-week, 24-hour-a-day business! To ensure clarity and accuracy, we use
the 24-hour clock to communicate time in our documentation, and frequently in conversation
with other health care professionals.
Here are the rules for converting a standard (am/pm) time to 24-hour time:
For times earlier than 1000 h (10 am), you put a zero at the front of the time.
For example: 9.30 am is expressed as 0930 h
In this case, the zero is useful before the 9 because it is telling us we are dealing with the
morning! Here is how you would say it aloud: "Oh nine thirty hours".
If the time is past noon (midday), you add the number 12 to it.
For example: 9.30 pm is expressed as 2130 h. (9 + 12 = 21)
If you are right on the hour, you use the word hundred.
For example:
8 am is 0800h and 8 pm is 2000 hours. Here is how you say them aloud: "Oh eight hundred
hours" and "twenty hundred hours".
If that sounds weird to you, don't worry, you get used to it! Practice using it in everyday speech
and writing, and while it may irritate your friends and family, it will make you more comfortable
with it!
Do not use colons, periods, or am/pm with 24-hour time.
So, 21:00 and 21.00 are wrong, and so is 2100 pm.
Always include the unit, hours (h), because you need to communicate that you are referring to
time, not a quantity of a physical substance.
So, in your documentation, say 2100h unless told to do otherwise.

Roman numerals

For example, II and ii both mean 2, not eleven or "eye eye".

Please note that Roman numerals are discouraged because they are easily misread, so you
should not write them. However, you may see them, so you need to know what they mean

Unclear notation

Unclear communication could endanger the safety of the patient!

Example 4u could mislead some one to be 44
Intended dose of 4 units in patient history interpreted as 44 units, because the “U” looks
like a 4. “U” should be written out as “unit.”
“Potassium chloride QD” in medication order interpreted as QID, because QD is written messily
and is also not a standard abbreviation. Should be written as “daily.” Also, for potassium, we
use “K” as an abbreviation, not “pot”!

How we communicate in health care

Written orders: prescribers may handwrite orders on paper in a chart.
Narrative notes and flow sheets: all health care professionals document their assessment
findings and their care.
Computerized charting: increasingly, computers are used to document all aspects of
assessments
Medication administration recordsA medication administration record (MAR) is used to
document medications as they have been given.
Telephone/verbal orders: prescribers may just verbally tell a nurse what to administer or do for
a patient
The best way to avoid using confusing abbreviations is to spell out a word. That said, there are
lots of standard abbreviations that you can use safely.
If you are uncertain whether your abbreviation is correct, spell out the whole word!

ER, CR, SR, XR

The most common route for medications is the oral (by mouth) route. Some medications have
been designed to enter the body slowly, over several hours. Usually this is accomplished with a
special coating on the drug.
We call such medications extended-release (ER or XR), slow release (SR), and controlled
release (CR).
The nurse must never crush a tablet or open a capsule if it has any of these abbreviations. The
abbreviation typically comes right after the name of the medication, and right before the
dosage:
OxyContin ER 40 mg
If you crush or open this type of medication, you will be giving your patient several hours' worth
of medication all at the same time, which could result in a dangerous overdose.

Drug form abbreviations

capsule- cap
tablet- tab
drop- gtt (this is from the Latin word for drop)
ampoule- amp
solution- sol
suspension- susp
elixir- elix
suppository- supp
ointment- ung (also from Latin)
Unless otherwise indicated, either capital or lower-case letters can be used. We don’t add an
“s” at the end of abbreviations, either: we say “2 tab” not “2 tabs”.

Abbreviations for routes

A route is how the drug gets into the body.
orally (by mouth) - po/PO
topically (on skin or mucous membrane) - top
sublingually (under the tongue) - SL (capitalize)
intradermally (into the dermis layer of the skin) - ID (capitalize)
subcutaneously (into the subcutaneous fat just under the skin) - subcut (note that you may see
SC, subQ or subc, but these are on the ISMP "Do Not Use" list, so avoid using them)
intramuscularly (into a muscle) - IM (capitalize)
intravenously (into a vein) - IV (capitalize)
via nasogastric tube - NG or NGT (capitalize)
rectally (through the rectum) - PR (capitalize and note that you may see R as well, but this can
be confusing, so don't use R)
Please note that in a quiz, test or exam, you can either use the description (by mouth) or the
adverb (orally), as long as you are clear and correct.

Time abbreviations
before meals - ac (again with the Latin!)
after meals - pc
immediately - stat
at bedtime - hs
every bedtime - qhs
when necessary - prn*
once a day- od (please note that this is an error prone abbreviation, so while you may see it, you
should not write it)
twice a day - b.i.d.
three times a day - t.i.d.
four times a day - q.i.d.
* The most prescribed prn medications are analgesics (pain killers). You will learn more about
pain management throughout your education at GBC, but please be proactive and inquire about
your patient's pain rather than waiting for them to ask, because patients often only ask after
they are in a lot of pain, which causes them needless suffering! Also, please note that in some
rehabilitation settings, prn pain medications are routinely given prior to physiotherapy, so if you
are placed in an orthopedic setting, please check with your clinical instructor regarding the
institution's pain management policy.
every hour - q1h
every two hours - q2h
every three hours - q3h
every four hours - q4h*
every six hours - q6h
every eight hours - q8h
every twelve hours - q12h
*Many students get q4h and q.i.d mixed up. Think about it: there are twenty-four hours in a
day. If you give a patient medication q4h over 24 hours, they receive 6 doses (24
hours divided by every four hours). If you give a patient a medication q.i.d., they receive the
medication every 6 hours (24 hours divided by four times). So, make sure you take your time
and think carefully about what the "q" means, or you might end up giving too many or not
enough doses!

NPO Orders
NPO means nothing by mouth (Latin again!). Sometimes the reason for this is that the patient
has just had a stroke or has some other issue impeding swallowing and this is a temporary safety
measure. Sometimes, the patient needs an empty stomach for a procedure
When you are caring for your patient, always make sure they are not NPO

Sometimes, students get the words "nothing" and "not" mixed up. They do not mean the same
thing! So, if you are asked to say what NPO means, write "nothing by mouth", or you will
have written the wrong thing!
Pharmacology: the study of drugs, their interactions with living organisms, how they work,
dosages and side effects.
Pharmacy: the art and science of compounding, preparing and dispensing drugs.
Pharmacotherapy: how drugs are used to prevent and treat disease
Pharmaceutics: the science of drug form designs. For example, a medication like Tylenol may
come in tablets, caplets or gel caps. Creating these different forms is pharmaceutics.
 Week3

Here is what the CNO says

 Nurses need to know why a patient is taking a medication.
 Nurses need to perform appropriate assessments before, during and after a medication is given.
Nurses must follow the “8 rights” of medication administration
 Nurses must have appropriate authority to give a medication. You will learn more about this
shortly.
Nurses are accountable for medications we give, no matter who orders them. Nurses should
withhold meds if they are concerned that those medications could harm a patient, and then
report their concerns to the prescriber
 GBC requires PN students to create original drug cards. These cards contain a summary of the
information needed to safely administer a medication.
 Research shows that writing out drug cards helps you learn and remember the information.

What we research: Names

 Trade names are always written with the first letter capitalized.
 Generic names are always written in all lower-case letters.
 You may have several different trade names for the same generic medication.
 Examples of trade names:
– Gravol
– Immodium
– Pepcid
 Examples of generic names:
– dimenhydrinate
– loperamide
– famotidine

Medications are classified in many ways:

– By therapeutic action
– By body system
– By chemical composition
– By OTC/Rx status

Learning the therapeutic classes of medications makes learning meds a lot easier, since most
meds within a particular therapeutic class work similarly
 Examples of therapeutic classes:
– Antibiotics
– Antihypertensives
– Analgesics
Drugs are further classified by their chemical composition, and this is usually referred to as a
pharmacological class.
 Examples of pharmacological classes:
– Quinolones
– Beta adrenergic antagonists
– Opioids
 We need to know why OUR patient is getting the particular medication. This is known as the
indication for a medication. In your drug book, you may also see the word “use” to describe an
indication.
There are two reasons that a nurse must be aware of the indication for which the patient is
receiving a particular drug:

One medication can have many indications.

For example, ASA can be given for:

Analgesia (reduce pain)

Anti-platelet aggregation (reduce blood clotting)

Anti-pyrexia (reduce fever)

Knowing why YOUR patient needs this medication will drive your other nursing assessments and
interventions; in other words, your nursing process

Using the example of ASA from the last slide, consider:

If you had a patient taking ASA for pain, you might ask the patient to tell you where the pain is, how
bad it is on a scale of 1-10, or when it started. Once you had given the ASA, you would check in
again to see how the pain was, which is called a follow-up. Any assessment made after an
intervention is called a follow-up

Now think about a patient taking this medication to reduce blood clotting. You would need to know
what condition the patient had that would require them to reduce the blood’s ability to clot, so that
you could make other assessments relevant to that condition. For example, patients usually take
blood-thinning medications to reduce the risk of stroke, or if they are at risk for stroke or for heart
attack. If you knew that your patient was at risk for stroke, you would assess for signs of stroke,
such as weakness or paralysis on one side of the body. If you knew that your patient was at risk for
heart attack, you would ask about any incidents of chest pain.

If your patient was taking ASA for a fever, you would check their temperature, and follow-up after
the med was given to see if the fever had come down. Since fevers accompany an infection, you
might also have other assessments particular to an infection, such as checking for a cough for a
patient with an upper respiratory infection.

Consider how different these three indications are, even though they are all being treated with the
same drug. It would not make sense to do a pain assessment for a patient with a fever, or to take
a temperature for a patient at risk for stroke. Knowing your particular patient’s indication will
drive your assessments, your patient teaching and any follow-up assessments that might be
appropriate.
A note about off-label uses

An off-label use is an indication that has not been approved for use by Health Canada. Often this is
because the drug is still being investigated for efficacy with a new indication.

For example, gabapentin is a medication that is indicated for the control of seizures and neuropathic
pain (pain from the nerves themselves). However, it also has an off-label use as a migraine
treatment. It would be important for you to know this, because the assessments and care you
provide for a patient with migraines is not the same as it would be for seizures or neuropathic pain.

Routes and doses

A route is the means by which the drug enters the body. Some drugs are available in more than one
route. For example, Gravol may be given PO, IV, and PR

The dose is the amount of medication the patient is to take. You won’t be expected to memorize
dosages of medication, but your drug research should include the usual ranges of doses for
particular indications.

Knowing the usual range of doses for a particular indication will help you to identify when a patient
is getting an unusually high or low dose

Routes, doses and effects

The way a medication is given will often influence how it affects the body.

A local effect is limited to the site where the medication was administered. This is the type of effect
that usually occurs with topical medications, such as ointments.

A systemic effect affects the entire body. Sometimes this is intentional, but sometimes it is just
unavoidable.

A therapeutic effect is the effect intended by the prescriber. Not all effects of medications are
desirable. We will discuss this shortly.

What do we research

We need to know for which patients this medication is potentially dangerous. This is known as
“cautions” and sometimes, as “contraindications”

 Cautions are conditions under which a medication MAY cause problems, for which nurses
should be on the lookout, for example:

– Patients who are breast feeding

– Patients with impaired renal or hepatic function.

 If your patient is taking a medication for which a caution is issued, take a better look at the
patient’s whole clinical picture and ask questions to make sure the drug is safe. You will learn
about how to ask these questions with more experience.
 Contraindications are conditions under which a medication WILL cause problems, and which
usually require nurses to withhold a medication.

– Allergies are a definite contraindication!

– Some other examples: giving an antihypertensive medication to a patient whose BP is

already really low; giving a laxative to a patient with diarrhea

 If your patient has a contraindication to a medication, DO NOT GIVE IT.

– Follow up by informing the prescriber and other relevant HCPs as soon

as possible, and document that you did so.

– Make sure that other nurses are aware of what you have found so that
they do not inadvertently administer the med.

Note: Cautions and contraindications are pre-existing conditions, NOT adverse (side) effects,

What we research: MOA

 Medications have particular effects on the human body. We call this the mechanism of action,
or MOA.Once you know this, you can predict nursing implications and potential adverse
effects.

 A well-written and useful MOA includes the following information (three key facts):

 The target organ(s) and/or system(s)

 The target physiological process(es)

 Whether the physiological process is increased by this drug or decreased by it

 Here is an example of an MOA as it might appear in a drug book:

“Selectively blocks beta1 adrenergic receptors”

and the purpose of a drug card is to help you understand the drug your patient is taking.

Here is the way you might write this MOA on a drug card:

“Blocks adrenergic receptors (which create a fight-or-flight response in some organs, such as the
heart and blood vessels), decreasing the sympathetic (fight-or-flight) response in those organs”

This MOA tells you the target tissue (heart and blood vessels), the target process (sympathetic
nervous system stimulation) and it tells you this process is inhibited.

Once you understand this, you can start to anticipate potential adverse effects, and plan ways to
minimize the danger to your patient. For example, if you know that decreasing the sympathetic
stimulation of the heart muscle will make the heartbeat slow down, you know that one adverse
effect is bradycardia (excessively slow heartbeat) and you can check the heart rate before giving the
medication to ensure that the heart rate doesn’t fall too low!
What we research: Side effects

When we research medications, we need to consider both the therapeutic effects and the
unintended effects of a medication. Any unintended effect is referred to as a side effect. However,
the term side effect is imprecise, because it does not make any distinction about the severity of the
effect.

An unintended and undesirable effect is an adverse effect, and that is the term you will hear most
often in pharmacology. Adverse effect usually refers to an effect which is non-life-threatening, such
as nausea or constipation.

Adverse events are more significant effects caused by a medication, such as cardiovascular changes.
To keep things simple, we will usually refer to any negative consequence of a medication as an
adverse effect, but you will hear the term adverse events used in future semesters.

Most adverse effects are predictable once the nurse is familiar with the MOA.

When you start to research medications, you may find it difficult to decide which adverse effects to
focus on, since most drug books list a lot.

Determining which adverse effects you should consider takes a lot of practice and patience!

Be patient with yourself as you learn to research adverse effects, it takes time!

Note: adverse effects are events which may occur after a medication is given. They should not be
confused with cautions, which are conditions the patient has before the med is given which may
cause a problem, nor with contraindications, which are also conditions the patient has before the
med is given which will cause a problem

What we research: Nursing implications

Nursing implications covers a wide range of assessments, precautions, teaching, follow up and care
for patients taking a particular medication. Drug books sometimes have other terms for this, such as
“nursing considerations”, or “nursing process

Nursing implications relate to how the nursing process must be applied to the administration of
drugs.
The Nursing Process and Drug Administration
 Examples:
– If you are giving a beta blocker, you should always assess both an apical pulse and BP. If
the apical pulse is under 60 bpm and/or the BP is less than 90/60, you should withhold
the drug and contact the prescriber.
– If you are giving a blood thinner, teach your patients the signs and symptoms of GI
bleeds.
– If you are giving a pain medication, go back and follow-up with the patient to determine
if the drug helped ease the pain.
 When looking at nursing assessments for a particular drug, prioritize “bedside” assessments,
such as taking BP and pulse, because these are things you already know how to do. Eventually,
you will also learn how to interpret lab results, and may even learn how to interpret ECG
readings.
 You should also think about your specific patient and how this medication may affect him or her
in particular, because of other medications, the reason he or she is in the hospital, or because of
co-morbidities.
Remember, you are giving holistic care!
– Co-morbidities are conditions that patients have at the same time as whatever brought
them to the hospital
 Example: Your patient has come to the hospital for a knee replacement. She is
diabetic. Her co-morbidity would be diabetes, which might mean there are
other things about this patient which require special care, such as her
vulnerability to infection.
– Pharmacokinetics (how a drug moves through the body)