Author: Mel Pinter, Phd, RN, CNE
Institution: Hinds Community College
Patient-Centered Care, Safety
Patient-centered care (PCC) and safety were the objectives for this learning activity.
This interactive hands-on learning activity was developed as part of first semester fundamentals of nursing course to provide understanding of pharmacokinetics and safe medication administration. The purpose of the activity was to engage the students and help them grasp the connection between absorption, distribution, metabolism, and excretion.
The activity correlated with the didactic content (pharmacokinetics and medication administration) to link the activity to how drugs are effected once they enter the body and how specific patient disorders can affect pharmacokinetics. Afterward, the students were asked to use clinical reasoning to determine how to manage patients with disorders that could impact the absorption, distribution, metabolism, and excretion of drugs.
As a ticket to class, students completed a crossword puzzle that included key terms related to pharmacokinetics and safe medication administration. The puzzle was reviewed at the beginning of class to ensure all students had the correct answers and to allow time for questions and clarification of terms. Students were divided into groups of five. Each group had access to a sponge (similar to a car wash sponge which measures 8.75” X 4.75”), a bottle of water, a bowl, a clear cup, a small funnel, and one denture tablet. The denture tablet was dissolved into ¼ cup of water to illustrate how caplets and tablets have to be dissolved before they can be absorbed by the body. Once the tablet was dissolved, this solution was poured into a sponge via the funnel. As the solution began to soak into the funnel, this represented the process of absorption. Absorption is the transformation of the drug from the site of entry in the body into the bloodstream. The process of distribution was discussed as the solution soaked the entire sponge. Distribution is the movement of the drug into body tissues. Metabolism was represented as the sponge being completely soaked. Metabolize means “to change.” Metabolism is the process by which drugs are changed and utilized by the body. The liver is the major site of drug metabolism and the importance of adequate liver function was discussed. Excretion was demonstrated by squeezing the water from the sponge into the bowl. Excretion is the removal of the drug from the body. The kidneys are the major site of drug excretion. The importance of adequate kidney function was discussed and how this could impact the effectiveness of drug therapy. After the sponge activity, the groups were given five index cards. Four of the cards had a condition listed and the fifth card had the rights of medication administration listed. The cards included: a patient decreased hepatic function; a patient with decreased renal function; an elderly patient who is eighty years old; an infant who is four months old; and the rights of medication administration. Based on the card selected, the student had to discuss how their specific condition impacted pharmacokinetics and safe medication administration. The patient with decreased hepatic function does not metabolize drugs as effectively as patients with adequate hepatic function. This patient should be monitored for drug accumulation and drug toxicity. The patient with decreased renal function should be monitored for drug toxicity and accumulation as the renal ability to excrete drugs is altered. Physiologic changes associated with aging alter the body’s response to drug absorption, distribution, metabolism, and excretion. Elderly patients have to monitored closely for drug toxicity. Infants have immature body systems that may affect the ability to absorb, distribute, metabolize, and excrete drugs. Collaboration with the healthcare provider regarding proper medication dosage should be discussed for elderly and infant patients. The student with the rights of medication administration card had to discuss how each right impacted safe medication administration.
The materials required an initial investment of approximately ten dollars. No funding was received for this activity. The demonstration required no special adaptation of the materials.
A sponge (similar to a car wash sponge which measures 8.75” X 4.75”), a bottle of water, a bowl, a clear cup, a small funnel, and one denture tablet.
As the students were sharing information from their activity and cards, faculty were circulating in the room to listen and confirm correct responses or to provide guidance on incorrect responses. Peer review was also encouraged as students shared information.
Student feedback was obtained using a survey which included the following items: This learning activity was beneficial; I enjoyed this interactive learning activity; I learned new information related to pharmacokinetics; In the future, I want to use more activities like the sponge activity to demonstrate key concepts; This teaching/learning activity helped me understand pharmacokinetics. Thirty-one of the thirty-eight students who participated, submitted evaluations. Graphic 1 displays the results of the student evaluation. All students either strongly agreed or agreed the learning activity met the learning objectives.