nursing pharmacology study guide pdf

nursing pharmacology study guide pdf

Pharmacology is the scientific study of drug origins‚ effects‚ and therapeutic uses; Nurses rely on pharmacology to educate patients‚ ensure safe medication administration‚ and promote positive health outcomes․

1․1 Definition and Scope of Pharmacology

Pharmacology is the scientific study of drugs‚ focusing on their origins‚ properties‚ mechanisms of action‚ and therapeutic effects․ It encompasses the discovery‚ development‚ and clinical application of medications to prevent‚ diagnose‚ and treat diseases․ Pharmacology is foundational in nursing practice‚ guiding safe and effective drug administration․ It includes understanding drug classifications‚ dosages‚ side effects‚ and interactions․ Nurses rely on pharmacological principles to assess patient needs‚ administer medications accurately‚ and monitor responses․ The scope of pharmacology in nursing extends to patient education‚ ensuring adherence to treatment plans and managing adverse reactions․ This knowledge is critical for delivering high-quality‚ evidence-based care and optimizing patient outcomes․

1․2 Branches of Pharmacology

Pharmacology comprises several specialized branches that guide nursing practice․ Pharmacokinetics studies how drugs are absorbed‚ distributed‚ metabolized‚ and excreted by the body․ Pharmacodynamics examines drug effects on biological systems․ Pharmacotherapeutics focuses on drug uses in treating diseases․ Toxicology investigates harmful drug effects‚ essential for managing adverse reactions․ Pharmacoepidemiology explores drug safety and patterns in populations‚ aiding in evidence-based practice․ These branches collectively provide a comprehensive framework for nurses to administer medications safely and effectively‚ ensuring optimal patient care and minimizing risks․

1․3 Importance of Pharmacology in Nursing

Pharmacology is vital in nursing as it ensures safe and effective medication administration․ Nurses must understand drug mechanisms‚ dosages‚ and potential interactions to prevent errors and adverse reactions․ This knowledge enables them to educate patients‚ monitor drug responses‚ and adjust care plans․ Pharmacology also guides individualized therapy‚ considering factors like age‚ health status‚ and comorbidities․ By mastering pharmacological principles‚ nurses contribute to evidence-based practice‚ improve patient outcomes‚ and enhance overall healthcare quality․ Additionally‚ pharmacology education prepares nurses for NCLEX success and lifelong learning in a field where drug therapies continually evolve․ It is a cornerstone of nursing practice‚ ensuring competency and patient safety․

Nursing Process in Pharmacology

The nursing process in pharmacology involves assessment‚ diagnosis‚ planning‚ implementation‚ and evaluation to ensure safe and effective drug therapy‚ promoting optimal patient outcomes and safety․

2․1 Assessment in Pharmacological Care

Assessment in pharmacological care involves gathering comprehensive patient data‚ including medical history‚ current medications‚ allergies‚ and health status․ Nurses evaluate the patient’s physical and psychological condition‚ as well as their ability to manage medications․ This step ensures personalized care‚ identifying potential risks and contraindications․ Accurate assessment guides the development of effective care plans‚ promoting safe and targeted drug therapy․ It also involves monitoring for adverse effects and ensuring patient understanding of medication regimens․ This foundational process is critical for preventing errors and optimizing therapeutic outcomes‚ aligning with the nurse’s role in patient advocacy and education․

2․2 Diagnosis and Planning in Drug Therapy

Diagnosis in pharmacological care involves identifying health problems or risk factors that can be addressed through drug therapy․ Nurses analyze assessment data to determine the appropriateness of prescribed medications and potential contraindications․ Planning includes establishing measurable goals‚ selecting interventions‚ and educating patients about their medication regimens․ This step ensures individualized care‚ considering factors like age‚ comorbidities‚ and lifestyle․ Nurses also prioritize patient safety by verifying dosages and potential drug interactions․ Effective planning fosters collaboration with healthcare teams‚ optimizing therapeutic outcomes․ It also involves documenting care plans and preparing for ongoing evaluation‚ ensuring alignment with patient needs and promoting adherence to treatment․

2․3 Implementation of Pharmacological Interventions

Implementation involves administering medications as prescribed and monitoring their effects․ Nurses ensure accuracy in medication administration‚ adhering to the “Six Rights”: right patient‚ drug‚ dose‚ route‚ time‚ and documentation․ They also educate patients about proper administration techniques‚ potential side effects‚ and the importance of adherence․ Monitoring includes observing for therapeutic responses and detecting adverse reactions early․ Nurses may adjust administration schedules or notify prescribers if issues arise․ Effective communication with patients and healthcare teams is crucial for safe and effective care․ This phase requires attention to detail and a patient-centered approach to maximize therapeutic benefits and minimize risks․ Proper documentation ensures continuity of care and accountability in practice․

2․4 Evaluation of Drug Effects

Evaluation involves assessing the effectiveness of drug therapy and identifying potential adverse effects․ Nurses monitor patients for therapeutic responses‚ such as improved symptoms or lab results‚ and document outcomes․ They also watch for signs of toxicity or allergic reactions․ Patient feedback is crucial in evaluating drug effects‚ as subjective symptoms may indicate issues․ Nurses collaborate with healthcare teams to adjust treatment plans if necessary․ Accurate documentation ensures continuity of care and informs future interventions․ This phase emphasizes patient safety and optimal therapeutic outcomes‚ ensuring medications are used effectively and safely․ Ongoing assessment and communication are key to achieving desired health goals and minimizing risks․

Pharmacological Principles

Pharmacological principles include drug absorption‚ distribution‚ metabolism‚ and excretion‚ as well as dose-response relationships and therapeutic indices․ These concepts guide safe and effective drug therapy in nursing practice․

3․1 Drug Absorption‚ Distribution‚ Metabolism‚ and Excretion

Drug absorption‚ distribution‚ metabolism‚ and excretion (ADME) are critical pharmacokinetic processes․ Absorption refers to how drugs enter the bloodstream‚ influenced by factors like route of administration and solubility․ Distribution involves transport via blood and tissues‚ affected by blood flow and protein binding․ Metabolism‚ primarily in the liver‚ alters drug activity through enzymatic processes․ Excretion eliminates drugs‚ often through kidneys or feces․ Understanding ADME helps nurses predict drug effects‚ optimize dosing‚ and manage potential interactions․ Factors like age‚ organ function‚ and disease states can alter these processes‚ impacting therapeutic outcomes and patient safety․ Nurses must consider these principles to ensure effective and safe drug therapy․

3․2 Dose-Response Relationship

The dose-response relationship describes how drug effects vary with differing doses․ It is fundamental for determining therapeutic efficacy and safety․ Graded dose-response affects individuals‚ while quantal dose-response applies to populations․ Factors like age‚ disease‚ and drug interactions influence this relationship․ Nurses use this knowledge to titrate medications‚ monitor for adverse effects‚ and educate patients‚ ensuring optimal outcomes and minimizing risks․ Understanding dose-response is crucial for safe and effective drug therapy in clinical practice․

3․3 Therapeutic Index and Safe Dosage

The therapeutic index (TI) is a critical concept in pharmacology‚ representing the ratio of a drug’s toxic dose to its therapeutic dose․ A high TI indicates a wider safety margin‚ while a low TI suggests a narrower range between effectiveness and toxicity․ Safe dosage is determined by balancing efficacy and potential harm‚ considering factors like patient age‚ weight‚ and health status․ Nurses must calculate doses accurately‚ especially for drugs with a narrow TI‚ to avoid adverse effects․ Understanding TI and safe dosage is essential for ensuring patient safety and optimizing drug therapy outcomes in clinical practice․

Drug Classification

Drugs are classified based on their therapeutic effects‚ chemical structure‚ or physiological effects․ Common classifications include central nervous system‚ cardiovascular‚ antimicrobial‚ respiratory‚ gastrointestinal‚ endocrine‚ and oncological agents․

4․1 Central Nervous System Drugs

Central Nervous System (CNS) drugs target the brain and nervous system to treat conditions like pain‚ anxiety‚ depression‚ and seizures․ Key categories include analgesics‚ anticonvulsants‚ antipsychotics‚ and sedatives․ Analgesics‚ such as opioids‚ relieve pain‚ while anticonvulsants like carbamazepine manage epilepsy․ Antipsychotics‚ including haloperidol‚ are used for mental health disorders․ Sedatives and hypnotics‚ such as benzodiazepines‚ help with anxiety and insomnia․ Nurses must understand these drugs’ mechanisms‚ side effects‚ and interactions to ensure safe administration․ Monitoring for CNS depression‚ dependency‚ or adverse effects like confusion is crucial․ Proper patient education on dosage and potential risks is essential for effective therapy and patient safety․

4․2 Cardiovascular Drugs

Cardiovascular drugs are used to manage conditions like hypertension‚ heart failure‚ and arrhythmias․ Common classes include antihypertensives (e․g․‚ beta-blockers‚ ACE inhibitors)‚ antiarrhythmics (e․g․‚ amiodarone)‚ anticoagulants (e;g․‚ heparin)‚ and diuretics․ Beta-blockers reduce heart rate and blood pressure‚ while ACE inhibitors improve cardiac output․ Diuretics help reduce fluid retention․ Nurses must understand their mechanisms‚ dosages‚ and potential side effects․ Monitoring for hypotension‚ electrolyte imbalances‚ or bleeding is critical․ Patient education on lifestyle modifications and adherence to therapy is essential․ These drugs require careful titration to optimize cardiovascular function and prevent complications‚ ensuring safe and effective treatment tailored to individual patient needs․

4․3 Antimicrobial and Anti-Infective Agents

Antimicrobial and anti-infective agents target bacterial‚ viral‚ fungal‚ and parasitic infections․ Common classes include antibiotics (e․g․‚ penicillins‚ cephalosporins‚ aminoglycosides)‚ antivirals (e․g․‚ oseltamivir)‚ antifungals (e;g․‚ fluconazole)‚ and antiparasitics․ Nurses must understand their mechanisms‚ such as cell wall inhibition or protein synthesis disruption․ Proper administration‚ dosing‚ and monitoring for side effects (e․g․‚ allergic reactions‚ nephrotoxicity) are crucial․ Patient education on adherence and resistance prevention is vital․ These agents require careful selection based on infection type and susceptibility․ Nurses play a key role in ensuring effective therapy while minimizing adverse effects and promoting safe use to combat infections and prevent complications․

4․4 Respiratory and Gastrointestinal Drugs

Respiratory drugs‚ such as bronchodilators (e․g․‚ albuterol) and antihistamines (e․g․‚ diphenhydramine)‚ alleviate conditions like asthma and allergies by relaxing airway muscles or reducing inflammation․ Gastrointestinal drugs‚ including H2 receptor antagonists (e․g․‚ ranitidine) and proton pump inhibitors (e․g․‚ omeprazole)‚ treat disorders like peptic ulcers and GERD by reducing stomach acid․ Nurses must administer these medications correctly‚ monitor for side effects‚ and educate patients on proper use․ Understanding drug mechanisms and patient responses is crucial for effective care and preventing complications․ These agents play a vital role in managing chronic respiratory and gastrointestinal conditions‚ improving patient comfort and quality of life․

4․5 Endocrine and Oncological Drugs

Endocrine drugs manage hormone-related disorders‚ such as diabetes and thyroid conditions․ Insulin and oral hypoglycemics regulate blood glucose‚ while thyroid hormones like levothyroxine treat hypothyroidism․ Oncological drugs target cancer cells‚ often through chemotherapy agents like doxorubicin and paclitaxel․ These drugs interfere with cell division‚ slowing tumor growth․ Nurses must administer them carefully‚ monitoring for side effects like myelosuppression and neuropathy․ Understanding drug mechanisms‚ dosing‚ and patient responses is vital for safe and effective care․ Proper handling and administration of these drugs are critical to prevent complications and improve patient outcomes in both endocrine and oncological treatments․

Priority Nursing Care

Priority nursing care focuses on patient safety‚ adverse drug reactions‚ and ensuring effective drug therapy․ Nurses monitor for side effects‚ educate patients‚ and optimize therapeutic outcomes․

5․1 Patient Safety and Adverse Drug Reactions

Patient safety is a top priority in nursing pharmacology․ Nurses play a critical role in identifying and managing adverse drug reactions‚ which can prevent harm and improve patient outcomes․ Key strategies include conducting thorough patient assessments‚ monitoring for potential side effects‚ and educating patients about medication risks․ Nurses must also be vigilant in reporting and documenting adverse events to enhance safety protocols․ By understanding drug mechanisms and contraindications‚ nurses can anticipate and mitigate harmful reactions‚ ensuring safe and effective drug therapy․ This knowledge is essential for optimizing care and upholding patient well-being in clinical settings․

5․2 Ensuring Effectiveness of Drug Therapy

Ensuring the effectiveness of drug therapy is a cornerstone of nursing practice․ Nurses play a vital role in optimizing therapeutic outcomes by tailoring care to individual patient needs․ This involves administering medications correctly‚ educating patients on proper use‚ and monitoring for desired effects․ Nurses must also assess for factors that may alter drug responses‚ such as age‚ renal function‚ or comorbidities․ Collaborating with healthcare teams and adhering to evidence-based guidelines further enhances therapy effectiveness․ By prioritizing patient education and adherence‚ nurses help patients achieve optimal health outcomes and minimize potential complications‚ ensuring safe and effective drug therapy in clinical settings․

5․3 Legal and Ethical Considerations

Legal and ethical considerations are fundamental in nursing pharmacology‚ ensuring safe and responsible medication management․ Nurses must adhere to laws regulating drug administration‚ including proper documentation and patient privacy․ Ethical principles such as beneficence‚ non-maleficence‚ autonomy‚ and justice guide decision-making․ Nurses must ensure informed consent‚ avoid harm‚ and respect patient rights․ Legal implications arise from medication errors or negligence‚ emphasizing the need for accuracy and accountability․ Ethical dilemmas‚ such as withholding medications‚ require careful consideration of patient autonomy versus therapeutic goals․ Staying informed about legal standards and ethical guidelines ensures nurses provide high-quality‚ patient-centered care while minimizing legal risks and upholding professional integrity․

Special Populations

Special populations‚ including geriatric‚ pediatric‚ and obstetric patients‚ require tailored pharmacological care due to unique physiological conditions and altered drug responses‚ ensuring safe and effective treatment․

6․1 Gerontological Pharmacology

Gerontological pharmacology focuses on drug therapy in elderly patients‚ addressing age-related physiological changes that alter drug absorption‚ distribution‚ metabolism‚ and excretion․ Nurses must consider polypharmacy risks‚ comorbidities‚ and renal/hepatic declines in the elderly․ Adverse drug reactions are more common due to increased sensitivity and reduced drug clearance․ Simplifying medication regimens and monitoring for toxicity are critical․ Nurses play a vital role in educating patients and caregivers about safe drug use‚ proper dosing‚ and potential interactions․ Tailoring pharmacological interventions ensures optimal therapeutic outcomes while minimizing risks in this vulnerable population․ Continuous assessment and adjustment of drug therapy are essential to meet the unique needs of geriatric patients effectively․

6․2 Pediatric Pharmacology

Pediatric pharmacology involves the study and application of drug therapy in infants‚ children‚ and adolescents․ Unlike adults‚ children’s bodies are constantly developing‚ leading to variations in drug absorption‚ metabolism‚ and excretion․ Nurses must consider factors such as age‚ weight‚ and developmental stage to ensure safe and effective medication administration․ Pediatric dosing is often weight-based‚ and formulations may differ‚ such as liquid suspensions for easier administration․ Monitoring for adverse effects is critical‚ as children are more susceptible to toxicity․ Nurses play a key role in educating parents and caregivers about proper dosing‚ potential side effects‚ and the importance of adherence to prescribed regimens․ Tailoring pharmacological care to pediatric patients ensures optimal therapeutic outcomes and minimizes risks associated with medication use in this vulnerable population․

6․3 Pharmacology in Pregnancy and Lactation

Pharmacology in pregnancy and lactation focuses on balancing therapeutic benefits for the mother with minimizing risks to the fetus or infant․ Physiological changes during pregnancy alter drug absorption‚ distribution‚ metabolism‚ and excretion‚ requiring careful dosing adjustments․ Nurses must assess the potential teratogenic effects of medications and use the FDA pregnancy categories as a guide․ During lactation‚ drugs may pass into breast milk‚ necessitating evaluation of infant exposure․ Nurses play a critical role in educating mothers about medication safety‚ emphasizing the importance of avoiding harmful substances and adhering to prescribed regimens․ This ensures the well-being of both mother and child while maintaining therapeutic efficacy․

6․4 Pharmacology in Patients with Chronic Conditions

Pharmacology in patients with chronic conditions involves managing long-term diseases requiring tailored drug regimens․ Nurses must consider comorbidities‚ drug interactions‚ and how chronic diseases affect drug metabolism․ Individualized treatment plans are crucial‚ balancing efficacy and safety․ Monitoring for adverse effects is essential‚ as chronic conditions often alter drug responses․ Patient education on medication adherence and lifestyle modifications is vital․ Nurses play a key role in minimizing polypharmacy risks and optimizing therapeutic outcomes‚ ensuring patients achieve their health goals while maintaining quality of life․

Adverse Drug Effects and Toxicity

Adverse drug effects and toxicity occur when medications cause harmful reactions․ Nurses must monitor for signs‚ manage symptoms‚ and educate patients to minimize risks and improve outcomes․

7․1 Types of Adverse Drug Reactions

Adverse drug reactions are categorized into dose-dependent and dose-independent types․ Dose-dependent reactions occur at therapeutic doses‚ while dose-independent reactions‚ such as idiosyncratic or allergic responses‚ can happen at any dose․ Nurses must identify these reactions early‚ as they can range from mild to life-threatening․ Monitoring for signs like rash‚ respiratory distress‚ or changes in vital signs is critical․ Proper documentation and prompt intervention are essential to prevent complications․ Understanding these types helps nurses tailor care‚ educate patients‚ and ensure safe medication use․ This knowledge is vital for effective pharmacological management and improving patient outcomes in clinical settings․

7․2 Monitoring for Adverse Effects

Monitoring for adverse drug effects is a critical nursing responsibility to ensure patient safety․ Nurses assess patients for signs and symptoms of adverse reactions‚ such as changes in vital signs‚ skin rashes‚ or respiratory distress․ Regular laboratory monitoring‚ such as liver and kidney function tests‚ is essential for drugs with potential toxicity․ Nurses also review medication histories to identify potential interactions; Early detection allows for timely interventions‚ such as adjusting doses or discontinuing harmful drugs․ Effective monitoring requires strong clinical skills‚ patient education‚ and collaboration with healthcare teams․ This process ensures optimal drug therapy outcomes while minimizing risks for patients․

7․3 Management of Drug Toxicity

Managing drug toxicity involves prompt identification and intervention to minimize harm․ Nurses prioritize supportive care‚ addressing symptoms like nausea or respiratory distress․ Specific antidotes‚ such as naloxone for opioid overdose‚ may be administered․ Enhancing drug elimination through methods like dialysis can reduce toxicity․ Decontamination‚ such as gastric lavage‚ may be considered if ingestion is recent․ Collaboration with healthcare teams ensures tailored treatment plans․ Patient education on avoiding drug interactions and proper medication disposal is crucial․ Documentation of toxicity events and reporting to pharmacovigilance systems help prevent future incidents․ Effective management requires skill‚ knowledge‚ and adherence to evidence-based protocols to ensure patient safety and optimal outcomes․

NCLEX Preparation

NCLEX preparation involves mastering pharmacology concepts through practice questions‚ test-taking strategies‚ and detailed reviews of key nursing pharmacology topics to ensure exam success․

8․1 Test-Taking Strategies

Effective test-taking strategies are crucial for success in the NCLEX exam․ Nurses should focus on prioritizing high-weight topics‚ such as pharmacology‚ and practice time management․

Practicing with NCLEX-style questions helps familiarize test-takers with the format and content․ Emphasize active learning by reviewing rationales for correct and incorrect answers․

Develop a systematic approach to reading questions‚ identifying key words‚ and eliminating incorrect options․ Utilize the process of elimination to increase the likelihood of selecting the correct answer․

Stay calm and manage anxiety during the exam․ Reviewing pharmacology concepts regularly and using study guides can enhance confidence and improve performance․

Mastering these strategies ensures nurses are well-prepared to tackle the NCLEX and achieve their goal of becoming licensed professionals․

8․2 Practice Questions and Case Studies

Practice questions and case studies are essential tools for mastering pharmacology concepts․ They simulate real-life scenarios‚ helping nurses apply theoretical knowledge to clinical practice․

Case studies focus on specific patient conditions‚ requiring nurses to analyze symptoms‚ diagnose issues‚ and recommend appropriate drug therapies․

Multiple-choice questions test understanding of drug classifications‚ dosages‚ and side effects‚ preparing nurses for the NCLEX exam format․

Regular practice with these resources enhances critical thinking and decision-making skills‚ ensuring nurses can provide safe and effective care․

Utilizing study guides with detailed explanations and practical examples further reinforces learning and improves exam readiness․

Combining practice questions with case studies creates a comprehensive approach to understanding pharmacology‚ benefiting both students and practicing nurses․

8․3 Review of Key Nursing Pharmacology Concepts

A thorough review of key pharmacology concepts is crucial for nursing students and professionals․ This includes understanding drug classifications‚ mechanisms of action‚ and pharmacokinetics․

Study guides emphasize patient safety‚ focusing on adverse drug reactions‚ therapeutic indices‚ and dosage calculations․

Nurses must grasp the nursing process in pharmacology‚ including assessment‚ diagnosis‚ and evaluation of drug effects․

Key concepts also cover legal and ethical considerations‚ ensuring compliance with medication administration standards․

Reviewing these principles helps nurses prioritize care‚ manage chronic conditions‚ and address special populations like pediatrics and gerontology․

Regularly revisiting these concepts ensures competence and confidence in clinical practice‚ aligning with NCLEX preparation and real-world scenarios․

8․4 Time Management Techniques

Effective time management is essential for successful pharmacology study․ Nurses can prioritize high-yield topics‚ such as drug classifications and adverse effects‚ to maximize learning efficiency․

  • Creating a structured study schedule ensures balanced coverage of all pharmacology concepts․
  • Incorporating active learning techniques‚ like flashcards and practice questions‚ enhances retention․
  • Allocating specific time blocks for review and practice tests helps simulate exam conditions․
  • Regular breaks and self-care practices prevent burnout and maintain focus․

By mastering these techniques‚ nurses can optimize their study time‚ leading to better comprehension and performance on pharmacology exams․

Mastering nursing pharmacology is crucial for safe‚ effective practice․ Utilizing study guides‚ NCLEX prep materials‚ and practice questions ensures confidence and competence in patient care․

9․1 Summary of Key Concepts

Nursing pharmacology focuses on the scientific study of drugs‚ their effects‚ and therapeutic applications․ Key concepts include understanding drug classifications‚ mechanisms of action‚ and therapeutic uses․ Nurses must grasp pharmacokinetics (absorption‚ distribution‚ metabolism‚ excretion) and pharmacodynamics (drug effects)․ Safety‚ dosage accuracy‚ and patient education are critical․ Adverse reactions‚ drug interactions‚ and contraindications must be monitored․ Legal and ethical considerations‚ such as informed consent‚ guide practice․ Utilizing study guides‚ NCLEX-style questions‚ and practical case studies enhances learning․ These resources aid in applying pharmacological principles to real-world scenarios‚ ensuring safe and effective patient care․ Continuous education and updates on drug therapies are essential for maintaining competency in nursing practice․

9․2 Continuing Education in Pharmacology

Continuing education in pharmacology is essential for nurses to stay updated on new drugs‚ dosages‚ and therapeutic advancements․ Study guides‚ webinars‚ and workshops provide accessible learning tools․ Resources like the Lippincott Pocket Drug Guide and pharmacology-specific PDFs offer evidence-based practices․ Nurses can enhance their knowledge through NCLEX-style questions and case studies‚ ensuring practical application․ Regular updates on drug interactions‚ side effects‚ and contraindications are crucial for patient safety․ Engaging in lifelong learning fosters competency‚ enabling nurses to deliver high-quality care․ Staying informed about pharmacological developments ensures adherence to best practices and improves patient outcomes in diverse healthcare settings․

9․3 Application of Pharmacology in Nursing Practice

The application of pharmacology in nursing practice involves administering medications safely and effectively․ Nurses use pharmacology knowledge to assess patients‚ monitor drug responses‚ and educate them on proper usage․ Study guides emphasize understanding drug classifications‚ dosages‚ and potential interactions․ Practical skills‚ such as calculating doses and identifying adverse effects‚ are crucial․ Nurses also prioritize patient safety by adhering to the six rights of medication administration․ Effective communication with healthcare teams ensures comprehensive care․ By integrating pharmacological principles into daily practice‚ nurses play a vital role in achieving optimal therapeutic outcomes and enhancing patient well-being․ This application is fundamental to delivering high-quality‚ evidence-based nursing care․

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