2024 Lesson 5 NCM 106 Pharmacology PDF

Instructional Material in NCM 106 (Pharmacology) | 51 UNIT II THE NURSE AND THE NURSING PROCESS IN PHARMACOLOGY The previous unit introduced your nursing roles and responsibilities in drug therapy are mandated by laws and governed by some ethical princi...

Instructional Material in NCM 106 (Pharmacology) | 51 UNIT II THE NURSE AND THE NURSING PROCESS IN PHARMACOLOGY The previous unit introduced your nursing roles and responsibilities in drug therapy are mandated by laws and governed by some ethical principles. As a nurse, you must be able to accurately prepare and administer drugs, teach patients and families, make appropriate referrals, evaluate the effects of drug therapy, and document your patient’s response to the therapy. The success of your patient’s drug therapy is influenced by your ability to use critical thinking skills combined with the principles of drug administration and the nursing process. Additionally, reporting and recording are crucial in drug therapy. The timely, thorough, and accurate documentation of facts is essential when recording your patient’s data, be it the result of your assessment or your client’s response to the therapy. Failure to record findings during an assessment or interpretation of a problem will result in loss of information and make the patient document unreliable. This unit covers three lessons, which are discussed in the next sections of this unit. The lessons are: Lesson 5 – The Nursing Process in Pharmacology Lesson 6 – Recording and Reporting, Types of Drug Effects, Drug Interactions Lesson 7 – Roles and Core Values of the Nurse as Applied in Pharmacology UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 52 LESSON 5: THE NURSING PROCESS IN PHARMACOLOGY And let us not grow weary of doing good, for in due season, we will reap if we do not give up. - Galatians 6:9 You learned in your previous courses about the significance of using the nursing process when providing care to your patient. In this lesson, you will use the nursing process as it relates to drug therapy. The nursing process is a systematic, problem-solving framework to help you provide comprehensive care to your patient’s medication therapy. It is a flexible, adaptable, and adjustable five-step process consisting of assessment, diagnosis of human need, planning with outcome identification, implementation including patient teachings, and evaluation of patient response to the therapy. It ensures the delivery of thorough, individualized, and quality nursing care to your patients, regardless of their age, gender, culture, medical diagnosis, or setting. At the end of this lesson, you must have:  identified relevant patient factors in relation to the patient’s drug therapy;  formulated priority nursing diagnoses and care plan in reference to the identified needs of the patient about the drug therapy;  discussed the specific nursing considerations/precautions in safe drug administration;  used available clinical evidence to ensure safe medication administration;  discussed ways to evaluate patient’s compliance and response to the prescribed drug therapy; and  appreciated the culture, values, and practices of the client as significant factors in influencing success of drug therapy. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 53 WARM-UP ACTIVITY. By Number. The nursing process is a scientific framework that guides nurses when providing care to patients. Can you still recall the different characteristics of the entire process? Test your memory by decoding the hidden answers. Use the given hints. 17 1 6 19 3 20 1 6 10 16 10 14 6 8 9 14 3 4 4 1 3 6 7 14 17 2 4 18 10 6 11 1-L 3-I 5-H 7-N 9-A 11-D 13-V 15-P 17-F 19-X 2-O 4-C 6-E 8-M 10-S 12-R 14-T 16-Y 18-U 20-B CENTRAL ACTIVITIES This lesson contains one learning input to further enhance your understanding of the nursing process as applied in pharmacology. Four learner activities are included in this lesson to assess your ability to apply your knowledge of the concepts. LEARNING INPUT 5.1. The Nursing Process in Pharmacology A major aspect of the nursing process is the use of critical thinking. You must be able to think critically in order to analyze a set of given data, develop conclusions, make decisions, and reflect upon all information drawn from the patient. The information may come from various aspects, such as the physical, mental, social, emotional, spiritual, economic, and cultural dimensions of the client. Special consideration of these many facets Figure 5.1. Steps of the nursing process. allows a more holistic approach to patient care. For example, the physician may focus on neurologic functioning and pathology, the nutritionist on the dietary regimen, the chaplain on the spiritual aspect, and the members of the family on the emotional and economic part. However, it is the nurse who critically thinks and incorporates all these aspects about the patient in order to develop and coordinate patient care. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 54 The nursing process consists of interrelated steps: assessment, diagnosis (analysis), planning and outcome identification, implementation (including monitoring and patient education), and evaluation (Figure 5.1). It remains as the fundamental process in the provision of comprehensive nursing care. Assessment. Assessment is the first step of the nursing process. It is an information-gathering phase to elicit relevant information about the patient. The information may come from a variety of sources, including the patient, the patient’s family or caregiver, and the patient’s chart or medical record. A systematic, comprehensive assessment includes gathering of objective and subjective data that enables you to identify problems and anything that may influence your patient’s drug therapy. Assessment is the basis to which nursing care is planned, implemented, and evaluated. While the specific information to be elicited may differ from one patient to another, the foci involved are the same. The key areas that you need to assess include the following: I. Patient’s history – this is an essential part of the assessment to determine factors that may influence the patient’s drug therapy. These important factors are  Drug use This aspect includes the patient’s profile of current medication, previous medications, the use of OTC drugs, illicit drugs, alternative therapies, alcohol consumption, nicotine, and caffeine intake. You have to be specific when asking the patient’s medications because the patient may not always tell all about his/her therapy, deliberately or inadvertently. Elicit important information such as dosage, route, frequency, and the prescribing health care provider, if any. Also, ask the patient regarding his/her knowledge of the therapeutic effect and side effects of the drug therapy. Moreover, determine patient compliance with regimen and the reasons for deviations. All these data provide essential insight into the current or past condition of the patient.  Medical / health conditions This aspect of assessment includes various medical and health conditions for which the drug therapy was indicated (e.g., high blood pressure, elevated glucose level, or pain) or that require cautious administration of medication (e.g. kidney disease, liver cirrhosis, heart disease, G6PD), allergies, pregnancy and lactation. In particular, past UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 55 exposure to drug or any allergen may provoke a serious allergic reaction in the future. Therefore, you must carefully elicit information about the patient’s allergy history to determine whether the patient actually experienced a true drug allergy, not adverse effects of the drug.  level of education/health literacy Health literacy refers to the patient’s ability to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Your patient’s education level and health literacy are important considerations in determining the type of teaching instructions to use and in planning the patient education program. Compared to a patient with a college degree, a patient with a grade school education may require simpler health instruction and educational materials. In like manner, a patient with a health professional background may be able to easily understand information related to drug therapy than a patient whose profession is non-health. Remember, however, that certain factors, including stress and illness, may impair a patient’s learning ability and readiness for information. Therefore, do not assume that your patient understands his/her condition and drug therapy based on a reported educational attainment.  knowledge about disease and therapy Patients who are more knowledgeable about their disease condition and medications may gain a sense of control and be more compliant with their drug therapy as compared to those who lack the essential information to understand their illness and therapy.  social support The increasing health care cost and risks associated with longer hospital stays lead to the trend of early discharge and continued home care among patients. Thus, determining your patients’ social support system (including community resources) before discharge is crucial to ensure they receive the kind of care and drug therapy assistance they need at home. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 56  financial support Your patient’s financial status can have an impact on initiating and maintaining drug therapy. A patient who lacks financial means may not be able to complete a prescribed drug regimen. For this reason, you may need to refer your patient to agencies that provide financial support.  pattern of healthcare As a nurse, it is important to determine your patient’s health care pattern. Practices such as self-medication, postponing clinic visits, and avoiding professional help can provide useful insights into the patient’s health behavior and perceived locus of control, which may influence his/her condition and drug therapy. Locus of control represents the belief systems at the opposite ends of a continuum It is where the patient places the primary causation of events in his/her life. Those who believe their life is largely controlled by outside forces (externals) are on one end of the spectrum. Those who believe they control their own lives (internals) are on the other end of the spectrum. For patients who believe that their illness is a form of punishment for their sins (external locus of control) may refuse to seek medical consultation during the early course of the disease. They may also be non-compliant with their treatment regimen because they believe that their fate is in the hands of the one who caused the illness.  lifestyle Lifestyle includes personal practices (e.g., smoking, intake of alcohol or caffeine, diet) that may contribute to the patient’s present health condition or that may interfere with the patient’s therapy. For example, mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. II. Physical Assessment – a thorough head-to-toe and body systems assessment allows you to focus on the anatomy and physiology that may affect and/or be affected by drug therapy. Consider the following factors when doing the physical assessment: UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 57  Age This factor is especially significant in young children and older adults because of their developmental differences compared to the general population. Extremes of age influence drug pharmacokinetics and pharmacodynamics; thus, they may require dosage adjustments based on the ability of the organ systems like the liver (to metabolize drugs) and the kidneys (to excrete the drug), and the sensitivity of the receptors and enzyme system. Additionally, consideration of the patient’s age would alert the nurse regarding possible concerns about drug delivery, such as the patient’s ability to swallow the pill or follow instructions related to drug intake. ADDITIONAL LEARNING. To learn more about pediatric and geriatric considerations in drug therapy, visit the following links: 1. https://www.msdmanuals.com/professional/geriatrics/drug- therapy-in-older-adults/pharmacokinetics-in-older-adults 2. https://www.msdmanuals.com/professional/geriatrics/drug- therapy-in-older-adults/pharmacodynamics-in-older-adults 3. https://www.msdmanuals.com/professional/pediatrics/princ iples-of-drug-treatment-in-children/pharmacokinetics-in- children  Height, weight, and body surface area (BSA) These characteristics are important because some drug dosages are computed based on these parameters. For example, most drugs in children are dosed according to body weight (mg/kg) or BSA (mg/m2).  Gender The anatomical and physiologic differences in men and women can influence drug’s effect and the body’s response. For example, women have slower gastric motility and intestinal transit than men; hence, they may need to wait longer between food consumption and medication if a drug is to be taken on an empty stomach. Examples of these drugs are captopril, felodipine, and ampicillin.  Race / Genetics Given the same medication, no two individuals will react to the drug in exactly the same way. Genetic differences explain why patients have varied responses to a given drug regimen. Pharmacogenetics and pharmacogenomics are relatively new branches of pharmacology that seek to determine how genes influence an individual’s response to drugs. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 58 Pharmacogenetics typically refers to drug effects involving a limited number of genes, whereas pharmacogenomics involves the study of complex multigene patterns within the genome. The ultimate goal for pharmacogenetics and pharmacogenomics is the development of personalized medicine wherein drugs are prescribed based on the patient's individual genetic and biological profile. For example, carbamazepine is an anticonvulsant drug that causes severe adverse effects, including Stevens-Johnson syndrome and toxic epidermal necrolysis. These adverse effects are highly associated with patients who carry the HLA- B*1502 allele. The incidence of individuals who have the HLA-B*1502 allele is 1 to 6/10 000 in countries with mainly white populations. In some Asian countries, the incidence is 10 times higher. By identifying the patient's genetic characteristics, the best pharmacologic regimen with the least adverse effects can be used to manage his/her illness. III. Other Factors – Consider certain aspects that are not covered by physical assessment, laboratory data, and diagnostic tests. The information in these aspects is fundamental in ensuring holistic and comprehensive patient care during drug therapy. These aspects include:  Religious/cultural factors The patient’s cultural practices, beliefs, and values may affect his/her response to the drug therapy. The study by Horne, et al. (2004) revealed that Asian American students had more negative views about medication than those who reported a European cultural background. Students with an Asian cultural background were significantly more likely to perceive medicines as being intrinsically harmful, addictive substances that should be avoided.  Physiologic factors The patient’s diurnal rhythm, acid-base balance, status of hydration, and electrolyte balance can affect drug’s action in the body. x ADDITIONAL LEARNING. Watch the Euronews at https://www.youtube.com/watch?v=0OdLiTL4TYs&t=60s to know more how your body clock can make drugs and vaccines more effective.  Psychological factors Salient factors that must be included in your assessment along this aspect include the patient’s attitude and impression about his/her therapy, condition, and the health care system. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 59 LEARNER ACTIVITY 5. 1. Sharing my culture. In your own household, identify religious and/or cultural factors that you think may affect you or any family member’s attitude or behavior regarding drug therapy. Explain how such factors can affect drug therapy. Share your insight to the class. Religious/Cultural How It Influences My Attitude/Behavior about Drug Belief/Practice or Drug Therapy Nursing Diagnosis Nursing diagnoses are formulated based on the analysis of data obtained through your assessment. A nursing diagnosis is a description of your patient’s needs or problems that you can manage through your nursing interventions. It provides a framework for selecting nursing actions to achieve the success of your patient’s therapy. You can formulate four types of nursing diagnoses depending on your analysis of the patient’s data: (1) actual, (2) risk/high-risk, (3) health promotion and wellness, and (4) syndrome. You have to remember that not all patient problems identified during an assessment are treated by the nurse alone. Many patient problems require a multidisciplinary approach. A collaborative problem exists when you know that you cannot legally order the definitive interventions required to manage the presenting circumstances of the patient. Hence, seeking direction or order from appropriate health team members will solve the collaborative problem. The most frequently used nursing problems that relate to drug administration include: (1) Ineffective Therapeutic Regimen Management (2) Deficient Knowledge (3) Noncompliance (4) Anxiety Because you are usually required to identify a nursing diagnosis with its three elements – the problem (P), its etiology (E), and defining signs and symptoms (S) – it is UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 60 important to determine the possible reasons that are contributing to or causing the problem as well as the manifestations that describe the problem. Likewise, recognizing the etiologic factor is significant in designing effective nursing interventions. For example, the nursing problem of Ineffective Therapeutic Regimen Management may be related to several causes, including troublesome adverse effects, lack of finances to obtain the drug, forgetfulness, or misunderstanding of the instruction. Each of the identified etiology requires a specific nursing intervention in order to solve the problem. LEARNER ACTIVITY 5. 2. Who is the culprit? Identify at least one (1) possible related etiologic factor for the following nursing problems: Nursing Problem Etiologic Factor/s (1) Disturbed Sleep Pattern (2) Noncompliance (3) Decreased Cardiac Output When you are done, submit your accomplishment to the submission folder of this lesson. Planning The planning phase of the nursing process entails a description of the steps that you will carry out to meet the expected patient outcomes. It includes a statement of the goals and objectives for the competent delivery of nursing care which takes into consideration the various aspects of the person. The characteristics of a good goal setting are:  C – client-centered  A – acceptable to both client and nurse  R – realistic and measurable  E – valuation components clearly identified  S – shared with other Health Care Professionals Since the planning phase anticipates the “working phase” of the nursing process, it is important that your plan of care is well written, understood, and communicated (as necessary) so that it can properly assist you and other members of the health team in carrying out interventions and in evaluating the effectiveness of the nursing care. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 61 Implementation Implementation is a natural outgrowth of the assessment and planning phases of the nursing process. It involves the actual administration of medication or initiation of medication schedule or patient education program. The success of carrying out these interventions depends on certain factors including the nurse’s knowledge (e.g. disease process, drug action, principles of drug administration), technical skills (e.g. drug preparation, techniques of administering medication, setting up an IV line), communications skills, and therapeutic use of self. There are three (3) types of interventions involved in drug therapy. These are interventions related to a) actual drug administration, b) provision of comfort measures, and b) patient/family education. a. Actual drug administration – to administer the drug safely and effectively, you must observe the 12 Rs of drug administration. Review the guidelines pertinent to these Rs.  right dose  right storage  right drug  right assessment  right patient  right evaluation  right route  right documentation  right time  right approach  right preparation  right to refuse ADDITIONAL LEARNING. Watch the video Rights of Medication Administration in Nursing at https://www.youtube.com/watch?v=TqVrR69Swr0 to review the nursing responsibilities and guidelines pertinent to the Rs of drug administration. PRACTICE FOR PNLE. Answer the following question: A patient is prescribed a medication for the treatment of glaucoma. The order is to administer Timolol 0.25% 1 gtt twice a day. Your NEXT action is to: A. Administer the medication as ordered. B. Hold the order until you can obtain an order clarification from the prescribing physician. C. Educate the patient on how to occlude the puncta before administering the medication. D. Confirm you have been dispensed with the right medication before administering the drug. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 62 LEARNER ACTIVITY 5. 3. True or False. Review the specific nursing actions for each of the aforementioned rights of medication administration. Answer the following exercises. Submit your work in the corresponding submission folder. Check the column that corresponds to your answer. T F 1. To ensure right patient, the nurse should ask the patient, “Is your name James Dela Cruz? 2. Ceftazidime and Cefepime are two drugs with different classifications. 3. Telephone orders must be signed by physicians within 8 hours. 4. Drug labels should be read at least thrice before administering. 5. Drugs in suspension form should be shaken well prior to administration. 6. A patient forgets to take his daily drug dose yesterday; therefore, he needs to take two tablets today to compensate for the missed dose. 7. When a patient has a positive gag reflex, the drug can be given by mouth. 8. To ensure right documentation, it is appropriate that the nurse records medication administration in advance. 9. The nurse should inject the medication solution subcutaneously when performing skin testing. 10. A medication ordered to be given q.i.d. should be given every 6 hours A crucial skill related to drug administration is your mathematical skill in drug computation. You must be able to use the standard formulas in determining the correct dosage of the drug regardless of its formulation (tablet or liquid) or route of administration (oral or IV medication). Likewise, you must be knowledgeable of the different measuring systems to be able to accurately convert measurements from one system to another as necessary. The more popular measurement systems include the Metric system, the Apothecary system, and the household system. Other systems of measurement are the Avoirdupois system, international units (IU), and milliequivalents (mEq). UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 63 UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 64 ADDITIONAL LEARNING. For additional lecture and exercises on drug computation, click this link: http://www.cwladis.com/math104/lecture3.php Enjoy your math! b. Comfort measures – You may help the patient initiate a number of comfort measures to cope with the effects of the drug therapy. These include:  managing adverse effects – these are interventions that are directed at decreasing the impact of the anticipated adverse effects of a drug and promoting safety of the patient (e.g. avoiding direct sunlight, increasing fluid intake, using side rails, adjusting light, observing proper skin care).  determine lifestyle adjustment – these are interventions that require patients to modify their lifestyle to cope effectively with drug therapy (e.g. dietary adjustment, alcohol restriction, proper scheduling of activities, avoiding the crowd).  understand the placebo effect – a placebo is a substance or treatment without therapeutic value. The placebo effect is a phenomenon in which the patient experiences beneficial effects after the administration of placebo. For years, the patient’s anticipation that a drug will be helpful has proved to have tremendous impact on the actual success of therapy. Some scholars contend that the mechanism involved in the placebo phenomenon is similar to positive thinking. Others conclude that the placebo effect involves a complex neurobiological reaction resulting to an increase in feel-good neurotransmitters, like endorphins and dopamine, and greater activities in certain brain regions that affect mood, emotional reaction, and self-awareness. The exact mechanism of how placebos work is still unknown. Nonetheless, the nurses’ and other health care providers’ attitude must be supportive of the patient’s therapy (e.g. kind words, gentle back rub, positive approach, sincere approach, active listening). c. patient/family education – patients are becoming increasingly responsible for their own care; hence, it is necessary that they have all the information they need to manage their drug therapy while in the hospital and as they prepare for discharge. Key elements that should be included in the patients’ drug education program are:  name, dosage, and action of drug – this is important to enhance patient’s awareness of their treatment regimen and avoid possible drug interactions. You may instruct your patient to keep a list of the medications he/she is taking. The list serves as a handy reference especially when the patient consults different health care providers. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 65  time of administration – proper timing of drug administration is important since drugs must maintain a desired blood concentration level in order to exert their therapeutic effect.  therapeutic response expected from the drug  special storage and preparation instructions  special considerations or precautions to observe while on drug therapy (e.g. OTC drugs, herbs, or other therapies to avoid, comfort measures, safety measures)  specific manifestations to expect when taking the drug  adverse reactions to report to the nurse or health care provider  additional instruction as needed related to drug administration (e.g. applying topical patch, instilling eye drop, injecting drug on self) ADDITIONAL LEARNING. For additional insights on patient education, read the following articles: 1. Patient Education Tips for New Nurses (from https://journals.lww.com/nursing/fulltext/2013/10000/Patient_ed ucation_tips_for_new_nurses.24.aspx) 2. Patient Education: Sharing a Passion, Sharing Resources (from https://www.cfp.ca/content/56/7/721.long) The goal of patient teaching in pharmacotherapy is safe and effective drug administration with the best therapeutic outcome possible. Consider each interaction with your patient as an opportunity for teaching to realize the goal. To promote patient’s learning, consider the following pointers:  There are three domains of learning: cognitive, affective, and psychomotor. You must be able to devise effective strategies in order to incorporate these three in the learning process.  Various factors such as prior knowledge and previous experience influence the learning of new concepts. Likewise, your attitude can have a powerful impact on the patient and the family. Your positive and non-judgmental attitude can foster the development of a trusting relationship which, in turn, can enhance learning.  Short discussions about your patient’ therapy given over time, such as providing information or instruction each time a medication is administered, is often more effective than one single occasion with large amounts of information.  Involving the learner in a discussion is an effective strategy to elicit his/her views toward the solutions to problems. Similarly, when learning involves UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 66 doing a procedure, a step-by-step demonstration of the procedure by the nurse followed by a reciprocal demonstration by the leaner is necessary to validate the patient’s degree of mastery.  Other factors that may influence the patient’s learning include focus of the learning, learning styles, organization, motivation, readiness to learn, educational level, culture, and internet access among others. Evaluation Evaluation is the phase that determines the extent to which the goals have been achieved. It is a part of the continual process that leads to changes in assessment, diagnosis, and intervention. The following areas are considered in evaluation: a. drug therapeutic response / desired effect b. occurrence of adverse effects c. occurrence of drug-drug, drug-food, drug-alternative, or drug-laboratory test interactions d. patient’s compliance e. efficacy of education program Lesson Summary The nursing process is a systematic framework with problem-solving steps to help the nurse provide safe and effective care. The interrelated steps of the nursing process are assessment, diagnosis (analysis), planning and outcome identification, implementation (including monitoring and patient education), and evaluation In applying the nursing process, the nurse needs to be skillful and knowledgeable in many areas including identification of patient cues and factors affecting drug therapy, computation of drugs, and provision of relevant patient instructions. The use of the nurse’s critical thinking abilities is also crucial while performing the steps of the nursing process. These skills are crucial in the delivery of safe and effective nursing care. UNIT II Lesson 5 The Nursing Process in Pharmacology Instructional Material in NCM 106 (Pharmacology) | 67 WRAP-UP ACTIVITY. Rounding-up. Review the lessons for today and round-up what you learned. Do you think you will be able to apply the lessons in your actual nursing practice? This ends lesson 5. Prepare for a 20-item quiz to check your understanding of the lesson. Good luck! REFERENCES: Berman, A., Snyder, S. J., & Frandsen, G. (2022). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice, Vol. 1 (11th ed.). Pearson Education Limited. Brown, M.J., Sharma, P., Mir, F. A. & Bennett, P. N. (2019). Clinical pharmacology (12th ed.). Elsevier Limited. Karch, A. M. (2017). Focus on nursing pharmacology (7th ed.) Wolters Kluwer Health, Incorporated. Woodrow, R. & Colbert, B. (2019). Essentials of pharmacology for health professions (8th ed.). Cencage Learning. “As nurses, we have the opportunity to heal the heart, mind, soul, and body of our patients, their families, and ourselves. They may forget our name, but they will never forget how we made them feel.” - Maya Angelou UNIT II Lesson 5 The Nursing Process in Pharmacology