Chapter_001.pptx

Chapter 1 The Nursing Process and Drug Therapy The Nursing Process     A research-supported organizational framework for professional nursing practice Ensures the delivery of thorough, individualized, and quality nursing care to patients Requires critical thinking Ongoing and constantly evolving...

Chapter 1 The Nursing Process and Drug Therapy The Nursing Process     A research-supported organizational framework for professional nursing practice Ensures the delivery of thorough, individualized, and quality nursing care to patients Requires critical thinking Ongoing and constantly evolving process 2 Contemporary Trends: The Quality and Safety Education for Nurses (QSEN) Project    Initiated in 2005 Preparing future nurses with the knowledge, skills, and attitudes (KSAs) needed to continuously improve the quality and safety of patient care within the health care system KSAs flow out of the QSEN initiatives and are being integrated into nursing education curricula and clinical outcomes. 3 Six Major Initiatives of QSEN       Patient-centered care Teamwork and collaboration Evidence-based practice (EBP) Quality improvement (QI) Safety Informatics 4 Contemporary Trends: Interprofessional Education Collaboration (IPEC)   Formed in 2009 Objective: Develop core competencies for interprofessional collaborative practice   Interprofessional education occurs when students from two or more professions learn from and with each other. Goal: Improve health outcomes 5 Contemporary Trends: Next Generation NCLEX (NGN)    Focus on clinical reasoning and clinical judgement skills New format of questions will appear on upcoming NCLEX Nursing programs are adjusting education programs to increase focus on critical thinking and clinical judgement in the clinical setting 6 Five Steps of the Nursing Process    Assessment Human Needs Statements (formerly Nursing Diagnoses) Planning     Goals Outcome criteria Implementation, including patient education Evaluation 7 Assessment   Data collection, review, and analysis Medication profile      Any and all drug use Prescriptions Over-the-counter medications Vitamins, herbs, and supplements Compliance and adherence 8 Audience Response System Question #1 The nurse answers a patient’s call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first? A.Check the orders and give the patient the requested pain medication. B.Provide comfort measures to the patient. C.Assess the patient’s pain and pain level. D.Evaluate the effectiveness of previous pain medications. 9 NOTE: No input is required to proceed. Answer to System Question #1 ANS: C The nurse should always assess a patient before any intervention. Although the nurse will check the orders and possibly give the medication (and possibly even perform the actions in responses B and D), the first priority is assessment. 10 Planning   Identification of goals and outcome criteria Goals   Objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria Outcome criteria    Concrete descriptions of patient goals Expectations for behavior For drug therapy: outcome is safe and effective administration of medications 11 Implementation   Initiation and completion of specific nursing actions as defined by the Human Needs Statements, goals, and outcome criteria Independent, collaborative, and dependent 12 Audience Response System Question #2 The patient’s medication administration record lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do? A. Give the medications PO with a small sip of water. B. Give the medications via the IV route because the patient is NPO. C. Hold the medications until after the test is completed. D. Call the health care provider to clarify the instructions. 13 Answer to System Question #2 ANS: D The dosage for the IV route would not be the same as for the PO route. Holding the medications may cause drug levels to drop and result in seizure activity, and giving the medications PO without consent may alter the test results. The nurse must never assume the route of medication administration and should consult the health care provider for clarification of the orders. 14 The “Rights” of Medication Administration Right drug  Right dose  Right time  Right route  Right patient  Right documentation Current practice standards suggest these additional “Rights”:  Right reason or indication  Right response   15 Audience Response System Question #3 The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at 2100. What will the nurse do first to determine whether the medication was given? A. B. C. D. Call the night nurse at home. Check the medication administration record. Call the pharmacy. Review the nurse’s documentation. NOTE: No input is required to proceed. 16 Answer to System Question #3 ANS: B The medication administration record is the legal documentation that the professional nurse uses to sign off medications that are given, so it should be checked first. 17 Medication Errors    Any preventable event that may cause or lead to inappropriate medication use or patient harm Patient-related events System-related events Will be discussed further in Chapter 5 18 Evaluation    Ongoing part of the nursing process Determining the status of the goals and outcomes of care Monitoring the patient’s response to drug therapy   Expected and unexpected responses Clear, concise documentation 19 Audience Response System Question #4 A nurse makes an error when administering medications to a patient. Which action by the nurse requires the supervising nurse to intervene? A. The nurse completes an incident report. B. The nurse informs the prescriber of the error. C. The nurse documents adverse effects of the medication error. D. The nurse records completion of an incident report in the medical record. NOTE: No input is required to proceed. 20 Answer to System Question #4 ANS: D If there is a medication error, the nurse should complete an incident report with the entire event, surrounding circumstances, therapeutic response, adverse effects, and notification of the prescriber described in detail. However, the nurse should not record completion of an incident report in the medical record. 21