The Nursing Process and Pharmacology: Chapter 4 PDF

Chapter 4 The Nursing Process and Pharmacology Clayton’s Basic Pharmacology for Nurses, 19th edition Michelle Willihnganz, MS, RN, CNE 1  Lesson 4.1 The Nursing Process and Pharmacology...

Chapter 4 The Nursing Process and Pharmacology Clayton’s Basic Pharmacology for Nurses, 19th edition Michelle Willihnganz, MS, RN, CNE 1  Lesson 4.1 The Nursing Process and Pharmacology (1 of 2) 1. Discuss the components and purpose of the nursing process. 2. Explain what the nurse does to collect patient information during an assessment. 3. Discuss how nursing diagnosis statements are written. 4. Differentiate between a nursing diagnosis and a medical diagnosis. 5. Discuss how evidence-based practice is used in planning nursing care. 2  Lesson 4.1 The Nursing Process and Pharmacology (2 of 2) 6. Differentiate between nursing interventions and outcome statements. 7. Explain how Maslow’s hierarchy of needs is used to prioritize patient needs. 8. Compare and contrast the differences between dependent, interdependent, and independent nursing actions. 9. Discuss how the nursing process applies to pharmacology. 3  The Nursing Process  Foundation for the clinical practice of nursing  Involves:  Assessment  Nursing diagnosis  Planning  Nursing intervention or implementation  Evaluation and recording therapeutic outcomes 4  Audience Response Question 1  What is the foundation for the clinical practice of nursing? a) Assessment b) Nursing process c) Planning d) Evaluation e) Implementation 5  Assessment  First step in the nursing process  Comprehensive collection of data, including:  Physical examination  Nursing history  Medication history  Professional observation  Assessment is an ongoing process that starts with admission and continues until the patient is discharged from care 6  Nursing Diagnosis  A clinical judgment about individual, family, or community responses to actual or potential health problems/life processes (NANDA-I)  Actual nursing diagnosis consists of a three-part statement that:  Uses a NANDA-I diagnostic label  Has contributing factors  Defines characteristics  One method used to help with a nursing diagnosis is Gordon’s Functional Health Patterns Model 7  Four Types of Nursing Diagnosis  Actual: Based on human responses and supported by defining characteristics  Risk/high-risk: Patient may be more susceptible to a particular problem  Health promotion and wellness: Only has a one-part label  Syndrome: Clusters signs and symptoms to predict certain circumstances or events 8  Audience Response Question 2  A clinical judgment that a person is more susceptible to a particular problem than others in the same situation is defined as which type of nursing diagnosis? a) Actual b) Health promotion/wellness c) Risk/high risk d) Syndrome 9  Nursing Diagnosis vs. Medical Diagnosis  Conditions described by nursing diagnoses can be accurately identified by nursing assessment methods  Nursing treatments/methods of risk-factor reduction can resolve condition  Nurses assume accountability for outcomes within scope of nursing practice  Nurses assume responsibility for research required to clearly identify the defining characteristics and causative factors 10  Audience Response Question 3  How does a nursing diagnosis differ from a medical diagnosis? a) A nursing diagnosis concerns a disease that impairs physiologic function. b) A nursing diagnosis evaluates a patient’s response to actual or potential health problems. c) A nursing diagnosis determines the rate of Medicare reimbursement. d) A nursing diagnosis does not consider potential future problems. 11  Collaborative Problems  Different from nursing diagnoses when the intervention used is to prevent or treat a problem and statement is worded with potential complication in the diagnosis  Evidence-based practice uses research to impact nursing practice changes; the interventions used in the research findings can be implemented into care plans 12  Focused Assessment  Process of collecting additional data specific to a patient or family that validates a suggested problem or nursing diagnosis  Collaborative problems that require prescriptive orders can be identified and differentiated from solutions that the nurse can implement and that are within the nurse’s scope of practice 13  Phases of Planning (Slide 1 of 2)  Four phases of a nursing care plan include:  Setting priorities  Developing measurable goal/outcome statements  Formulating nursing interventions  Formulating anticipated therapeutic outcomes 14  Phases of Planning (Slide 2 of 2)  Setting priorities: Identify problems and prioritize which ones are more important and must be attended to first, depending on patient needs  Developing measurable goal statements: Write short- and long-term goals for the patient to be followed when providing care  Formulating nursing interventions and anticipated outcomes: Plan which intervention to use based on anticipated patient behavior 15  Evidence-Based Practice  Application of data from scientific research to make clinical decisions about individual patient care  Goal is to improve patient outcomes by implementing best practices evolved from scientific studies  Uses best care practices to improve patient outcomes 16  Priority Setting  Maslow’s hierarchy of needs  Physiologic needs  Safety needs  Belonging needs  Self-esteem needs  Self-actualization needs 17  Measurable Goal and Outcome Statements  Measurable goal statement: Starts with an action word that is followed by behavior or behaviors to be performed by patient or the patient’s family within a specific amount of time  All goal and outcome statements must be individualized and based on patient’s abilities 18 Nursing Intervention or Implementation (1 of 2)  Actual process of carrying out the established plan of care  Nursing actions are suggested  Dependent actions: Performed by a nurse based on health care provider’s orders  Interdependent actions: Implemented with the cooperation of a team  Independent actions: Provided by nurse by virtue of education and license 19 Nursing Intervention or Implementation (2 of 2)  Nursing interventions: Meeting the physical needs of the patient, providing for patient safety, monitoring for potential complications, assessing and evaluating to identify changes in the patient’s needs  Therapeutic outcomes are developed to evaluate the effectiveness of the care given 20  Evaluating and Recording Therapeutic and Expected Outcomes  All care is evaluated against:  Nursing diagnoses (goal statements)  Nursing interventions  Patient responses  Evaluation process involves patient, family, and significant others who provide feedback and help determine goals 21  Nursing Actions  Dependent: Performed by the nurse on the basis of the healthcare provider’s orders  Interdependent: Implemented cooperatively with other members of the healthcare team  Independent: Not prescribed by a healthcare provider, but nurse can provide by virtue of the education and licensure held 22  Audience Response Question 4  Which is an independent nursing action? a) Orders medications based on the patient’s medical diagnosis b) Orders laboratory tests depending on the medications ordered c) Chooses an alternate route for medications if indicated d) Verifies the correct route of medication administration 23  Anticipated Therapeutic and Expected Outcome Statements  Anticipated therapeutic statements and expected outcome statements are developed to document the effectiveness of the care delivered  Therapeutic outcomes can be used by the student to identify the outcomes anticipated from the use of the drugs listed in a particular classification 24  Evaluation  Final phase of five-step nursing process  Involves nurse determining whether the expected outcomes were met  Recognizes the successful completion of previously established goals  Provides a means for the input of new significant data that indicate the development of additional problems or lack of therapeutic responsiveness 25  Assessment (1 of 2)  Reasons for obtaining a drug history are to:  Evaluate need for medication  Obtain current and past use of over-the-counter medication  Identify problems related to drug therapy 26  Assessment (2 of 2)  Relies on three sources  Primary source: Produced by patient  Secondary sources: Relatives, significant others, medical records, lab reports  Tertiary sources: Literature to provide background information, diagnostic tests, diet 27  Audience Response Question 5  Which piece of information obtained during a patient assessment is a subjective finding? a) Patient states, “I have pain in my abdomen.” b) Temperature of 38.5° C c) 400 mL of clear, yellow urine d) Blood pressure of 116/74 mm Hg 28  Nursing Diagnosis and Pharmacology  Nursing diagnoses often can be formulated based on the patient’s drug therapy  Most commonly associated with drug treatment for a disease or adverse effects from drug therapy  Also can originate from pathophysiology caused by drug interactions  Review the drug monographs to identify problems related to medication therapy 29  Planning  Identify the therapeutic intent and common and serious adverse effects  Confirm recommended dosage and route of medication  Check that scheduling of administration of medicine is based on the provider’s orders  Teaching patients  Keep written response records  Techniques of self-administration as needed  Proper storage and refilling of medications 30 Nursing Intervention or Implementation (1 of 2)  Dependent nursing actions  Interdependent nursing actions  Independent nursing actions 31 Nursing Intervention or Implementation (2 of 2)  Nurses prepare the prescribed medications using procedures to ensure patient safety  Select correct supplies (syringes, etc.)  Verify all aspects before preparation  Collect appropriate data to serve as baseline for later assessments  Administer medication by correct route  Document all aspects of administration  Implement actions to minimize expected side effects  Educate patient as appropriate 32  Evaluating Therapeutic Outcomes  Evaluation procedure for determining therapeutic outcomes of drug therapy include:  Assessing patient responses to medications  Determining signs and symptoms of recurring illness  Assessing any adverse effects  Determining the patient’s ability to receive education and self-administer medication, as well as the potential for compliance 33 Questions? 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