Nursing Process in Pharmacology Exam 3 PDF

Application of the Nursing Process in Pharmacology NURS 1060: Exam 3 OUTCOME  Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas Philosophy. COMPETENCY  Describe factors that create a culture of s...

Application of the Nursing Process in Pharmacology NURS 1060: Exam 3 OUTCOME  Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas Philosophy. COMPETENCY  Describe factors that create a culture of safety related to medication administration.  Discuss patient-teaching related to medications. CONCEPT  Clinical Decision Making: A process used to examine and determine the best actions to meet desired goals; requires anticipating, recognizing and organizing patient problems to respond with urgency and/or importance in a preferential order to avoid or minimize adverse changes in a patient’s condition.  Safety: Minimizing risk of human harm through both system effectiveness and individual performance.  Teaching & Learning: A collaborative process between teacher and learner designed to produce a change in knowledge and behavior. UNIT OUTCOMES  Discuss preadministration self-preparation of knowledge for safe medication administration.  Discuss application of the nursing process in drug therapy.  Describe patient education related to drug therapy. Why Should a Student Nurse/RN Learn About Drugs?  Essential for SAFE nursing practice  Much more required than the Five Rights  Right drug, patient, dose, route, time,  Plus the right documentation Nursing Responsibilities Regarding Drugs  Correct administration, without additional interventions, cannot ensure that treatment will result in the therapeutic objective.  Proper delivery is only the beginning of a nurse’s responsibility.  The nurse must know  What medications are appropriate for the patient  What drugs are contraindicated for the patient  The probable consequences of the interaction between drug and patient   Follows the patient’s status most closely  Identify and intervene to correct mistakes made by pharmacists and The nurse’s prescribers role as a  First member of the health care team to observe and patient evaluate drug responses and intervene if required advocate  Must know the therapeutic response that a medication is likely to elicit to determine beneficial or not beneficial effect.   Last line of defense for the patient  Ethically and legally unacceptable to administer a drug that is harmful to the The nurse’s patient—even though the role as a medication has been prescribed by a licensed patient prescriber and dispensed by a licensed pharmacist advocate  The nurse MUST follow the ANA Code of Ethics and the Nurse Practice Act – Standards of Care and Scope of Practice Minimizing Adverse Effects Know the major adverse effects the drug can produce The time when these reactions are likely to occur Monitor/Assess for adverse interactions Teaching Example: Advise the patient to avoid OTC drugs that can interact with the prescribed medication. Minimizing Adverse Effects Take a comprehensive drug history:  Rx  OTC  Herbs  Home remedies  Recreational drugs and substances  Self-treatment with complementary and alternative drugs  Allergies Making PRN Decisions  Meaning “as needed”  Nurse has discretion regarding how much drug to give and when to give it.  Know the reason for drug use.  Be able to assess the patient’s medication needs. Example PRN Decision  morphine sulfate 10 mg orally every 4 hours as needed  acetaminophen 325-650 mg orally every 4 hours as needed  cyclobenzaprine (Flexeril) 10 mg orally every 8 hours as needed  Which order do you choose? Application of Pharmacology in Patient Education  Drug name -generic and trade  Therapeutic category – anti-hypertensive/antibiotic  Dosage size –tablet or mg or ml  Dosing schedule- daily or twice a day  Route and technique of administration- oral/injectable  Expected therapeutic response and when it should develop – literature may refer to onset/peak/duration  What to do if a dose is missed Application of Pharmacology in Patient Education  Duration of treatment – days/weeks/months/ongoing  Method of drug storage – cool dry or refrigerator  Symptoms of major adverse effects – nausea, weakness  Major adverse drug-drug and drug-food interactions  Example: Tetracycline avoid antacids, Ca vitamins and dairy products  Know Prescriber’s Name and Telephone contact in the event of therapeutic failure  drug does not improve the problem  patient experiences adverse reactions Application of Pharmacology in Patient Education  When contacting the prescriber provide:  Drug name  Dose  How often taken  Necessary for prescriber to be able to advise the patient regarding any questions, concerns or problems. Application of the Nursing Process in Drug Therapy Case Study  Sam is a nurse working on the cardiology floor. He has an order to administer a dose of atenolol (a beta-blocker medication) to a patient at 0800. What actions should the nurse take prior to administering the medication? What is the anticipated therapeutic effect of this medication? Pre-Administration Assessment  Assessment data collection MUST be complete and accurate (helps identify high-risk patients)  Patient history  Physical examination  Laboratory results  Assess before administration to determine if drug is appropriate AT THIS TIME  Assess after administration to evaluate therapeutic responses and adverse effects by comparison to baseline data  VS, Physical assessment, Lab results, etc…  Assessment of the patient’s capacity for self-care Physical, Cognitive, Emotional Pre-Administration Assessment  WHY ? WHAT IS THE CONCERN?  Identifying high-risk patients:  Liver and kidney impairment  Genetic factors  Drug allergies  Pregnancy  Elderly and pediatric Nursing Problems (Nursing Diagnoses)  Identify potential (risk for) Nursing Problems/Diagnoses that the drug might cause.  Use data collected in assessment to determine the patient’s capacity for self-care: Identify (Actual) Nursing Diagnoses if needed  Physical, Cognitive, Emotional  Identify “Knowledge deficit” regarding the drug Planning  Define goals  Setting priorities  Identifying specific interventions- Examples:  Drug administration  Interventions to minimize adverse effects  Patient education  Establishing objective criteria for evaluation Implementation  Drug administration  5 Rights  Include Patient Education immediately at bedside Implementation Dosage and Administration  Read the medication order carefully.  Read the medication label carefully.  Don’t administer any drug if you don’t understand the indications (reason for its use) for this patient. Implementation Dosage and Administration  Many Drugs have more than one indication.  Example: Regular Insulin  Label use: Treat hyperglycemia by lowering blood glucose  Off-label use: Given with other medications to treat hyperkalemia by causing potassium (K) to enter cells Evaluating and Promoting Therapeutic Effects  Often involves reassessment  The nurse must know:  the rationale for treatment (indications/goal)  the nature and time course of the intended response (when to evaluate)  Cannot effectively evaluate a drugs effect unless the indications for this patient are known by the nurse. Evaluating and Promoting Therapeutic Effects Examples:  Monitoring serum drug levels  Peak and trough  Therapeutic Range: above MEC and below Toxic  Checking vital signs after giving the medication Evaluating and Promoting Therapeutic Effects  Patient adherence or plan for adherence to the prescribed regimen  Patient Nonadherence or indication for nonadherence to the prescribed regimen  Patient satisfaction with treatment  Patient dissatisfaction with treatment Critical Thinking Question  You are preparing to administer an antihypertensive medication. The patient’s BP was taken and is 120/75. What next action should the nurse take? a) Administer the medication as ordered. b) Assess the baseline BP and previous BPs related to the last dose of this medication to determine if the medication should be administered. c) Call the prescriber, report the current blood pressure, and ask if the medication should be administered d) Withhold the medication because the patient’s BP is normal and does not need an antihypertensive medication.