PH CM1 CU 4 - NURSING PROCESS IN PHARMACOLOGY.pdf

Bachelor of Science in Nursing NCMA 216 (PHARMACOLOGY) COURSE MODULE COURSE UNIT WEEK 1 4 4 Nursing Process in Pharmacology...

Bachelor of Science in Nursing NCMA 216 (PHARMACOLOGY) COURSE MODULE COURSE UNIT WEEK 1 4 4 Nursing Process in Pharmacology ü Read course and unit objectives ü Read study guide prior to class attendance ü Read required learning resources; ü Refer to unit terminologies for jargons ü Proactively participate in classroom discussions ü Participate in weekly discussion board (Canvas) ü Answer and submit course unit tasks 1. Karch, A. M. (2019). Focus on nursing pharmacology. Lippincott Williams & Wilkins. 2. Kee, Joyce Le Fuer and Hayer, Evelyn R., Pharmacology: A Nursing Process Approach, 5th Edition, 2006, by Elsevier (Singapore) PTE LTD 3. Lilley, Linda lane & Harrington, Scott, Pharmacology and the Nursing Process, 5th Edition, by Elsevier (Singapore) PTE LTD At the end of the course unit (CM), learners will be able to: 1. Apply the nursing process in relation to the conduct of drug therapy. 2. Perform appropriate assessment technique prior to, during, and after the drug therapy. 3. Incorporate evidence- based skills and practices in the application of drug. pharmacologic principles in drug therapy. 4. Customize nursing interventions based on Philippine culture and values. 5. Use appropriate communication techniques/ strategies to ensure a working relationship with the client and/or support system in medication administration. 6. Integrate being an A.C.H.I.E.V.E.R. in the practice of nursing pharmacology. ASSESSMENT: information gathering regarding the current status of a particular patient, including evaluation of past history and physical examination; provides a baseline of information and clues to effectiveness of therapy. EVALUATION: part of the nursing process; determining the effects of the interventions that were instituted for the patient and leading to further assessment and intervention. IMPLEMENTATION: actions undertaken to meet a patient’s needs, such as administration of drugs, comfort measures, or patient teaching. NURSING: the art of nurturing and administering to the sick, combined with the scientific application of chemistry, anatomy, physiology, biology, nutrition, psychology, and pharmacology to the particular clinical situation. NURSING DIAGNOSIS: statement of an actual or potential problem, based on the assessment of a particular clinical situation, which directs needed nursing interventions. NURSING PROCESS: the problem-solving process used to provide efficient nursing care; it involves gathering information, formulating a nursing diagnosis statement, carrying out interventions, and evaluating the process. THE NURSING PROCESS } Utilizing steps of nursing process ensures that the interdisciplinary practice of pharmacology results in safe, effective, and individualized medication administration and outcomes for patients. } Although not all nursing theorists completely agree on this process that defines the practice of nursing, most do include certain key elements: assessment, nursing diagnosis, implementation, and evaluation. Application of the nursing process with drug therapy ensures that the patient receives the best, safest, most efficient, scientifically based, holistic care. 1. Assessment (gathering information) is the first step of the nursing process. This involves systematic, organized collection of data about the patient. The data must include information about physical, intellectual, emotional, social, and environmental factors for holistic care. These data are used to identify actual and potential health problems. The database established during assessment provides a foundation for subsequent steps in the process. Important methods of data collection are the patient interview, medical and drug-use histories, the physical examination, observation of the patient, and laboratory tests. Two major aspects associated with assessment are the patient’s history (past illnesses and the current problem) and examination of his or her physical status. Three reasons for obtaining a drug history § To evaluate need for medication § To obtain current and past use of over-the-counter medication § To identify problems related to drug therapy 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 Comprehensive collection of data, including: a. History The patient’s past experiences and illnesses can influence a drug’s effect. This will help to promote safe and effective use of the drug and prevent adverse effects, clinically important drug–drug, drug–food, or drug–alternative therapy interactions, and medication errors. b. Chronic Conditions Chronic conditions can affect the pharmacokinetics and pharmacodynamics of a drug. Certain conditions (e.g., renal disease, heart disease, diabetes, chronic lung disease) may be contraindications to the use of a drug. c. Drug Use  Prescription drugs, over-the-counter (OTC) drugs, street drugs, alcohol, nicotine, alternative therapies, and caffeine may have an impact on a drug’s effect. Patients often neglect to mention OTC drugs or alternative therapies because they do not consider them to be actual drugs or they may be unwilling to admit their use to the health care provider. d. Allergies A patient’s history of allergies can affect drug therapy. Past exposure to a drug or other allergens can provoke a future reaction or necessitate the need for cautious use of the drug, food, or animal product. e. Level of Education and Understanding Gathering information about the patient’s level of understanding about his or her condition, illness, or drug therapy helps the nurse to determine where the patient is in terms of his or her status and the level of explanation that will be required. Stress, disease, and environmental factors can all affect a patient’s learning readiness and ability. f. Social Support Patients are being discharged from health care facilities earlier than ever before, often with continuing care needs. Often patients need help at home with care and drug therapy. g. Financial Supports Financial constraints may cause a patient not to follow through with a prescribed drug regimen. For example, the drug may be too expensive or the patient may lack the means to get to a pharmacy to obtain the drug. In some situations, a less expensive drug might be appropriate in place of a very expensive drug. h. Pattern of Health Care Knowing how a patient seeks health care provides the nurse with valuable information to include when preparing the patient’s teaching plan. Information about patterns of health care also provides insight into conditions that the patient may have but has not reported or medication use that has not been stated. i. Physical Examination To determine if any conditions exist that would be contraindications or cautions for using the drug and to develop a baseline for evaluating the effectiveness of the drug and the occurrence of any adverse effects. j. Weight A patient’s weight helps to determine whether the recommended drug dose is appropriate. k. Age The child’s developmental age will influence pharmacokinetics and pharmacodynamics; the immature liver may not metabolize drugs in the same way as in the adult, or the kidneys may not be as efficient as those of an adult. As patients age, the body undergoes many normal changes that can affect drug therapy, such as a decreased blood volume, decreased gastrointestinal absorption, reduced blood flow to muscles or skin, and changes in receptor-site responsiveness.  2. Nursing Diagnosis The nurse analyzes the database to determine actual and potential health problems. These problems may be physiologic, psychologic, or sociologic. Each problem is stated in the form of a nursing diagnosis, which can be defined as an actual or potential health problem that nurses are qualified and licensed to treat. A complete nursing diagnosis consists of two statements: (1) a statement of the patient's actual or potential health problem, followed by (2) a statement of the problem's probable cause or risk factors. Typically, the statements are separated by the phrase related to, as in this example of a drug- associated nursing diagnosis: “noncompliance with the prescribed regimen [the problem] related to inability to self-administer medication [the cause].” Five 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 § Possible: suspected problems requiring additional data § Wellness: clinical judgment about a transition from one level to a higher level § Syndrome: cluster signs and symptoms to predict certain circumstances or events 3. Planning In the planning step, the nurse delineates specific interventions directed at solving or preventing the problems identified in analysis. The plan must be individualized for each patient. When creating a care plan, the nurse must define goals, set priorities, identify nursing interventions, and establish criteria for evaluating success. In addition to nursing interventions, the plan should include interventions performed by other healthcare providers. Planning is an ongoing process that must be modified as new data are gathered. Four phases of a nursing care plan a. Setting priorities § Identify problems and prioritize which ones are more important and must be attended to first, depending on patient needs b. Developing measurable goal/outcome statements § Write short- and long-term goals for the patient to be followed when providing care c. Formulating nursing interventions and d. Formulating anticipated therapeutic outcomes § Plan which intervention to use based on anticipated patient behavior 4. Implementation Involves taking the information gathered and synthesized into nursing diagnoses to plan the patient care. This process includes setting goals and desired patient outcomes to assure safe and effective drug therapy. These outcomes usually involve ensuring effective response to drug therapy, minimizing adverse effects, and understanding the drug regimen. 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  Three types of nursing interventions are frequently involved in drug therapy: a. drug administration b. provision of comfort measures c. patient/family education. a. Proper Drug Administration The nurse must consider seven points, or “rights,” to ensure safe and effective drug administration. 1) Right drug and patient, 2) Right storage of drug, 3) Right and most effective route, 4) Right dose, 5) Right preparation, 6) Right timing, and 7) Right recording of administration. Remembering to review each point before administering a drug will help to prevent medication errors and improve patient outcomes. b. Comfort Measures A patient is more likely to be compliant with a drug regimen if the effects of the regimen are not too uncomfortable or overwhelming. c. Placebo Effect The anticipation that a drug will be helpful (placebo effect) has proved to have tremendous impact on the actual success of drug therapy. For example, a back rub, a kind word, and a positive approach may be as beneficial as the drug itself. d. Managing Adverse Effects Such interventions include environmental control (e.g., temperature, light), safety measures (e.g., avoiding driving, avoiding the sun, using side rails), and physical comfort measures (e.g., skin care, laxatives, frequent meals). e. Lifestyle Adjustment Some medications and their effects require that a patient make changes in his or her lifestyle. For example, patients taking diuretics may have to rearrange their day so as to be near toilet facilities when the drug action peaks. Patients taking bisphosphonates will need to plan their morning so they can take the drug on an empty stomach, stay upright for at least one-half hour, and plan their first food of the day at least one-half hour after taking the drug. f. Patient and Family Education With patients becoming increasingly responsible for their own care, it is essential that they have all of the information necessary to ensure safe and effective drug therapy at home. In fact, many states now require that patients be given written information. 5. Evaluation Evaluation is part of the continuing process of patient care that leads to changes in assessment, diagnosis, and intervention. The patient is continually evaluated for therapeutic response, the  occurrence of adverse drug effects, and the occurrence of drug–drug, drug–food, drug– alternative therapy, or drug–laboratory test interactions. In some situations, the nurse evaluates the patient simply by reapplying the beginning steps of the nursing process and then analyzing for changes, either positive or negative. The process of evaluation may lead to changes in the nursing interventions being used to provide better and safer patient care. DRUG CALCULATION: § CLARK’S RULE: CHILD’s DOSE = ADULT DOSE X WEIGHT IN POUNDS ----------------------------------------------------- 150 § YOUNG’S RULE: CHILD’s DOSE = ADULT DOSE X AGE IN YEARS § ----------------------------------------------- AGE IN YEARS + 12 § FRIED’S RULE: CHILD’s DOSE = ADULT DOSE X AGE IN MONTHS ------------------------------------------------ 150 § DOSE = DESIRED DOSE ----------------------- X QUANTITY STOCK § CALCULATING INTRAVENOUS FLUID RATE: AMOUNT TO BE INFUSED DROP FACTOR RATE = ------------------------------------- X ------------------------------- HOUR OF INFUSION 60 MINUTES / HOUR 1. Karch, A. M. (2019). Focus on nursing pharmacology. Lippincott Williams & Wilkins. 2. Kee, Joyce Le Fuer and Hayer, Evelyn R., Pharmacology: A Nursing Process Approach, 5th Edition, 2006, by Elsevier ( Singapore) PTE LTD 3. Lilley, Linda lane & Harrington, Scott, Pharmacology and the Nursing Process, 5th Edition, by Elsevier (Singapore) PTE LTD Lehne, Richard A. Pharmacology for Nursing Care 7th edition, by Sauders Elsevier Lilley, Linda lane & Harrington, Scott, Pharmacology and the Nursing Process, 5th Edition, by Elsevier (Singapore) PTE LTD Make a Nursing Care Plan using the nursing process applied in pharmacology learned in this course: Chief Complaint: Fever History of Present Illness: 3 days PTA, patient experienced low grade fever (undocumented) associated with cough and colds. He self medicated with lagundi herbal capsule w/c afforded temporary relief. 2 days PTA, patient still with cough, colds and low grade fever (undocumented) hence consulted a private physician and was given Paracetamol 500mg q4h for the fever and Ambroxol 30mg TID for 5 days w/c afforded temporary relief of the symptoms. Few hours PTA, symptoms persisted accompanied with body malaise and an episode of minimal gum bleeding w/c prompted patient to consult a private physician. He was advice for admission hence transferred in our institute. Physical Examination: Patient conscious, coherent, febrile, NICRD with the ff: BP: 100/70 mmHg RR: 22 cpm CR: 82 bpm T: 38.5˚C HE-ENT/SKIN: Pink palpebral conjuctiva, anicteric sclera, dry lips, (+) nasal discharge, (-) tonsillopharyngeal congestion, (-) cervicolymphadenopathy CHEST: Symmetrical chest expansion, clear breath sounds, (-) retraction, (-) crackles Adynamic precordium, normal rate, regular rhythm, no murmur, grossly normal extremities, (-) cyanosis, (-) edema ABDOMEN/ RECTUM: flat abdomen, soft, tender, normoactive bowel sound LABORATORY TESTS: Hemoglobin 198g/dl, Hematocrit 40%, WBC 4.5/mcl. Chest X-ray- normal. Urinalysis is unremarkable. Assessment Diagnosis Background Planning Intervention Rationale Evaluation Knowledge