Adams ch06 lecture

PHARMACOLOGY FOR NURSESPHARMACOLOGY FOR NURSES
A Pathophysiological ApproachA Pathophysiological Approach
FOURTH EDITIONFOURTH EDITION
Copyright © 2014, © 2011, © 2008 by Pearson Education, Inc.
All Rights Reserved
CHAPTER
The Nursing Process
in Pharmacology
6

Pharmacology for Nursing: A Pathophysiology Approach, Fourth Edition
Michael Patrick Adams | Leland N. Holland | Carol Urban
Steps of Nursing ProcessSteps of Nursing Process
• Assessing
• Diagnosing
• Planning
• Implementing
• Evaluating

Figure 6.1 The five overlapping phases of the nursing process. Each phase depends on the accuracy of the
other phases Source: Berman, Audrey J.; Snyder, Shirlee, Kozier, KOZIER & ERB’S FUNDAMENTALS OF
NURSING, 9th edition. © 2012 Reprinted and electronically reproduced by permission of Pearson Education, Inc.,
Upper Saddle River, New Jersey.

Assessment of the PatientAssessment of the Patient
• Systematic collection, organization,
validation, and documentation of
patient data
• Health history and physical assessment
• Baseline data gathered; will be
compared to later information from
observations

• Subjective data—what patient describes
• Objective data—physical assessment,
laboratory tests, other diagnostic
sources

• Health history tailored to patient clinical
condition
– Includes use of all
medications/supplements taken
• Physical assessment – objective data
on patient’s condition

Table 6.1 Health History Assessment Questions
Pertinent to Drug Administration
continued on next slide

Table 6.1 (continued) Health History Assessment
Questions Pertinent to Drug Administration

Assessment of PatientAssessment of Patient
• Once pharmacotherapy is initiated,
assessment focuses on reaction to
medication.
– Watch for desired response
– Adverse effects
– Patient capability to assume
responsibility for self-administration

Medication Errors and DietaryMedication Errors and Dietary
SupplementsSupplements
• Dietary supplements and herbal
medications must be monitored.
– Can increase or cancel effect of
prescribed medications

Nursing Diagnoses for DrugNursing Diagnoses for Drug
AdministrationAdministration
• Often most challenging part of nursing
• Focus is on patient’s needs, not nurse’s
• Three main areas of concern
– Promoting therapeutic drug effects
– Minimizing adverse drug effects
– Maximizing patient ability for self-care

Nursing Diagnoses for DrugNursing Diagnoses for Drug
• May focus on patient’s response to
actual or potential health and life
processes

Risk Diagnosis Includes:Risk Diagnosis Includes:
• Diagnostic statement
• Related factor or inferred cause

Actual Diagnosis Includes:Actual Diagnosis Includes:
• Diagnostic statement
• Related factor or inferred cause
• Evidence to support statement

Most Common Nursing DiagnosesMost Common Nursing Diagnoses
for Medication Administrationfor Medication Administration
• Deficient Knowledge
– Patient not properly educated about
medication
• Noncompliance
– Patient properly educated, but chose not
to take medication

Some Diagnoses for DrugSome Diagnoses for Drug
• Activity Intolerance
• Risk for Falls
• Urinary Incontinence
• Oral Mucous Membrane Impaired
• Consult books on nursing diagnoses

Table 6.2 Common Nursing Diagnoses Applicable to
Drug Administration

Table 6.2 (continued) Common Nursing Diagnoses
Applicable to Drug Administration

Nurse Planning PhaseNurse Planning Phase
• Prioritizes diagnoses, formulates
desired outcomes, and selects nursing
interventions that can assist patient to
return to an optimum level of wellness

Goals for Patient ReceivingGoals for Patient Receiving
MedicationsMedications
• Based on nursing diagnosis
• Focused on what patient will achieve or
do
• Prioritized
• Discussed with patient or caregiver
• Can be short- or long-term goals

Goals for Patient ReceivingGoals for Patient Receiving
• Goals focused on
– Safe and effective administration
– Therapeutic outcome
– Treatment of side effects

Outcomes for Patients ReceivingOutcomes for Patients Receiving
• Specific, measurable criteria
• Evaluate degree to which goal is met
• Focus on what patient will achieve or
do
• Discuss with patient or caregiver

Outcomes for Patients ReceivingOutcomes for Patients Receiving
• Should be written and should include
– Subject (patient)
– Action required by subject
– Circumstances
– Expected performance
– Specific time frame

Implementation PhaseImplementation Phase
• Nurse applies knowledge, skills, and
principles of nursing care to move
patient toward desired goal and optimal
wellness.

Aim of InterventionsAim of Interventions
• Patient returned to optimal level of
wellness
• Safe and effective administration of
medications

Implementation Phase ActionsImplementation Phase Actions
• Administering medication
• Continued assessment of patient
• Monitoring drug effects
• Documenting medications
• Patient teaching

Monitoring Drug Effects Is PrimaryMonitoring Drug Effects Is Primary
InterventionIntervention
• Monitor for identified therapeutic effect
• Reassessing patient
– Physical condition
– Vital signs
– Body weight
– Lab values
– Serum drug levels

Monitoring Drug Effects Is PrimaryMonitoring Drug Effects Is Primary
InterventionIntervention
• Taking patient statements
• Monitoring side or adverse effects

Documentation of MedicationDocumentation of Medication
• Administration of medication
• Therapeutic and adverse effects
• Patient statements
• Objective assessment data

Patient TeachingPatient Teaching
• Primary role for nurses
• Directly related to
– Knowledge deficit
– Noncompliance
• Provide written material to patient
• Elderly and pediatric patients are
special challenge.
• May need to co-teach patient’s
caregiver

Evaluation Is a CheckpointEvaluation Is a Checkpoint
• Compares patient current status with
desired outcome
– If goal met, focus may shift to next
highest priority
– If not met, plan may require revisions
• Overall goal is safe, effective
medication administration.
• Therapeutic outcome should be best
possible; take steps to ensure success.

Evaluation Begins New Cycle WhenEvaluation Begins New Cycle When
• New assessment data is gathered and
analyzed.
• Nursing diagnoses are reviewed or
rewritten.
• Goals and outcomes are refined.
• New interventions are carried out.

Table 6.3 Important Areas of Teaching for a Patient
Receiving Medications

Table 6.3 (continued) Important Areas of Teaching
for a Patient Receiving Medications

Adams ch06 lecture

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