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    1. 1. The Nursing Process 1
    2. 2. Pharmacology and the Nursing Process The Nursing Process is crucial for safe medication administration.“Crucial = of the greatest significance in determining an outcome” 2
    3. 3. Pharmacology and the Nursing ProcessNursing Process draws together all of the aspects of the patient:PhysicalCulturalCognitiveSpiritualSexualFinancialRecognizing these aspects allows for a more holistic approach to patient care 3
    4. 4. The Nursing Process• A research-based organizational framework for professional nursing practice• Central to all nursing care• Encompasses all steps taken by the nurse in caring for a patient• Ongoing and constantly evolving process Critical thinking Flexibility is important 4
    5. 5. The Nursing Process• Assessment• Nursing diagnosis• Planning – Goals – Outcome criteria• Implementation• Evaluation 5
    6. 6. Nursing ProcessAssessment• Data collection -Subjective, objective - Accurate 6
    7. 7. Nursing ProcessNursing diagnosis• Decision about the need/problem (actual or at risk for)Three parts• Human response to illness• “related to”• “as evidenced by” 7
    8. 8. Nursing ProcessNursing diagnosis• critical thinking• creativity• accurate data collection• It is a statement about the patient’s status and will guide nursing interventions 8
    9. 9. Nursing ProcessPlanning• Identification of goals -Must be patient-centered• Outcome criteria -Must be SMART -have a time frame• Prioritization 9
    10. 10. Nursing ProcessImplementation• Initiation and completion of the nursing care plan as defined by the nursing diagnoses and outcome criteria 10
    11. 11. Nursing ProcessEvaluation• Ongoing part of the nursing process• Determining the status of the goals and outcomes of care 11
    12. 12. The Nursing Process and Medication AdministrationAssessment 1. Health- 3. Diagnostic Tests, lab values allergies 4. Medication History pattern of health care – Prescriptions experiences/ illnesses – OTCs level of education – Herbals understanding of the disease – Responses to medications process (therapeutic and adverse financial support responses) 2. Physical assessment – age and weight social support at home chronic conditions 12
    13. 13. The Nursing Process and Medication AdministrationNursing Diagnosis• Human response to illness (actual or risk) – drug therapy may only be a small part of the total pt picture – or, at times it may be an all consuming factor in the patient’s life• Drug therapy is incorporated into the total picture 13
    14. 14. The Nursing Process and Medication AdministrationPlanning 1. Identification of possible interactions knowledge of the prescribed medication over-the-counter (OTC) drugs, herbs 2. Client and family education level of patient understanding of disease level of education 3. Gather equipment, review procedures, safety measures timing and frequency of drugs storage of drugs This phase leads to the provision of safe effective medication administration 14
    15. 15. The Nursing Process and Medication AdministrationImplementation 1. Maximizing therapeutic effect 2. Minimizing adverse effects provide comfort measures and help pt. cope with the therapeutic or adverse effects of a drug 3. 10 rights of medication administration 15
    16. 16. The Nursing Process and Medication AdministrationEvaluation• Monitoring the patient’s response to drug therapy 1. Expected outcome 2. Unexpected outcome 16
    17. 17. The Five Rights of Medication Administration• Right drug• Right dose• Right time• Right route• Right patientMedication errors are a major problem in health care today 17
    18. 18. Plus Five Rights ofMedication Administration• Right documentation• Right assessment• Right to education• Right evaluation• Right to refuse 18
    19. 19. 1. RIGHT DRUG• Pt should receive the drug that was prescribed.• Medication orders may be prescribed by: – Physician – Dentist – Podiatrist (foot doctor) – Licensed health care provider• Prescription = written on prescription pad• Drug orders = written in “order sheets” included in pt’s chart 19
    20. 20. DRUG ORDERSAccurately written drug orders are part of patient rights 20
    21. 21. Six Elements of a Drug Order1. Name of the patient2. Date order is written (start/ stop dates may be ordered)3. Name of medication4. Dosage includes size, frequency, and number of doses5. Route of delivery6. Signature of the prescriber 21
    22. 22. Medication CardBed # Ward Name of Patient Medication FrequencyDate ordered Signature 22
    23. 23. January 16, 2012 at 3:30pmPatient Juan Dela Cruz is admitted at Ward F bed # 2. The patient is hooked with 1 L D5LR at 30 gtts/min, on left cephalic vein. Start cefuroxime 750mg, q8h, ANST. F2 Ward F 12 Dela Cruz, Juan 8 Cefuroxime (Zinacef) 750 mg 4 q 8 h ANST (+/- ) 1/16/12 lmn 23
    24. 24. DRUG ORDERS4 categories:3. Standing Order – Maybe an ongoing order – Maybe given for a specific # of doses/days – May have special instructions – May include PRN orders 24
    25. 25. DRUG ORDERS4 categories:2. One-time – Given 1x, at a specific time 25
    26. 26. DRUG ORDERS4 categories:3. PRN orders – Given at client’s request and nurse’s judgement 26
    27. 27. DRUG ORDERS4 categories:4. Stat orders – Given at once, immediately 27
    28. 28. DRUG ORDERSNursing Implications:3. Check that the medication order is complete and legible.5. Know the reason why the drug is being administered to client. 28
    29. 29. 3 CHECKS before drug administration: •At the time of contact with the drug bottle/container •Before pouring/preparing the drug •After pouring/preparing the drug 29
    30. 30. DRUG ORDERS4. Medication card of Kardex should include the date the medication was ordered and any last date. – Ex. Controlled drugs that need to be renewed q 48h – Anticoagulant & antibiotics renewed after 7 days – Cancellation of drugs when the client gpes to surgery. 30
    31. 31. DRUG ORDERS5. The 1st dose, one time and “as needed” medication orders should be checked against original orders.6. Be aware of certain drugs that sound alike and are spelled similarly. 31
    32. 32. 2. RIGHT DOSE • Dose prescribed for a particular clientNursing Implications:4. Calculate dose correctly. When in doubt, it should be calculated and checked by another nurse.6. Check references (PPDR, drug package insert) for recommended range of specific drug doses. 32
    33. 33. 3. RIGHT TIME• Time at which the prescribed dose should be administered.Nursing Implications:• Administer at specific time. 33
    34. 34. Nursing Implications:2. Administer that are affected by foods, before meals. 34
    35. 35. Nursing Implications:3. Administer that can irritate the stomach with food.4. Drug administration schedule maybe adjusted to fit the client’s lifestyle, activities, tolerances or preferences. 35
    36. 36. Nursing Implications:5. It is the nurse’s responsibility to check whether the client is scheduled for any diagnostic procedures that would contraindicate the administration of medications. 36
    37. 37. Nursing Implications: 6. Check the expiration date.Discard the medication or return it to the pharmacy if the date has passed. 37
    38. 38. Nursing Implications:7. Antibiotics should be administered at even intervals throughout a 24- hr period so that therapeutic blood levels are maintained. 38
    39. 39. 4. RIGHT ROUTE • Necessary for adequate absorptionNursing Implications:1. Assess ability to swallow before administration. 39
    40. 40. Nursing Implications:2. Do not crush/mix medications in other substances without consulting the pharmacist.• Don’t mix with sweet substances to “trick” children.• Don’t mix in an infant’s formula feeding. 40
    41. 41. Nursing Implications:3. Use aseptic technique when preparing and administering drugs.Sterile technique is required with parenteral route. 41
    42. 42. Nursing Implications:4. Administer at the appropriate site.5. Stay with client until oral drugs have been swallowed. 42
    43. 43. Nursing Implications:6. If it is necessary to combine medication with another substance, explain this to the client. 43
    44. 44. 5. RIGHT PATIENT• Nurse must verify the client’s identity before any drug administrationNursing Implications:4. Verify by checking the identification bracelet. – Some institutions put the client’s photo on his/her health record. 44
    45. 45. Nursing Implications:2. Distinguish between 2 clients with same last name – Have warnings highlighted in bright color on ID tools, such as medication cards, bracelet or Kardex. 45
    46. 46. Nursing Implications:3. Some institutions have ID bracelets coded for allergy status. – Nurse must be aware of this policy. 46
    47. 47. 6. Right Documentation• Requires the nurse immediately record the appropriate information about the drug administered. – Name of drug – Dose and route of administration – Time and data of administration – Nurse’s initial/signature – Response to medication, including unexpected reactions, should also be recorded, accdg to institution policy 47
    48. 48. 48
    49. 49. 7. Right Assessment• Requires appropriate data must be collected before administration of the drug. 49
    50. 50. 8. Right to Education• Requires that client receive accurate and thorough information about the medication And how it relates to his or her particular situation. 50
    51. 51. 8. Right to Education• Client teaching should include: – Therapeutic purpose – Possible SE – Any diet/lifestyle restrictions – Skill of administration – Lab monitoring 51
    52. 52. 8. Right to Education• Coincides with the principle of informed consent – Based on the individual having the knowledge necessary to make a decision. 52
    53. 53. 9. Right Evaluation• Requires effectiveness of the medication be determined by the client’s response to the medication• Appropriate to determine the extent of side effects and adverse effects, if any. 53
    54. 54. 10. Right to Refuse the Medication• Client can and do refuse to take a medication.• It is the nurse’s responsibility to determine, when possible, the reason for refusal and to take reasonable measures to facilitate the client’s taking of medication. 54
    55. 55. Nursing actions when client refuses to take medications:3. Explain the risk of refusing to take the medication, and reinforce the reason for the medication.5. When the medication is refused, this refusal should be documented immediately.7. Inform the nurse manager or health care provider when an omission and refusal to take medication pose a specific threat to the client. 55
    56. 56. Patient’s Rights• In addition to the 10 medication “rights”…… DO YOU THINK PATIENTS HAVE OTHER MEDICATION “RIGHTS”?• What additional systems would you like to see in place to ensure safe drug administration? 56
    57. 57. Association of Nursing Service Administrators of the Philippines, inc (ANSAP)10 Golden Rules for Administering Drugs Safely:3. Right drug5. Right drug to the right patient7. Right dose9. Right drug by the right route11. Right drug at the right time 57
    58. 58. Association of Nursing Service Administrators of the Philippines, inc (ANSAP)10 Golden Rules for Administering Drugs Safely:3. Document each drug you administer.5. Teach your patient about the drugs he is receiving.7. Take a complete patient drug history (risk of adverse drug reactions when a number of drugs are taken/when pt is taking alcohol drinks)10. Find out if the patient has any allergies.12. Be aware of potential drug-drug or drug-food interactions. 58
    59. 59. General Guidelines for Correct Administration of MedicationsPreparation:3. Wash hands before preparing medications.5. Check for drug allergies, check the assessment hx and Kardex. 59
    60. 60. General Guidelines for Correct Administration of MedicationsPreparation:3. Check medication order with health care provider’s orders, Kardex, medication sheets and medication card.4. Check label on container 3x.5. Check expiration date on drug label, card; use drug only if date is current. 60
    61. 61. General Guidelines for Correct Administration of MedicationsPreparation:6. Recheck drug dose calculation with another nurse.7. Verify doses of drugs that are potentially toxic with another nurse/pharmacist. 61
    62. 62. General Guidelines for Correct Administration of MedicationsPreparation:8. Pour tablet/capsule into the cap of the drug container. With unit dose, open packet at bedside after verifying client identification.9. Pour liquid at eye level. Meniscus, the lower curve of the liquid, should be at the line of the desired dose.10. Dilute drugs that irritate gastric mucosa (aspirin, potassium) or give with meals. 62
    63. 63. General Guidelines for Correct Administration of MedicationsAdministration:3. Administer only those drugs that you have prepared. Do not prepare medications to be administered by another. 63
    64. 64. General Guidelines for Correct Administration of MedicationsAdministration:2. Identify the client by ID band, ID photo and name tag/band. 64
    65. 65. General Guidelines for Correct Administration of MedicationsAdministration:3. Offer ice chips to numb taste buds when giving bad-tasting drugs. 65
    66. 66. General Guidelines for Correct Administration of MedicationsAdministration:4. When possible, give bad- tasting medication first, followed by pleasant-tasting liquids. 66
    67. 67. General Guidelines for Correct Administration of MedicationsAdministration:5. Assist the client to appropriate position, depending on the route of administration.6. Provide only liquids allowed on the diet. 67
    68. 68. General Guidelines for Correct Administration of MedicationsAdministration:7. Stay with the client until the medications are taken. 68
    69. 69. General Guidelines for Correct Administration of MedicationsAdministration:8. Administer no more than 2.5-3mL of solution IM at 1 site. Infants receive no more than 1 mL of solution IM at 1 site and no more than 1 ml SQ. Never recap needles (universal precaution), use the “fishing method” instead. 69
    70. 70. General Guidelines for Correct Administration of MedicationsAdministration:9. When administering drugs to a group of clients, give drug last to clients who need extra assistance. 70
    71. 71. General Guidelines for Correct Administration of MedicationsAdministration:10. Discard needles and syringes in appropriate containers.11. Drug disposal is dependent on agency policy. Controlled substances must be returned to the pharmacy. Some disposals need signature of witness. 71
    72. 72. General Guidelines for Correct Administration of MedicationsAdministration:12. Discard unused solutions for ampules.13. Appropriately store (some require refrigeration) unused stable solutions from open vials. 72
    73. 73. General Guidelines for Correct Administration of MedicationsAdministration:14. Write date and time opened, and your initials on label.15. Keep narcotics in a double- lock drawer or closet. medication carts must be locked at all times when a nurse is not in attendance. 73
    74. 74. General Guidelines for Correct Administration of MedicationsAdministration:16. Keys to the narcotics drawer must be kept by the nurse and not stored in a drawer or closet.17. Keep narcotics in a safe place, out of reach of children and others in the home.18. Avoid contamination of one’s own skin or inhalation to minimize chances of allergy or sensitivity dev’t. 74
    75. 75. General Guidelines for Correct Administration of MedicationsRecording:3. Report drug error immediately to client’s health care provider and to the nurse manager. Complete incident report. 75
    76. 76. General Guidelines for Correct Administration of MedicationsRecording:2. Charting: record the drug given, time, route and your initials.3. Record drugs promptly after given, especially STAT doses.4. Record effectiveness and results of medications administered, esp PRN medications. 76
    77. 77. General Guidelines for Correct Administration of MedicationsRecording:5. Report to health care provider and record drugs that were refused with reason for refusal.6. Record amount of fluid taken with medications in input and output chart. 77
    78. 78. General Guidelines for Correct Administration of MedicationsWhat to avoid during drug administration:3. Do not be distracted when preparing medications.5. Do not give drugs prepared by others.7. Do not pour drugs from containers with labels that are difficult to read/whose labels are partially removed/fallen off. 78
    79. 79. General Guidelines for Correct Administration of MedicationsWhat to avoid during drug administration:4. Do not transfer drugs from one container to another.5. Do not give medications for which the expiration date has passed.6. Do not guess about drugs and drug doses. Ask when in doubt. 79
    80. 80. General Guidelines for Correct Administration of MedicationsWhat to avoid during drug administration:7. Do not use drugs that have sediment, are discolored, or are cloudy (should not be)8.Do not leave prepared medications out of sight.9. Do not give drugs id the client says he/she has allergies to the drug or drug group. 80
    81. 81. General Guidelines for Correct Administration of MedicationsWhat to avoid during drug administration:10. Do not call the client’s name as the sole means of identification.11. Do not give drug if the client states the drug is different from the drug he or she has been receiving. Check the order. 81
    82. 82. General Guidelines for Correct Administration of MedicationsWhat to avoid during drug administration:12. Do not recap needle, use universal precaution.13. Do not mix drug with large amount of food or beverage or foods that are contraindicated. 82