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Nursing Process


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Nursing Process

  1. 1. Nursing Process in Drug Therapy
  2. 2. Assessment <ul><li>Collecting data </li></ul><ul><ul><li>Observing </li></ul></ul><ul><ul><li>Interviewing </li></ul></ul><ul><ul><li>Lab results </li></ul></ul><ul><ul><li>Diagnostic results </li></ul></ul><ul><li>Initial assessment or baseline assessment </li></ul><ul><li>Ongoing assessment of effect, adverse reactions. </li></ul>
  3. 3. Initial Assessment <ul><li>ALLERGIES </li></ul><ul><li>Head to toe </li></ul><ul><li>Vital signs, pain 5 th vital sign </li></ul><ul><li>Symptoms, c/o </li></ul><ul><li>Previous meds and reactions </li></ul>
  4. 4. <ul><li>After collection of data, they need to be analyzed for their relevance to the pts current condition and nursing care needs. </li></ul>
  5. 5. Planning/Goals <ul><li>Involving identifying the expected outcomes of prescribed drug therapy. </li></ul><ul><li>The outcomes should be very specific, clear and written with objective criteria in a clearly measurable way. </li></ul><ul><li>Examples??? </li></ul>
  6. 6. Interventions <ul><li>Implementing planned activities. </li></ul><ul><li>Teaching about medications </li></ul><ul><li>Solving problems related to drug therapy </li></ul><ul><li>Promoting compliance </li></ul><ul><li>Identifying barriers to compliance </li></ul><ul><li>Resources to facilitate therapy goals </li></ul>
  7. 7. General Interventions <ul><li>Promoting health </li></ul><ul><li>Preventing or decreasing need for drugs </li></ul><ul><li>Non-drug measures to enhance therapeutic effects or decrease adverse effects, examples? </li></ul>
  8. 8. Patient Teaching <ul><li>Nurse must know to be able to teach the patient </li></ul><ul><li>Early discharges </li></ul>
  9. 9. Evaluation <ul><li>Evaluating pt’s status in relation to stated goals and expected outcomes </li></ul><ul><li>May initiate re-assessment, examples? </li></ul><ul><li>Compliance issues </li></ul><ul><li>Home therapy </li></ul>
  10. 10. Drug and Dose Selection <ul><li>Use as few drugs as possible </li></ul><ul><li>Least amount of least potent drug for desired effect </li></ul><ul><li>Drugs may be given in a loading dose and then maintenance dose </li></ul><ul><li>Dosages based on 150lb person, may have to decreased because of renal or hepatic impairment </li></ul>
  11. 11. Drug therapy in Children <ul><li>Special considerations because of size, developmental level and organ function </li></ul><ul><li>Less predictable than in adults </li></ul><ul><li>Most drug use is empiric because of few studies in children </li></ul><ul><li>Doses extrapolated from those established for adults </li></ul><ul><li>Wt and BSA often used to dose </li></ul>
  12. 12. Administration <ul><li>Child cooperation </li></ul><ul><li>IM injection </li></ul><ul><ul><li>Infants- thigh </li></ul></ul><ul><ul><li>>18 months- deltoid </li></ul></ul><ul><ul><li>> 3yrs- ventrogluteal </li></ul></ul><ul><ul><li>EMLA patch 1 hour prior to injection </li></ul></ul>
  13. 13. Drug Therapy in Older Adults <ul><li>Adverse effects may be d/t physiologic changes assoc with aging. </li></ul><ul><li>Organ function more important than physiological age. </li></ul><ul><li>Cumulative effects </li></ul><ul><li>Polypharmacy </li></ul>
  14. 15. Drug selection and dosage <ul><li>Least potent, least dose, least amount of time to attain therapeutic effect. </li></ul><ul><li>Frequent reassessment. </li></ul>
  15. 16. Drug Administration <ul><li>Vision </li></ul><ul><li>Non child proof. </li></ul><ul><li>Schedules, charts, dosed containers. </li></ul><ul><li>Family and friends assistance. </li></ul>
  16. 17. Renal Impairment <ul><li>Pts with diabetes, HTN, HF may have renal insufficiency. </li></ul><ul><li>RF may develop from hypovolemia, shock d/t sepsis or blood loss. </li></ul><ul><li>ARF results from renal blood flow or function is impaired. </li></ul><ul><li>CRF results from disease process that destroy renal tissue. </li></ul>
  17. 19. <ul><li>Alter dosages for renal failure. </li></ul><ul><li>Monitor pt for worsening renal failure. </li></ul><ul><li>I/O, increasing fluids. </li></ul><ul><li>Avoid nephrotoxic drugs. </li></ul>
  18. 20. <ul><li>Medications that frequently cause ARF include amphotericin B, aminoglycosides, ACEIs, Lithium, IV contrast dyes, and NSAIDs. Dosages of all potentially nephrotoxic medications should be adjusted for renal function and ultimately substituted for after consultation with the physician. </li></ul>
  19. 21. Hepatic Impairment <ul><li>Primary liver disease, cirrhosis, hepatitis </li></ul><ul><li>Impaired blood flow </li></ul><ul><ul><li>HF </li></ul></ul><ul><ul><li>Shock </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Major surgery </li></ul></ul><ul><li>Hepatotoxic drugs </li></ul>
  20. 24. <ul><li>Close monitoring during drug therapy for signs of increasing liver failure. </li></ul><ul><li>Liver function tests, or LFTs, include tests for bilirubin, a breakdown product of hemoglobin, and ammonia, a protein byproduct that is normally converted into urea by the liver before being excreted by the kidneys. LFTs also commonly include tests to measure levels of several enzymes, which are special proteins that help the body break down and use (metabolize) other substances. Enzymes that are often measured in LFTs include gamma-glutamyl transferase (GGT); alanine aminotransferase (ALT or SGPT); aspartate aminotransferase (AST or SGOT); and alkaline phosphatase (ALP). LFTs also may include prothrombin time (PT), a measure of how long it takes for the blood to clot. </li></ul>
  21. 25. Drug Selection and Dosage <ul><li>Least potent, least dose, least amount of time for therapeutic effect. </li></ul><ul><li>ETOH is toxic to liver and increases the risks of hepatotoxicity when on meds. </li></ul><ul><li>Drugs affecting hepatic blood flow can aggravate liver impairment. </li></ul><ul><li>At risk for drug toxicity because of inability to metabolism. No 1 st pass thru liver. </li></ul>
  22. 26. Drug Therapy at Home <ul><li>Assess compliance. </li></ul><ul><li>Herbal remedies </li></ul><ul><li>Safety of environment. </li></ul><ul><li>Assess pts ability to take meds. </li></ul><ul><li>Assess understanding of medications and regime. </li></ul><ul><li>Teach med info, including adverse effects, therapeutic effects, precautions, instructions. </li></ul>