The Nursing Process (Lilley p. 6) Assessment Nursing diagnosis Planning Goals Outcome criteria Implementation Evaluation Critical thinking is a major part of the nursing process and involves the use of the mind and thought processes to gather information and then develop conclusions, make decisions, draw inferences, and reflect upon all aspects of patient care. Many institutions use a five-step nursing process; however, there are other models. NURSING APPLICATION: What parts of the assessment can be obtained from the exemplar above? Copyright © 2011 by Elsevier Inc. All rights reserved.

The Nursing Process (cont’d) (Lilley p. 7) Assessment Data collection Subjective, objective Medication history Prescriptions Over-the-counter medications Herbal therapies Responses to medications (therapeutic and adverse) The five steps are an overlapping process; each step builds on the one that precedes it. The elements of the nursing process address the physical, emotional, spiritual, sexual, financial, cultural, and cognitive aspects of a patient. NURSING APPLICATION: List assessment information gathered from the exemplar above. Copyright © 2011 by Elsevier Inc. All rights reserved.

The Nursing Process (cont’d) (Lilley p. 9) Nursing diagnosis Three steps Human response to illness (actual or at risk) “Related to” “As evidenced by” The development and classification of nursing diagnoses has been carried out by NANDA. Nursing diagnoses are the result of critical thinking, creativity, and accurate collection of data regarding the patient as well as the drug. Nursing diagnoses related to drug therapy will most likely grow out of data associated with the following: deficient knowledge; risk for injury; noncompliance; and various disturbances, deficits, excesses, impairments in bodily functions, and/or other problems or concerns as related to drug therapy. NURSING APPLICATION: Discuss appropriate nursing diagnoses for Ms. Jackson. Copyright © 2011 by Elsevier Inc. All rights reserved.

The Six Rights of Medication Administration (Lilley p. 11) Right drug Right dose Right time Right route Right patient Right documentation The registered nurse should check all medication orders and/or prescriptions. To ensure that the correct drug is given, the nurse must check the specific medication order against the medication label or profile three times before giving the medication. The nurse should conduct the first check of the right drug/drug name while preparing the medication for administration. What are some of the categories of drug administration? (Oral, enteral, parenteral, and percutaneous) NURSING APPLICATION: How does the nurse determine whether Ms. Jackson is the patient for whom a drug is ordered? Copyright © 2011 by Elsevier Inc. All rights reserved.

Copyright © 2011 by Elsevier Inc. All rights reserved. Evaluation (Lilley p. 7) Ongoing part of the nursing process Determining the status of the goals and outcomes of care Monitoring the patient’s response to drug therapy Expected and unexpected responses Clear, concise documentation The nurse is expected to know the desired effect and side effects of drugs administered, as well as recognize adverse effects and allergic reactions. It is systematic, ongoing, and a dynamic phase of the nursing process as related to drug therapy. It includes monitoring the fulfillment of goals and outcome criteria, as well as monitoring the patient's therapeutic response to the drug and its adverse effects and toxic effects. NURSING APPLICATION: What information will be evidence that Ms. Jackson is responding to a medication? How will the nurse know the expected results of taking a drug? Copyright © 2011 by Elsevier Inc. All rights reserved.

Metrics: Conversions Between Units (Gray Morris p. 66) Convert means to change from one unit to another, such as mg to mcg Done by moving decimal Left to divide; right to multiply Each metric unit in health care differs by 1000 or 3 decimal places Conversion factors: 1 kg = 1000 g 1 g = 1000 mg 1 mg = 1000 mcg 1 L = 1000 mL In health care, each unit of measure in common use for purposes of medication administration differs by 1000. In the metric system the most common units used are the kilogram, gram, milligram, microgram, liter, milliliter, and centimeter. To convert or make a conversion means to change from one unit to another. This conversion can be simply changing a measure to its equivalent in the same system. NURSING APPLICATION: If Ms. Jackson's family states that she drank 500 mL  of fluid today, what percentage of one liter did she drink? Copyright © 2011 by Elsevier Inc. All rights reserved.

Metrics: Conversions Between Units (cont’d) (Gray Morris p. 67) Smaller to larger: DIVIDE: move left Example: 100 mL = ___ L (CF: 1000 mL = 1 L) (smaller) (larger) Move decimal 3 places to left : 100 mL = 0.1 L   Larger to smaller: MULTIPLY: move right Example: 0.75 g = ___ mg (CF: 1 g = 1000 mg) (larger) (smaller) Move decimal 3 places to right: 0.750 g = 750 mg To make conversions within the metric system, remember the common conversion factors (1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1,000 mcg, and 1 L = 1000 mL) To convert a smaller unit to a larger one, divide by moving the decimal point three places to the left. To convert a larger unit to a smaller one, multiply by moving the decimal three places to the right. NURSING APPLICATION: How much juice in milliliters did Ms. Jackson consume if she had 3/4 of a liter? Copyright © 2011 by Elsevier Inc. All rights reserved.

Apothecary: Units of Measure (Gray Morris p. 70) Minims and drams (Ʒ) no longer used: some syringes or cups may still have markings Nurse needs to know 1 pint = 16 fluid ounces 1 quart = 32 fluid ounces = 2 pints Weight Grain = gr Be careful not to confuse gr with g for gram Metric equivalents: gr 15 = 1 g and gr 1 = 60-65 mg Most meds are based on the equivalent gr 1 = 60 mg The apothecary system of measurement is an English system that is considered to be one of the oldest systems of measure. It is also called the fraction system because parts of units are expressed by using fractions, with the exception of the fraction one half, which is expressed as ss. The notations in this system are unusual and can be confusing. The Institute for Safe Medication Practices (ISMP) has recommended that all medications be prescribed and calculated with metric measures. The unusual notations and inclusion of fractions and Roman numerals have caused concern about use of the apothecary system. NURSING APPLICATION: How should safety measures be implemented if a medication is ordered in an apothecary unit of measurement for Ms. Jackson? Copyright © 2011 by Elsevier Inc. All rights reserved.

Household: Background (Gray Morris p. 73) Old system and least accurate Capacities of glasses and utensils vary by brand unless CALIBRATED Advise use of droppers and devices provided with medications for accurate dosing Memorize: 1 teaspoon (t, tsp) = 5 mL 1 tablespoon (T, tbs) = 15 mL 1 measuring cup = 8 oz It is a modified system designed for everyday use at home. Nurses need to be familiar with household measures, because clients often use utensils in the home to take prescribed medications. Capacities of utensils such as a teaspoon, a tablespoon, and a cup vary from one house to another; therefore liquid measures are approximate. It is imperative that nurses become adept in converting from one system to another. NURSING APPLICATION: Ms. Jackson's son said that she took 2 tablespoons of a laxative, but he was concerned that this may have been too much. What should the nurse tell the son? Copyright © 2011 by Elsevier Inc. All rights reserved.

Household: Solutions (Gray Morris p. 74) Use calibrated spoons and measuring cups! Normal saline (0.9%) 2 teaspoons salt in 4 cups of water Acetic acid (0.25%) 3 tablespoons of white vinegar in 4 cups of water Used for some wound/dressing care and for cleaning equipment Sometimes solutions may have to be made at home with household measures. Household and apothecary measures are used most often in the home care setting and less often in the clinical setting. These measures may be eliminated in the near future because of the goal within health care to improve medication labeling and because of recommendations of organizations such as The Joint Commission and ISMP regarding abbreviations and the use of metric measures for medications to reduce medication errors. NURSING APPLICATION: What does the nurse need to remember about household measuring devices? Copyright © 2011 by Elsevier Inc. All rights reserved.