EDMUNDS 7 TH EDITION INTRODUCTION TO CLINICAL PHARMACOLOGY

NURSING PROCESS ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION (of interventions) EVALUATION THINK: AD-PIE

The Nursing Process 3 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Responsibilities Dictated by licensure and experience RN: licensure and authority to carry out all steps of the nursing process LPN/LVN: works under the supervision of the RN; can assess, implement, and evaluate with guidance 4 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

ASSESSMENT SUBJECTIVE DATA INFORMATION GIVEN BY THE PT OR FAMILY (information cannot be measured) PATIENT HISTORY SOCIAL INFORMATION EX: I can’t breathe very well; I need my inhaler. OBJECTIVE DATA (obtained through observation; information that is observed or could be verified by another) INSPECTION – accessory muscles used PALPATION PERCUSSION AUSCULTATION – rales noted

FURTHER ASSESSMENTS SIGNS AND SYMPTOMS – RR 32 CURRENT MEDICATION USAGE CONTRAINDICATIONS FOR DRUG THERAPY ALLERGIES SIDE EFFECTS METABOLIC INCOMPATABILITIES INTOLERANCES G6PD PKU MIGRAINE TRIGGERS

Question 1 The nursing process is followed when administering medications to the patient. The first step is: 1. Planning. 2. Assessment. 3. Evaluation. 4. Implementation. 7 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Question 2 Which of the following is an example of objective data? 1. Chief problem 2. Laboratory results 3. Medical history of patient 4. Review of body systems 8 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Diagnosis A conclusion about the patient's problems, based on his or her signs and symptoms: The physician makes a medical diagnosis. The nurse makes a nursing diagnosis. 9 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

DIAGNOSIS BASED ON ASSESSMENTS PRIORITIZED INDIVIDUALIZED TO THE PATIENT NANDA APPROVED (nursing) EX: Impaired gas exchange related to poor gas exchange as evidenced by 90% O2 saturation

Diagnosis (cont.) To make a nursing diagnosis, ask: What are the major problems for the patient? What procedures or medications will the patient require? What special knowledge or equipment is required to give these medications? What special concerns or cultural beliefs does the patient have? What does the patient understand? 11 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

PLANNING DETERMINE THE PATIENT PRIORITY NEED SET A PATIENT CENTERED GOAL Decide the reason each med is given Know action, classification, safe dosage range, parameters for holding the drug, interactions and side effects Plan for special procedures Develop a patient teaching plan

Four Steps of Planning 1. Determine the reason for each medication to be given. 2. Learn information about the medication. 3. Plan for special storage, techniques, or equipment. 4. Develop a patient teaching plan. 13 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Four Steps of Planning (cont.) Prior to medication administration, critical thinking is essential to: Verify the accuracy of the medication by checking the medication record against the physician’s original order. Determine whether the type of medication and the dosage are appropriate for the patient. 14 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Planning If the nurse determines that: the medication order is unclear or appears incorrect or the patient’s condition would decline with the medication or the physician did not have all the relevant information needed before writing the order or there is a change in patient condition The medication is HELD until the order is clarified. 15 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Question 3 The student LPN is preparing to administer morning medications. Before giving the patient the medication, the student should: (Select all that apply) 1. Ask the roommate to verify the patient’s name. 2. Ask the patient his or her name. 3. Check the patient’s identification bracelet. 4. Check the nameplate on the door. 16 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

IMPLEMENTATION Following the care plan Give the medication accurately and safely It is your responsibility to know: 1. why each drug was ordered 2. what each drug’s action is 3. know how to safely administer it

KNOW THE 7 RIGHTS OF DRUG ADMINISTRATION 1. DRUG – CHECK 3 TIMES!!! 2. TIME 3. DOSE 4. PATIENT 5. ROUTE 6. DOCUMENTATION 7. REASON

NEVER EVER, EVER, EVER GIVE A DRUG YOU DID NOT PREPARE YOURSELF, EVEN IF YOU REALLY, REALLY TRUST THE PERSON

EVALUATION WATCH THE PATIENT FOR A RESPONSE TO THE INTERVENTION Therapeutic, side effects or allergic responses LIKE AN END ASSESSMENT OF THE PATIENT RESPONSE TO TREATMENT EX: THERAPEUTIC RESPONSE OF RESPIRATORY INHALER WOULD BE A DECREASE IN ACCESSORY MUSCLE USE AND RESPIRATORY RATE

PATIENT TEACHING AND LITERACY CHAPTER 2

TERMS COMPLIANT – PLAN OF CARE IS FOLLOWED NONCOMPLIANT – DOES NOT FOLLOW THE PLAN OF CARE CONCORDANCE – THE TEAM WORKS TOGETHER LITERACY – ABILITY TO READ, WRITE, AND SPEAK ENGLISH; do math and solve problems at the level needed to function on the job/ in society HEALTH LITERACY – ABILITY TO UNDERSTAND AND USE INFORMATION TO REMAIN HEALTHY

% ASKING FOR INFORMATION 7% SOUGHT INFORMATION ABOUT THEIR MEDICATIONS 19% RELIED ON PHARMACIST 40% RELIED ON PHYSICIAN 34% ARE UNINFORMED

PATIENT TEACHING PROCESS ASSESS WHAT THE PATIENT KNOWS ASSESS THE PATIENT’S SPECIFIC NEEDS TO LEARN WILLINGNESS TO LEARN DECIDE WHAT NEEDS TO BE TAUGHT SELECT A TEACHING METHOD ASSESS RETENTION OF KNOWLEDGE USE A VARIETY OF TEACHING METHODS

KEY INFORMATION DRUG NAME INTENDED USE AND ACTION ROUTE, DOSE, FORM, AND TIME TO TAKE STORAGE OR PREPARATION INSTRUCTION COMMON SIDE EFFECTS (& what to do) INTERACTIONS (food, drug, etoh) HOW TO REFILL/ CALL MD WHAT TO DO IF MISS A DOSE HOW WILL PATIENT KNOW IF DRUG IS WORKING WELL

TEACHING PLAN PTS ARE ABLE TO REMEMBER 3 MAJOR THINGS / SESSION (researched data) VERBAL EDUCATION –discussion WRITTEN INFORMATION – labels, pamphlets, handouts, books, internet AUDIOVISUAL – video, TV ads, DVD, CD-ROM

Question 1 Research has shown that patient education materials should be written at which grade level? 1. Third- to fifth-grade level 2. Fifth- to seventh-grade level 3. Seventh- to ninth-grade level 4. Ninth- to eleventh-grade level 27 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

WRITTEN INFORMATION BE SURE GOALS ARE STATEDTO ONE – TWO OBJECTIVES FOCUS ON BEHAVIOR TO BE ACHIEVED USE CLEAR HEADINGS, PHOTOS, SPACE USE COMMON FAMILIAR WORDS ASK PATIENT TO WRITE/ DO/ SAY/ OR SHOW THEIR UNDERSTANDING USE ONE/ TWO SYLLABLE WORDS HAVE PATIENT CHOOSE WHICH PHAMPLET LEVEL OF INFORMATION THEY ARE ABLE TO UNDERSTAND (LITERACY)

Ways to Enhance Learning Plan for frequent nurse-patient contact Fit the plan to patient’s needs and culture Provide feedback and encouragement Encourage active patient involvement in care Employ behavioral contract between patient and nurse 29 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

DEMONSTRATION OF LEARNING HAVE PATIENT RESTATE THE INFORMATION GIVE A SHORT TEST HAVE THE PATIENT DEMONSTRATE THE DRESSING, INJECTION, MEDICATION DELIVERY, ETC SUMMARIZE, REPEAT, & KISS,,,,,

Question 2 Which of the following is the best statement related to medication teaching? 1. “All patients can learn about medications in the same setting.” 2. “The method and pace for teaching must be designed for each patient.” 3. “Using a single teaching method is most effective.” 4. “Encourage all family members to be present for each session.” 31 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Question 3 The nurse is developing a medication teaching plan. To make the plan more effective, it is important to: (Select all that apply) 1. Teach all the information in one visit. 2. Use only one style of providing the information. 3. Assess the patient’s readiness to learn. 4. Request that the patient repeat back information. 32 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

QUESTIONS?