The Nursing Process and Drug Therapy Chapter 1 The Nursing Process and Drug Therapy Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. The Nursing Process A research-based organizational framework for professional nursing practice Ensures the delivery of thorough, individualized, and quality nursing care to patients Requires critical thinking Ongoing and constantly evolving process Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Five Steps of the Nursing Process Assessment Nursing diagnosis Planning Goals Outcome criteria Implementation including patient education Evaluation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Assessment Data collection, review, and analysis Medication profile Any and all drug use Prescriptions Over-the-counter medications Vitamins, herbs, and supplements Compliance and adherence Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question The nurse answers a patient’s call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first? Check the orders and give the patient the requested pain medication. Provide comfort measures to the patient. Assess the patient’s pain and pain level. Evaluate the effectiveness of previous pain medications. Correct answer: C Rationale: The nurse should always assess a patient before any intervention. Although the nurse will check the orders and possibly give the medication (and possibly even perform the actions in responses B and D), the first priority is assessment. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Nursing Diagnosis Nursing diagnoses are used to communicate and share information about the patient and the patient experience Common nursing diagnoses related to drug therapy include: Deficient knowledge Risk for injury Noncompliance Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Nursing Diagnosis Three-step process: Human response to illness, injury, or significant change Factors related to the response (“related to”) Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Planning Identification of goals and outcome criteria Goals Objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria Outcome criteria Concrete descriptions of patient goals Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question The patient’s medication administration record lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do? Give the medications PO with a small sip of water. Give the medications via the IV route because the patient is NPO. Hold the medications until after the test is completed. Call the health care provider to clarify the instructions. Correct answer: D Rationale: The dosage for the IV route would not be the same as for the PO route. Holding the medications may cause drug levels to drop and result in seizure activity, and giving the medications PO without consent may alter the test results. The nurse must never assume the route of medication administration and should consult the physician for clarification of the orders. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Implementation Initiation and completion of specific nursing actions as defined by the nursing diagnoses, goals, and outcome criteria Independent, collaborative, dependent Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

The “Six Rights” of Medication Administration Right drug Right dose Right time Right route Right patient Right documentation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at 2100. What will the nurse do first to determine whether the medication was given? Call the night nurse at home Check the medication administration record Call the pharmacy Review the nurse’s notes Correct answer: B Rationale: The medication administration record is the legal documentation that the professional nurse uses to sign off medications that are given, so it should be checked first. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Evaluation 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 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question A nurse makes an error when administering medications to a patient. Which action by the nurse requires the supervising nurse to intervene? The nurse completes an incident report. informs the prescriber of the error. documents adverse effects to the medication error. records completion of an incident report in the medical chart. Correct answer: D Rationale: if there is a medication error, the nurse should complete an incident report with the entire event, surrounding circumstances, therapeutic response, adverse effects, and notification of the prescriber described in detail. However, the nurse should not record completion of an incident report in the medical chart. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.