1. Applying the Nursing Process to Drug Therapy
Role of the RN in Medication
Assessment & Administration

2. Assessment of Client Collect Subjective & Objective data:
Client, Drug & Environment
Use current Drug handbook/text reference/
licensed pharmacist
Complete a drug history
Perform a Nursing Physical Assessment
Create a medication profile

3. Assessing Drug History of Client
OTC meds (e.g. aspirin, vitamins, dietary supplements, NSAIDS, laxatives, dietary supplements, antacids, minerals, elements)
Prescription Medications (e.g. birth control pills, hormone replacements, drugs for sexual dysfunction)
Street drugs (e.g. marijuana, cocaine, PCP, LSD, illegal narcotics i e. oxycontin)

4. Drug History (continued)
Herbals & homeopathic substances
Problems with drug therapy in the past (e.g., allergies, adverse effects, diseases or injuries, organ pathology)
Growth & development issues as related to the client’s age and specific expectations( e.g. Erickson's stages of development) and task for each major group

5. The Interview Process Establish a therapeutic relationship with client
Use open ended questions (avoid “yes” or “No” answers)
Questions/content of questions should include:
Oral intake of client: how does client tolerate fluids
swallow problems
Laboratory/diagnostic test value e.g. renal, liver panels, hgb/hct., protein, albumin levels.

6. Interview process/Med eval
Consider client’s experience with meds/health care system, previous hosp.
Check vital signs (establish baseline)
List meds client is taking /how taken/when
List new meds ordered
Use holistic framework- identify emotional, physical, cognitive, cultural & socioeconomic factors impacting drug therapy & nursing process

7. Interview Process/med eval (cont.)
Check drugs adverse effects & contraindications, routes of administration, toxicity, therapeutic levels
Drug action
Are there any “age specific” developmental concerns
How does the cultural origin & racial/ethnic group of client influence the drug therapy

8. Medication Orders Orders must contain six elements: Client’s name
Date & time order was written
Name of the medication
Dosage (includes size, frequency & number of doses)
Route of delivery
Signature of prescriber

9. Researching the medication ordered
Use current text/handbook
Review:
classification, mechanism of action
doses, routes, side effects, contraindications, drug incompatibilities
interactions, precautions & nursing implications

10. Analysis of Date: developing a nursing diagnosis
Base diagnosis on conclusion about risk factors, actual client needs or problems based on knowledge base.
E.g. nursing diagnosis include:
Deficient knowledge; risk for injury; noncompliance
Diagnosis based on s/e or risk factors e.g.:. fatigue, constipation, impaired tissue perfusion, sexual dysfunction, sleep disturbance, urinary retention

11. Planning care: identifying goals & outcome criteria
Prioritize the nursing diagnosis
Specify objective, measurable, realistic goals
Establish a time period for achievement of outcomes
If order is in question- do not give- call physician for clarification/further instructions.
Document all information obtained!!

12. Implementation
Requires constant communication& collaboration with client& health care team
Follow the “six rights”:
Right drug
Right dose
Right time
Right route
Right client
Right documentation

13. Client/patient’s rights with regards to medication
Right to a “double check”
Right to proper storage/documentation
Right to accurate calculation& preparation
Right to careful checking of transcription of orders
Client safety- use of correct administration procedures
Right to accurate routes of administration

14. Client/patient rights –cont’d
Right to close consideration of special situations e.g.: difficulty with swallowing, client with NG tube or who is unconscious
Right to having all measures taken to prevent and report med errors if they occur
Right to individualized /complete client teaching
Right of accurate/cautious monitoring
Right to accurate documentation

15. Evaluation of drug therapy: an ongoing part of the nursing process
Monitor client responses to the drug
Monitor expected and unexpected responses
Monitor therapeutic (intended effects), side effects , adverse effects & toxic effects
Document !! Very important!!