Applying the Nursing Process to Drug Therapy

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
  clients 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 clients 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
• Clients 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

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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/patients 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 contd

• 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!!