Chapter 1: The Nursing Process and Drug Therapy

List the five phases of the nursing process
1.) assessment
2.) nursing diagnoses
3.) planning
4.) implementation
5.) evaluation

Identify the components of the assessment process for patients receiving medications, including collection and analysis of subjective and objective data

Discuss the process of formulating nursing diagnoses for patients receiving medications
– Goals and Outcome Criteria

Identify goals and outcome criteria for patients receiving medications

Discuss the evaluation process as it relates to the administration

Develop a nursing care plan that is based on the nursing process as it relates to medication administration

Discuss the professional responsibility and standards of practice for the professional nurse as related to the medication and administration process

Briefly discuss the “Six Rights” associated with safe medication administration
1.) Right patient

Discuss the professional responsibility and standards of practice for the professional nurse as related to the medication administration process

Discuss the additional rights associated with safe medication administration

implementation or fulfillment of a prescriber’s or caregiver’s prescribed course of treatment or therapeutic plan by a patient. Use of compliance versus adherence in this textbook is supported by NANDA-I nursing diagnoses

Goals Statements
are time specific and describe generally what is to be accomplished to address a specific nursing diagnosis

Medication error
any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm

an informed decision on the part of the patient not to adhere and/or follow a therapeutic plan or suggestion. Use of noncompliance versus non adherence in this textbook is supportive used in the current listing of NANDA

Nursing process
an organizational framework for the practice of nursing. It encompasses all steps taken by the nurse in caring for a patient: assessment, nursing diagnoses, planning (with goals and outcome criteria), implementation of the plan (with patient teaching) and evaluation

Outcome criteria
Description of specific patient behaviors or responses that demonstrate meeting of or achievement of goals related to each nursing diagnosis. These statements (like goals) are verifiable, framed in behavioral terms, measurable, and time specific, whereas goals are broad.

any health care professional licensed by the appropriate regulatory board to prescribe medications.

*nursing process* is
a well-established, research supported framework for professional nursing practices

Features of the nursing process
It is flexible, adaptable and adjustable

includes establishment of goals and outcome criteria

includes patient education

nursing process usually involves
the delivery of thorough, individualized, and quality nursing care to patients, regardless of age, gender, medical diagnosis or setting

nursing process and pharmacology
all five phases describe how it relates to pharmacological practice

Critical thinking
major part of the nursing process and involves the use of the mind the mind and thought processes to gather information and then develop conclusions, make decisions, draw inferences, and reflect upon all aspects of patient care.

Elements of the Nursing Process address
the physical, emotional, spiritual, sexual, financial, cultural, and cognitive aspects of a patient.

It is the professional nurse who thinks critically about
processes, and incorporates all of these aspects and points of information about the patient and then uses this information to *develop and coordinate patient care.*

information about the patient may come from a variety of sources, including the patient, the patient’s family, caregiver, or significant

A holistic nursing assessment includes gathering data about the whole individual, including:
physical/emotional realms, religious preference, health beliefs, sociocultural characteristics, race ethnicity, lifestyle, stressor, socioeconomic status, educational level, motor skills, cognitive ability, support systems, lifestyle, and use of any alternative or complement therapies

Assessment about the specific drug focuses on:
– information about OTC, and herbal/complementary/alternative
– attention to drug action, signs and symptoms of allergic reactions; adverse effects; dosages and routes of administration; contraindications; drug incompatibilities; drug-drug-drug-food, and drug laboratory test interactions; and toxicities and available antidote

Gather additional data about the patient and a given drug by asking simple questions, such as:
– tolerance of fluids?
– swallowing ability of pills, tablets, capsules, and liquids

*Follow up question:* if there is a degree of difficulty swallowing
– What is the degree of difficulty swallowing?
– Are there solutions to the problem? such as: use of thickening agents with fluids or use of other dosage forms?

Results of laboratory exams and diagnostic tests related to organ function and drug therapy?
– *Renal function*- blood urea nitrogen level, serum creatinine level)
– *hepatic function*: total protein level, serum levels of bilirubin, alkaline phosphatase, creatinine phosphokinase, other liver enzymes?

*Assessment Review*
Objective data
information available through the senses, such as what is seen, felt, heard, and smelled.
– chart laboratory test results, reports of diagnostic procedures, physical assessment, and examination findings
– Specific data: age, height, weight, allergies, medication profile, and health history

*Nursing Diagnosis*
Part I “Deficient knowledge”
– this is the statement of the human response of the patient to illness, injury, medication, or significant change.
– this can be an actual response, an increased risk, or an opportunity to improve the patient’s health status.

*Nursing Diagnosis* related to knowledge:
deficient or readiness for enhanced knowledge

*Nursing Diagnosis*
*Part 2* Related to lack of experience with medication regimen and second grade reading level as an adult.”
– Portion of the statement identifies factors rested to the response, it often includes multiple factors with some degree of connection between them.
– nursing diagnosis does not claim that their is a causal relationship between factors.

*Nursing Diagnosis*
*Part 3*
“As evidenced by inability to perform a return demonstration and inability to state adverse effects to report to the prescriber.”
This statement lists clues, cues, evidence, and/or data that support the nurse’s claim that the nursing diagnosis is accurate.

Past health history:
– What are the patient’s experiences with use of any drug regimen?
– What are the patient’s relationship with health care professionals and/or experiences with previous therapeutic regiment?
– What medications is the patient currently taking?
– Are there any issues with compliance?

Explanatory Models
– Any use of folk medicines or folk remedies?
– What is the patient’s understanding of the medication?
– Are there any age related concerns?

compliance vs. adherence
Both used to describe the extent to which patients take medications as prescribed.

implies more collaboration and active role between patients and their providers.

Check following prescription or medication for the following *6 elements*?
1.) patient’s name
2.) date the drug order was written
3.) name of drugs
4.) drug dosage amount and frequency
5.) route of administration
6.) prescriber’s signature

Nursing diagnoses are a means of
communicating and sharing information about the patient and the patient experience

Nursing diagnoses related to drug therapy will most likely grow out of data associated with:
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.

North American Nursing Diagnosis Association – International

The purpose of NANDA-I is to
increase the visibility of nursing’s contribution to the care of patient’s and to further develop, refine, and classify the information and phenomena related to nurses and professional nursing practice

Formulation of nursing diagnosis *3 Steps*
1. ) human response to patient to illness, injury or significant change.
2.) identify the factor related to the response, with more than one factor often named. (no cause and effect statement)
3.) cues, clues and evidence, or other data that support the nurse’s claim that the diagnoses is accurate

Tips for writing a nursing diagnoses include:
1.) Begin with a statement of a human response
– connect the first part of the statement or human response with the second part, the cause using “related to”
2.) If a appropriate; select a cause for the second part of the statement that can be changed by nursing interventions; *avoid negative wording or language*
3.) List clues or cues that lead to more defining characteristics

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy
– Activity intolerance (and risk for)
– risk for *adverse reaction* to iodinated contrast media
– ineffective *Airway clearance*
– risk for *Allergy response,* latex
– risk for *Aspiration*

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy
– risk for *Bleeding*
– disturbed *body image*
– body temperature, risk for imbalance
– ineffective *breathing pattern*

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– cardiac output, decreased
– caregiver role, strain (and risk for)
– Comfort, impaired ( and readiness for enhanced)
– Communication, readiness for enhanced
– Confusion (acute, chronic, or risk for acute)
– Constipation ( perceived and risk for acute)
– Coping (defensive, ineffective, and readiness for enhanced)

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– death anxiety
– decision-making, readiness for enhanced
– Diarrhea

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– Electrolyte imbalance
– Falls, risk for
– Fatigue
– Fear
– Fluid volume deficient ( and excess, risk for deficient, and risk for imbalanced)

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– gas exchange, impaired
– growth and development, delayed
– health maintenance, ineffective
– home maintenance, impaired
– health seeking behavior
– human dignity, risk for comprised
– hyperthermia
– hypothermia

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– Immunization status, readiness for enhanced
– incontinence (functional urinary, overflow urinary, reflex urinary, stress urinary, urge urinary, risk for urge urinary)
– Infection, risk for
– Injury, risk for
– Insomnia
– Knowledge (deficient, readiness for enhanced)

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– response, risk of *Latex allergy*
– sedentary *Lifestyle*
– risk for impaired *liver function*
– risk for *loneliness*
– impaired *Memory*
– (impaired bed, impaired physical, impaired wheelchair) *Mobility*

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– Nausea
– Noncompliance
– impaired (less than body requirements, more than requirements, risk for imbalanced, readiness for enhanced) *Nutrition*
– impaired *Oral mucous membrane*

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– Pain (acute, chronic)
– peripheral neurovascular dysfunction
– risk for peripheral neuromuscular dysfunction
– risk for *poisoning*
– risk for *Powerlessness*

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– *Self care deficit*: bathing, dressing
– Self-esteem, chronic low (and risk for)
– Self-esteem, low (situational, risk for situational)
– Self- health management (ineffective and readiness for enhanced)
– Sensory perception, disturbed
– Sexual dysfunction
– Sexuality pattern, ineffective
– Skin integrity, impaired (and risk for)
– disturbed *Sleep deprivation*
– Stress overload
– risk for *Suicide*
– delayed *surgical recovery*
– impaired *swallowing*

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy


– *therapeutic regiment management(, ineffective family
– impaired *Tissue integrity*
– Tissue perfusion (risk for decreased cardiac, risk for ineffective cerebral, or ineffective peripheral

Current NANDA-I-Approved Nursing Diagnoses Most Relevant to Drug Therapy
*U, V, W*
– urinary elimination (impaired, readiness for enhanced)
– urinary retention
-impaired *verbal communication*
– impaired *Walking*

When does the planning phase begin?
after data is collected

The major purposes of the planning phase are to:
– prioritize the nursing diagnoses
– specify goals and outcome criteria
* includes time frame of achievement

The planning phase proves time to:
– obtain special equipment for interventions
– review possible procedures or techniques to be used
– gather information for oneself (the nurse) or for the patient

Planning phase leads to the the provision of safe care if
– professional judgment is combined with the acquisition of knowledge about the patient and the medications to be given

*Characteristics of*
Goals and Outcome Criteria
– goals are objective, measurable, and realistic, with an established time period for achievement of the outcomes, which are specifically stated in the outcome criteria.

*Patient Goals* reflect
expected and measurable changes in behavior through nursing care and are developed in collaboration with the patient.

*Patient Goals* developed in the planning phase of the nursing process are:
– behavior based and may be categorized into physiologic-psychologic, spiritual, sexual, cognitive, motor, and other domains

*Outcome criteria( are concrete descriptions of patient goals.

*They are:*

– patient focused
– succinct
– well-thought out

Outcome criteria includes:
expectation for behavior indicating something that can be changed within a specific time frame or deadline

Outcome criteria *reflect*
each nursing diagnoses and ends with the development of a nursing care plan

Outcome criteria provide:
a standard for measuring movement toward goals.

Outcome criteria around medication
– address special storage, and handling techniques, administration procedures, equipment needed, drug interactions, adverse effects, and contraindications.

Implementation is guided by
preceding phases of the nursing process (assessment, nursing diagnosis, and planning)

Implementation *requires*
constant communication and collaboration with the patient and members of the health care team involved in the patient’s care, as well as with any family members, significant others, or other caregivers.

Implementation *consists of*
initiation and completion of specific nursing actions- as defined by nursing diagnoses

Implementation of *nursing actions* may be
– independent
– collaborative
– dependent on a prescriber’s order

*Implementation/Nursing Action*
Statements of interventions include:
frequency, specific instructions, and any other pertinent information

6 Rights of Medication Administration
– right drug
– right dose
– right time
– right route
– right patient
– *right documentation* (last one added)

Distribution of Medication begins with:
the provider’s orders
*must focus on medication distribution as a whole

Additional Rights to consider (besides the 6 rights) (for Individual/patient focus)
– *patient safety*, ensured by use of the correct procedures equipment, and techniques of medication administration and documentation
– *Individualized* holistic, accurate, and complete *education*
– Double-checking and constant analysis of the system the process of administration, including all those involved, such as the prescriber, the nurse, the nursing unit, and the pharmacy department
– proper drug storage
– Accurate calculation and preparation of the dose of medication and proper use of all types of medication systems
– Careful checking of the transcription of medication orders
– Close considerations of special situations (e.g. patient difficulty in swallowing, use of a nasogastric tube, unconsciousness of the patient, advanced patient age)
– Implementation of all appropriate measures to prevent a report medication errors

What does administering the *right drug* begin with?
the nurse’s license

What should you do if you have doubts or an error is deemed possible?
Contact the prescriber or pharmacist immediately

Six Rights of Medication Administration
*Right Drug* Process
– begins with validation
– checking all medication orders and/or prescriptions
– conduct the first check of the right drug/ drug name while you prepare the medication for administration
– *Consider* whether the drug is appropriate for the patient

All medication orders or prescriptions are required by law to be signed by -who?
the patient’s prescriber
* therefore always obtain written consent

If a verbal order is given, the prescriber must sign the order within
24 hours

Should you use a drugs generic or brand name during the administration process?
generic name

Always confirm that the drug is appropriate for the patient’s —-
age and size

Where do you identify the dose of a medication?
On the providers order

What items should you check before administering a medication?
– dose: appropriate for the patient’s age and size
– check prescribed dose against the drugs in stock

The nursing process is: The systematic method of critical thinking used by professional nurses to develop individualized plans of care and provide care for patients The framework within which nurses provide care to patients in an organized and effective manner …

Diagnosis A clinical judgment based on information. Medical Diagnosis Identification of a disease condition based on specific evaluation of signs and symptoms. WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my …

List the components of the nursing process 1. Assessment (data collection) 2. Nursing diagnosis 3. Planning 4. Implementation 5. Evaluation Define “critical thinking”. Directed, purposeful, mental activity by which ideas are evaluated, plans are constructed, and desired outcomes are decided. …

Different Assessments Medical Assessment: Fractured Hip Nursing Assessment: Pain, ROM, bed sores, ambulating ***Nurses care about pt’s response the illness Characteristics of the Nursing Process Assessment, diagnosing, outcome identification, implentating, evaluation 1. Framework for providing nursing care to patients, families, …

Critical thinker Raises questions/problems and formulates them clearly and precisely ◦Gathers and assesses relevant information ◦Arrives at conclusions and solutions that are well-reasoned and tests them against relevant standards ◦Is open-minded and recognizes alternative views ◦Communicates effectively about solutions to …

Actual Nursing Diagnosis (126) NANDA I describes it as “human responses to health conditions/life processes that exists in an individual, family, or community. It is supported by defining characteristics (manifestations, signs and symptoms) that cluster in patterns of related cues …

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