Pharmacology and the Nursing Processnur.uobasrah.edu.iq/images/pdffolder/2.Pharmacology and... · 2018-10-11 · Nursing process in the drug therapy •Each part of nursing process

Lecture 2

Pharmacology and Nursing Process

(Nursing Process in Drug Therapy)

Objectives:

Upon completion of this lecture, student will be able to answer the

following questions:

1. What are the responsibilities of the nurses in drug therapy?

2. Define Medication Errors and explain general principles of

drug administration to prevent medication errors

3. Define the Nursing Process in general

4. Explain what is involved in each step of the nursing process as

it relates to drug therapy.

8-Oct-18

Dr. Utoor Talib

o The responsibilities of nurses regarding drugs, including:

before, during, and after a drug administration.

Understand the pharmacological principles for all drugs

given to each patient and have adequate knowledge about

the patients who are receiving these drugs and the disorder

for which the patient is being treated.

Intervene to make the drug regimen more tolerable for

patients.

8-Oct-18 Dr. Utoor Talib

Preparing and administering the drugs to the patient.

• Preparing and administering the prescribed drug to the patients is a fundamental responsibility of the nurse in many health care settings.

• Nurses are both ethically and legally responsible for correct administration of drugs.

For safe and accurate drug administration, nurses should use the “Six Rights” and their subsequent additions as a guideline. (Right drug to Right patient in the Right dose by the Right route at the Right time and with Right documentation).

• By following the “Six Rights” in the drugs administration, the nurse ensure that a drug will be administered as prescribed (Correct administration).


After the administration, the nurse is responsible for

the following:

Recording the administration of the drugs

Observing, evaluating and recording the patient’s

response to the drug and to intervene if required.

− Evaluating and recording the therapeutic or desired response

(when applicable), such as relief of pain, decrease in body

temperature, relief of itching, and decrease in the number of

stools passed……etc.

− Observing, recording and reporting the adverse reactions and

intervene if required. The frequency of these observations

will depend on the drug administered. The nurse must record

all suspected adverse reactions and must immediately report

serious adverse reactions to the primary care provider.

8-Oct-18

The nurse has an important role as

– protect the pt against the medication

errors.

• The nurse is the patient's last line of defense against

medication errors.

• It is ethically and legally unacceptable for you to administer

a drug that is harmful to the patient – even though the

medication has been prescribed by a licensed prescriber and

dispensed by a licensed pharmacist.

8-Oct-18

• Medication Errors: is any occurrence (preventable event)

that may cause or lead to inappropriate medication use or patient

harm while the medication is in the control of healthcare

professional, patient, or consumer.

• Medication errors are a major problem in health care today –

major cause of morbidity and mortality.

• Because nurse is the last person who checks medications prior to

administration, therefore the nurse responsible to detect and

protect the patient against the mistakes made by other member

of health care team. Medication errors may occur during any

phase of drug therapy, including:

− When the drug is prescribing – in transcribing drug orders (write

down)

− When the drug is dispensing – drug supply

− In administration of the drug


• Source of medication errors

Prescribers Pharmacist Nurses Drugs manufacturers

Consumer/patients and their families Circumstances

• What are the causes of medication errors

among nurses ?

• What are responsibilities of nurses regarding

medication errors??

Nursing process

Review of the nursing process • Generally, the nursing process is a conceptual framework for nursing

action that nurses employ to guide the health care delivery.

• Using the nursing process requires practice, experience, and a constant updating of knowledge.

• Nursing process is a systematic way of gathering and using information to plan and provide individualized effective patient care.

• Nursing Process consisting of problem-solving steps that must be involved in all steps taken by the nurse in caring for a patient.

**Nursing process generally consists of five phases:** 1. Assessment

2. Analysis (nursing diagnosis)

3. Planning- individual for each patient

4. Implementation- some collaborative with physician and others are independent

5. Evaluation


Nursing

Process

• Assessment and interventions are the “action” phases whereas analysis

of assessment data and establishing nursing diagnoses and goals are

“thinking” phases.


Nursing process in the drug therapy • Each part of nursing process is applicable, with

modification, to the administration of medications.

guides nursing decisions about drug

administration to ensure the patient's

safety, and meet medical and legal standards.

• The nursing process is Crucial for safe medication

administration.

• “Crucial” = the greatest significance in determining an

outcome.

• Application of the nursing process in drug therapy is

directed at individualizing treatment, which is critical to

achieving the therapeutic objective. 8-Oct-18 Dr. Utoor Talib

Assessment

Initial assessment Ongoing assessment

• Assessment consists of collecting data (objective and

subjective data) about the pt – These data are used to identify

actual and potential health problems.

• The database established during assessment provides a

foundation for subsequent steps in the process (e.g.,

effectiveness of drug therapy). Important methods of data

collection are

Pt interview

Medical and drug-use histories

observation of the patient

Physical examination

laboratory tests

Collection of data

about the patient


• Before any drug is administered, the nurse must obtain

and process pertinent information regarding the

patient’s medical history, physical assessment, disease

processes, and learning needs and capabilities. Growth

and developmental factors must always be considered.

• It is important to remember that a large number of

variables influence a patient’s response to medications.

• Having a firm understanding of these variables can

increase the success of pharmacotherapy.

• The extent of the assessment and collection of data

before and after a drug administered will depend on the

type of drug and the reason for its use.


• Initial or pre-administration assessment – Collection of

base line data before administration of drugs to identify the

variable that can affect an individual's responses to drugs and

evaluate the effectiveness of the drug and the presence of any

adverse reactions.

• The goals of Initial or preadministration assessment is to gather data needed for :

• 1. Collection of baseline data needed to evaluate therapeutic responses. • 2. Collection of baseline data needed to evaluate adverse effects. • 3. Identification of high-risk patients • 4. Assessment of the patient's capacity for self-care - applies more or less equally to all drugs

Specific to the

particular drug

being used.


• Ongoing assessment – Collection of data after

administration of drugs and has 2 basic goals:

1. Collect data related to effectiveness of the drug. • Objective data include blood pressure, pulse, respiratory

rate, temperature, weight, examination of the skin,

examination of an intravenous infusion site, and

auscultation of the lungs……...

• Subjective data include any statements made by the

patient about relief or non-relief of pain or other

symptoms after administration of a drug…..

2. Monitor for adverse drug reactions.


Analysis & Nursing Diagnosis

What is the problem???

• In this step, the nurse analyzed database that collected previously

to determine actual and potential health problems associated with

drug therapy and formulates one or more nursing that nurses are qualified and licensed to treat.

• Nursing diagnosis used to identify patient problems that can be

solved or prevented by independent nursing actions – (actions

that do not require a physician’s order and may be legally

performed by a nurse) and should be individualized according to

the patient’s condition and the drugs prescribed .

• Nursing diagnosis may apply to a specific group or type of drug .

• Nursing diagnosis provide the framework for selections of nursing interventions to achieve expected outcomes.


• A complete nursing diagnosis consists of two statements:

a statement of the patient actual and potential health problems followed by a statement of the problem's probable cause or risk factors.

• The two statements separated by the phrase related to – example of a drug-associated nursing diagnosis: noncompliance with the prescribed regimen [problem] related to inability to self-administered medication [the cause]

• Some time followed by 3rd statement – the signs, symptoms, or other evidence of the problem. E.g., “noncompliance related to complex medication administration schedule [the cause] as evidenced by missed drug doses and patient’s statement that the schedule is confusing [the evidence].

• With respect to drug therapy, the analysis phase of the nursing process has three objectives. 8-Oct-18

Dr. Utoor Talib

• Objectives of nursing analysis:

1. Judgment of appropriateness of the prescribed regimen.

2. Identifying potential health problems that the drug might cause.

3. Determining the patient's capacity for self-care.

⁎ Nurses must analyze the data collected during assessment to determine if the proposed treatment is effective and safe or not.

⁎ Judging appropriateness of the prescribed regimen, is made by:

1. Considering the medical diagnosis

2. The known actions of the prescribed drug.

3. The patient’s prior responses to the drug

4. The presence of contraindications to the drug 8-Oct-18 Dr. Utoor Talib

• **Identifying potential health problems that the drug might cause

→ →Identification of potential adverse effects and drug interaction.

This is accomplished by integrating knowledge of the drug under

consideration and the data collected during assessment. Once

potential adverse effects and drug interaction have been identified,

pertinent nursing diagnosis can be easily formulated .

• **Determining the patient's capacity for self-care. Analysis

must characterize the patient's capacity for self-care and indicates

potential obstacles

E.g., if treatment is likely to cause respiratory depression, an appropriate nursing

diagnosis would be impaired gas exchange related to drug therapy.

E.g., visual impairment, reduced manual dexterity (skill), impair cognitive function, insufficient understanding of the prescribed regimen, nearly all these patients will be unfamiliar with self-administration of drugs. a nursing diagnosis applicable to almost every patient is “knowledge deficit related to the drug regimen.”

8-Oct-18

North American Nursing Diagnosis Association (NANDA )

has approved a list of diagnostic categories to be used in

formulating the nursing diagnosis.

The most frequently used Nursing Diagnosis related to the

administration of drugs developed by NANDA, include:

• Effective Therapeutic Regimen Management

• Ineffective Therapeutic Regimen Management

• Deficient Knowledge

• Noncompliance

• Anxiety


Examples: Nursing Diagnoses That Can Be Derived from Knowledge of Adverse Drug Effects

Drug Adverse Effect Related Nursing Diagnosis

Aspirin Gastric erosion Pain related to aspirin-induced gastric erosion

Atropine Urinary retention Urinary retention related to drug therapy

Digoxin Dysrhythmias Ineffective tissue perfusion related to drug-

induced cardiac dysrhythmias

Furosemide Excessive urine

production

Deficient fluid volume related to drug-induced

diuresis

Gentamicin Damage to the

eighth cranial

nerve

Disturbed sensory perception: hearing

impairment related to drug therapy

Glucocorticoids Thinning of the

skin

Impaired skin integrity related to drug therapy


Planning /Goals: (how to manage the problem)

• Once data have been analyzed and nursing diagnosis are formulated, the

nurse delineated specific interventions directed to solving or preventing the

problem identified in analysis. The plan must be individualized for each pt.

• Good planning will allow you to promote beneficial drug effects. E.g., good

planning will allow you to anticipate adverse effects – rather than react to

them after the fact.

• During planning phase, goals and outcome criteria are formulated. The

expected outcome describes the maximum level of wellness that is

reasonably attainable for the patient.

• Common expected patient outcomes related to drug administration, in

general, include:

greater accuracy in drug administration,

patient understanding of the drug regimen, and

improved patient compliance with the prescribed drug therapy after

discharge from the hospital.

• Planning is a going process that must be modified as new data are gathered.


Planning consist of

• 1. Defining goals: the objective of planning is to formulate ways to achieve goal of drug therapy = maximum benefit (maximize therapeutic response) with minimum harm (minimizing or preventing adverse reactions & interactions). The objective of planning is to formulate ways to achieve this goal.

• 2. Setting priorities: it is extremely difficult & requires information about drug under consideration & the patient's unique characteristics. Highest priority is given to life threatening conditions. (e.g, anaphylactic shock, ventricular fibrillation). These may be drug induced or the result of disease.

• High priority is also given to reactions that cause severe, acute discomfort and to reactions that can result in long-term harm.

• Since we cannot manage all problems simultaneously, less severe problems must wait until the patient and care provider have the time and resources to address them.


3. Identifying interventions: the heart of planning is identification of nursing interventions. These interventions can be divided into 4 major groups:

o drug administration – you must consider dosage and route of administration as well as less obvious factors, including timing of administration with respect to meals, side effects and with respect to administration of other drugs. E.g, if a drug causes sedation, it may be desirable to give the drug at bedtime, rather than in the morning or during the day.

o interventions to enhance therapeutic effects – Nondrug measures can help promote therapeutic effects and should be included in the plan. For example, drug therapy of hypertension can be combined with weight loss (in overweight patients), salt restriction, and smoking cessation

o interventions to minimize adverse effects and interactions

o pt educations –The plan should account for the patient’s capacity to learn, and it should address the following: technique of administration, dosage and timing, duration of treatment, method of drug storage, measures to promote therapeutic effects, and measures to minimize adverse effects.

4. Establishing criteria for evaluation: we need to established objective criteria by which measure desired drug responses. Without such criteria, we could not determine if our drug was doing anything useful.


Implementation (Interventions)

• Implementation: actions undertaken to meet a patient’s needs, such as administration of drugs, comfort measures, or patient teaching

• Implementation is a natural outgrowth of the assessment and planning phases of the nursing process.

• This step begins with carrying out the interventions identified during planning.

• In the administration of drugs, implementation refers to the preparation and administration of one or more drugs to a specific patient.

• Before administering a drug, the nurse reviews the collecting data obtained on assessment and considers any additional data, such as blood pressure, pulse, or statements made by the patient. The decision of whether to administer the drug is based on an analysis of all information.


Implementation of the care plan in drug therapy has 4

major components:

1. Drug administration – perform any nursing actions

before administration of a drug. Administer drug

according to the "Six Rights

2. Pt education – teach or educate patient/family about

drug, disease process, treatment regimen, etc

3. Intervention to promote therapeutic effects

4. Intervention to minimize adverse effects


Evaluation:

• This step is performed to determine the degree to which treatment has succeeded and accomplished by analyzing the data collected following implementation.

• Evaluation is a decision-making process that involves determining the effectiveness of the nursing interventions in meeting the expected outcomes.

• Some outcomes can be evaluated within a few minutes of drug administration (e.g., relief of acute pain after administration of an analgesic), but most require longer periods.

• Evaluation should identify those interventions that should be continued, those that should be discontinued, and potential new interventions that might be implemented.

• Evaluation completes the initial cycle of the nursing process and provides the basis for beginning the cycle anew.


When related to the administration of a drug, this phase of the nursing process is used to evaluate the patient for:

1. effectiveness of the drug regimen—therapeutic responses

2. adverse drug reactions and interactions

3. compliance (adherence to prescribe regimen)

4. patient/family's understanding of the drug regimen.

5. satisfaction with treatment

• How frequently evaluations are performed depends on the expected time course of therapeutic and adverse effects.

• Like assessment, evaluation is based on laboratory tests, observation of the patient, physical examination, and patient interviews. The conclusions drawn during evaluation provide the basis for modifying nursing interventions and the drug regimen.

• After evaluation, certain other decisions may need to be made and plans of action implemented.


Documents

Pharmacology and the Nursing Processnur.uobasrah.edu.iq/images/pdffolder/2.Pharmacology and... · 2018-10-11 · Nursing process in the drug therapy •Each part of nursing process