Adams ch06 lecture

PHARMACOLOGY FOR NURSESPHARMACOLOGY FOR NURSESA Pathophysiological ApproachA Pathophysiological Approach

FOURTH EDITIONFOURTH EDITION

Copyright © 2014, © 2011, © 2008 by Pearson Education, Inc.All Rights Reserved

CHAPTER

The Nursing Process in Pharmacology

6

Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban

Steps of Nursing ProcessSteps of Nursing Process

• Assessing• Diagnosing• Planning• Implementing• Evaluating


Figure 6.1 The five overlapping phases of the nursing process. Each phase depends on the accuracy of the other phases Source: Berman, Audrey J.; Snyder, Shirlee, Kozier, KOZIER & ERB’S FUNDAMENTALS OF NURSING, 9th edition. © 2012 Reprinted and electronically reproduced by permission of Pearson Education, Inc., Upper Saddle River, New Jersey.


Assessment of the PatientAssessment of the Patient

• Systematic collection, organization, validation, and documentation of patient data

• Health history and physical assessment• Baseline data gathered; will be

compared to later information from observations



• Subjective data—what patient describes• Objective data—physical assessment,

laboratory tests, other diagnostic sources



• Health history tailored to patient clinical condition– Includes use of all

medications/supplements taken• Physical assessment – objective data on

patient’s condition


Table 6.1 Health History Assessment Questions Pertinent to Drug Administration

continued on next slide


Table 6.1 (continued) Health History Assessment Questions Pertinent to Drug Administration



Table 6.1 (continued) Health History Assessment Questions Pertinent to Drug Administration


Assessment of PatientAssessment of Patient

• Once pharmacotherapy is initiated, assessment focuses on reaction to medication.– Watch for desired response– Adverse effects– Patient capability to assume

responsibility for self-administration


Medication Errors and Dietary Medication Errors and Dietary SupplementsSupplements

• Dietary supplements and herbal medications must be monitored.– Can increase or cancel effect of

prescribed medications


Nursing Diagnoses for Drug Nursing Diagnoses for Drug AdministrationAdministration

• Often most challenging part of nursing• Focus is on patient’s needs, not nurse’s• Three main areas of concern

– Promoting therapeutic drug effects– Minimizing adverse drug effects– Maximizing patient ability for self-care


Nursing Diagnoses for Drug Nursing Diagnoses for Drug AdministrationAdministration

• May focus on patient’s response to actual or potential health and life processes


Risk Diagnosis Includes:Risk Diagnosis Includes:

• Diagnostic statement• Related factor or inferred cause


Actual Diagnosis Includes:Actual Diagnosis Includes:

• Diagnostic statement• Related factor or inferred cause• Evidence to support statement


Most Common Nursing Diagnoses Most Common Nursing Diagnoses for Medication Administrationfor Medication Administration• Deficient Knowledge

– Patient not properly educated about medication

• Noncompliance– Patient properly educated, but chose not

to take medication


Some Diagnoses for Drug Some Diagnoses for Drug AdministrationAdministration

• Activity Intolerance • Risk for Falls • Urinary Incontinence• Oral Mucous Membrane Impaired• Consult books on nursing diagnoses


Table 6.2 Common Nursing Diagnoses Applicable to Drug Administration



Table 6.2 (continued) Common Nursing Diagnoses Applicable to Drug Administration


Nurse Planning PhaseNurse Planning Phase

• Prioritizes diagnoses, formulates desired outcomes, and selects nursing interventions that can assist patient to return to an optimum level of wellness


Goals for Patient Receiving Goals for Patient Receiving MedicationsMedications

• Based on nursing diagnosis• Focused on what patient will achieve or

do • Prioritized• Discussed with patient or caregiver• Can be short- or long-term goals


Goals for Patient Receiving Goals for Patient Receiving MedicationsMedications

• Goals focused on – Safe and effective administration– Therapeutic outcome– Treatment of side effects


Outcomes for Patients Receiving Outcomes for Patients Receiving MedicationsMedications

• Specific, measurable criteria• Evaluate degree to which goal is met• Focus on what patient will achieve or do• Discuss with patient or caregiver


Outcomes for Patients Receiving Outcomes for Patients Receiving MedicationsMedications

• Should be written and should include– Subject (patient)– Action required by subject– Circumstances– Expected performance– Specific time frame


Implementation PhaseImplementation Phase

• Nurse applies knowledge, skills, and principles of nursing care to move patient toward desired goal and optimal wellness.


Aim of InterventionsAim of Interventions

• Patient returned to optimal level of wellness

• Safe and effective administration of medications


Implementation Phase ActionsImplementation Phase Actions

• Administering medication• Continued assessment of patient• Monitoring drug effects• Documenting medications• Patient teaching


Monitoring Drug Effects Is Primary Monitoring Drug Effects Is Primary InterventionIntervention

• Monitor for identified therapeutic effect• Reassessing patient

– Physical condition– Vital signs– Body weight– Lab values– Serum drug levels


Monitoring Drug Effects Is Primary Monitoring Drug Effects Is Primary InterventionIntervention

• Taking patient statements• Monitoring side or adverse effects


Documentation of Medication Documentation of Medication AdministrationAdministration

• Administration of medication• Therapeutic and adverse effects• Patient statements• Objective assessment data


Patient TeachingPatient Teaching

• Primary role for nurses• Directly related to

– Knowledge deficit– Noncompliance

• Provide written material to patient• Elderly and pediatric patients are special

challenge.• May need to co-teach patient’s caregiver


Evaluation Is a CheckpointEvaluation Is a Checkpoint

• Compares patient current status with desired outcome– If goal met, focus may shift to next

highest priority– If not met, plan may require revisions

• Overall goal is safe, effective medication administration.

• Therapeutic outcome should be best possible; take steps to ensure success.


Evaluation Begins New Cycle Evaluation Begins New Cycle WhenWhen

• New assessment data is gathered and analyzed.

• Nursing diagnoses are reviewed or rewritten.

• Goals and outcomes are refined.• New interventions are carried out.


Table 6.3 Important Areas of Teaching for a Patient Receiving Medications



Table 6.3 (continued) Important Areas of Teaching for a Patient Receiving Medications