NUR 106 (UNIT 1) CH 4 The Nursing Process in Drug Therapy and Patient Safety

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NUR 106 Pharmacology CCTC Fall 2011 Cheryl L DeGraw

assessment

information gathering regarding the current status of a particular patient, including evaluation of past history and physical examination; provides a baseline of information and clues to effectiveness of therapy

evaluation

part of the nursing process; determining the effects of the interventions that were instituted for the patient and leading to further assessment and intervention

implementation

actions undertaken to meet a patient's needs, such as administration of drugs, comfort measures, or patient teaching

nursing

the art of nurturing and administering to the sick, combined with the scientific application of chemistry, anatomy, physiology, biology, nutrition, psychology, and pharmacology to the particular clinical situation

nursing diagnosis

statement of an actual or potential problem, based on the assessment of a particular clinical situation, which directs needed nursing interventions

nursing process

the problem-solving process used to provide efficient nursing care; it involves gathering information, formulating a nursing diagnosis statement, carrying out interventions, and evaluating the process

The Nursing Process steps:

1. Assessment (gathering information)
2. Nursing diagnosis (analyzing the information gathered to arrive at some conclusions)
3. Interventions (actions undertaken to meet the patient's needs, such as administration of drugs, education, and comfort measures)
4. Evaluation (determining the effects of the interventions that were performed)

Nurses use the nursing process to

provide a framework for organizing the information that is needed to provide safe and effective patient care.

The steps of the nursing process

are constantly being repeated to meet the ever-changing needs of the patient.

Proper Drug Administration:

There are seven points to consider in the safe and effective administration of a drug: drug, storage, route, dosage, preparation, timing, recording

Proper Drug Administration: Drug

Know that it is standard nursing practice to ensure that the drug being administered is the correct dose and the correct drug, and that it is being given at the correct time and to the correct patient.

Proper Drug Administration: Storage

Be aware that some drugs require specific storage environments (e.g., refrigeration, protection from light).

Proper Drug Administration: Route

Determine the best route of administration; this is frequently established by the formulation of the drug. Nurses can often have an impact in modifying the route to arrive at the most efficient, comfortable method for the patient based on the patient's specific situation. When establishing the prescribed route, check the proper method of administering a drug by that route.

Proper Drug Administration: Dosage

Calculate the drug dosage appropriately, based on the available drug form, the patient's body weight or surface area, or the patient's kidney function.

Proper Drug Administration: Preparation

Know the specific preparation required before administering any drug. For example, oral drugs may need to be shaken or crushed; parenteral drugs may need to be reconstituted or diluted with specific solutions; and topical drugs may require specific handling, such as the use of gloves during administration or shaving of a body area before application.

Proper Drug Administration: Timing

Recognize that the administration of one drug may require coordination with the administration of other drugs, foods, or physical parameters. As the caregiver most frequently involved in administering drugs, the nurse must be aware of and juggle all of these factors, as well as educate the patient to do this on his or her own.

Proper Drug Administration: Recording

After assessing the patient, making the appropriate nursing diagnoses, and delivering the correct drug, by the correct route, in the correct dose, and at the correct time, the nurse should document that information in accordance with the local requirements for recording medication administration. Box 4.3 summarizes points to consider for proper drug administration.

Nursing diagnoses are made using

the information gathered during the assessment phase of the nursing process. A nursing diagnosis states the actual or potential response of a patient to a clinical situation.

Interventions include

safe and effective drug administration, provisions of comfort measures to help the patient cope with the therapeutic or adverse effects of a drug, and patient and family education to ensure safe and effective drug therapy

Nursing assessment must include

information on the history of past illnesses and the current complaint, as well as a physical examination; this provides a database of baseline information to ensure safe administration of a drug and to evaluate the drug's effectiveness and adverse effects.

Evaluation is

a continual process that assesses the situation and leads to new diagnoses or interventions as the patient reacts to the drug therapy.

A patient reports to you that she has a drug allergy. In exploring the allergic reaction with the patient, the following might indicate an allergic response:
a. increased urination.
b. dry mouth.
c. rash.
d. drowsiness.

c. rash.

It is important to obtain a medical history from a patient before beginning drug therapy because
a. many medical conditions alter the pharmacokinetics and pharmacodynamics of a drug.
b. it is part of the nursing protocol.
c. a baseline is needed for evaluating drug effects.
d. it is the first step in the nursing process.

a. many medical conditions alter the pharmacokinetics and pharmacodynamics of a drug.

A nursing diagnosis
a. directs medical care.
b. helps the patient become more compliant.
c. shows actual or potential alteration in patient function.
d. determines insurance reimbursement in most cases.

c. shows actual or potential alteration in patient function.

A patient receiving an antihistamine complains of dry mouth and nose. An appropriate comfort measure for this patient would be
a. use of a humidifier and an increase in fluid consumption.
b. voiding before taking the drug.
c. avoiding exposure to the sun.
d. a back rub.

a. use of a humidifier and an increase in fluid consumption.

When establishing the nursing interventions appropriate for a given patient
a. the patient should not be actively involved.
b. the family or other support systems should not be consulted.
c. teaching is important only if the patient seems compliant.
d. an evaluation of all of the data accumulated should be incorporated to achieve an effective care plan.

d. an evaluation of all of the data accumulated should be incorporated to achieve an effective care plan.

The evaluation step of the nursing process
a. is often not necessary.
b. is important only in the acute setting.
c. is a continual process that redirects nursing interventions as needed.
d. includes making nursing diagnoses.

c. is a continual process that redirects nursing interventions as needed.

A client has been through a teaching format for digoxin (generic), a drug used to increase the effectiveness of the heart's contractions. Which of the following statements would indicate that the teaching was effective?
a. "I need to take my pulse every morning before I take my pill."
b. "Sometimes I forget my pills, but I usually make up the missed ones once I remember."
c. "This pill might help my hay fever."
d. "I don't remember the name of it, but it is the white one."

a. "I need to take my pulse every morning before I take my pill."

Multiple Response: Select all that apply.

A client is being started on a laxative regimen. Before beginning the regimen, the nurse would perform which of the following assessments?
a. Liver function test
b. Abdominal examination
c. Skin color and lesion evaluation
d. Lung auscultation
e. 24-hour urine
f. Cardiac assessment

a. Liver function test
b. Abdominal examination
c. Skin color and lesion evaluation

The nursing care of a patient receiving drug therapy should include measures to decrease the anticipated adverse effects of the drug. Which of the following measures would a nurse consider to decrease adverse effects?
a. A positive approach
b. Environmental temperature control
c. Safety measures
d. Skin care
e. Refrigeration of the drug
f. Involvement of the family

b. Environmental temperature control
c. Safety measures
d. Skin care

A nurse is preparing to administer a drug to a client for the first time. What questions should the nurse consider before actually administering the drug?
a. Is this the right patient?
b. Is this the right drug?
c. Is there a generic drug available?
d. Is this the right route for this patient?
e. Is this the right dose, as ordered?
f. Did I record this properly?

a. Is this the right patient?
b. Is this the right drug?
d. Is this the right route for this patient?
e. Is this the right dose, as ordered?

List the seven points to consider in the safe and effective administration of a drug.

1. Correct drug and patient
2. Correct storage of the drug
3. Correct and most effective route
4. Correct dosage
5. Correct preparation
6. Correct timing
7. Correct recording of administration

The first step of the nursing process, which involves the systematic, organized collection of data about the patient, is called _______.

assessment

The continual process that assesses the situation and leads to new diagnoses or interventions as the patient reacts to the drug therapy is called _______.

evaluation

_______ use the data gathered during the assessment to determine actual or potential problems that require specific nursing interventions.

Nursing diagnoses

Inadvertent drug-drug interactions may occur when a patient does not report use of _______ or _______ when given a prescription drug.

over-the-counter drugs or herbal therapies

Patients should always be told the name, action, and _______ of each drug being taken.

dose

A drug is known to cause dizziness. An important safety warning for the patient taking that drug would be _______.

avoid driving a car or operating dangerous machinery

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