Presentation on theme: "Applying the Nursing Process to Drug Therapy"— Presentation transcript:
1Applying the Nursing Process to Drug Therapy Role of the RN in MedicationAssessment & Administration
2Assessment of Client Collect Subjective & Objective data: Client, Drug & EnvironmentUse current Drug handbook/text reference/licensed pharmacistComplete a drug historyPerform a Nursing Physical AssessmentCreate a medication profile
3Assessing 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)
4Drug History (continued) Herbals & homeopathic substancesProblems with drug therapy in the past (e.g., allergies, adverse effects, diseases or injuries, organ pathology)Growth & development issues as related to the client’s age and specific expectations( e.g. Erickson's stages of development) and task for each major group
5The 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 fluidsswallow problemsLaboratory/diagnostic test value e.g. renal, liver panels, hgb/hct., protein, albumin levels.
6Interview process/Med eval Consider client’s experience with meds/health care system, previous hosp.Check vital signs (establish baseline)List meds client is taking /how taken/whenList new meds orderedUse holistic framework- identify emotional, physical, cognitive, cultural & socioeconomic factors impacting drug therapy & nursing process
7Interview Process/med eval (cont.) Check drugs adverse effects & contraindications, routes of administration, toxicity, therapeutic levelsDrug actionAre there any “age specific” developmental concernsHow does the cultural origin & racial/ethnic group of client influence the drug therapy
8Medication Orders Orders must contain six elements: Client’s name Date & time order was writtenName of the medicationDosage (includes size, frequency & number of doses)Route of deliverySignature of prescriber
9Researching the medication ordered Use current text/handbookReview:classification, mechanism of actiondoses, routes, side effects, contraindications, drug incompatibilitiesinteractions, precautions & nursing implications
10Analysis 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; noncomplianceDiagnosis based on s/e or risk factors e.g.:. fatigue, constipation, impaired tissue perfusion, sexual dysfunction, sleep disturbance, urinary retention
11Planning care: identifying goals & outcome criteria Prioritize the nursing diagnosisSpecify objective, measurable, realistic goalsEstablish a time period for achievement of outcomesIf order is in question- do not give- call physician for clarification/further instructions.Document all information obtained!!
12ImplementationRequires constant communication& collaboration with client& health care teamFollow the “six rights”:Right drugRight doseRight timeRight routeRight clientRight documentation
13Client/patient’s rights with regards to medication Right to a “double check”Right to proper storage/documentationRight to accurate calculation& preparationRight to careful checking of transcription of ordersClient safety- use of correct administration proceduresRight to accurate routes of administration
14Client/patient rights –cont’d Right to close consideration of special situations e.g.: difficulty with swallowing, client with NG tube or who is unconsciousRight to having all measures taken to prevent and report med errors if they occurRight to individualized /complete client teachingRight of accurate/cautious monitoringRight to accurate documentation
15Evaluation of drug therapy: an ongoing part of the nursing process Monitor client responses to the drugMonitor expected and unexpected responsesMonitor therapeutic (intended effects), side effects , adverse effects & toxic effectsDocument !! Very important!!