The Nursing Process and Pharmacology Jeanelle F. Jimenez RN, BSN, CCRN Chapter 4 The Nursing Process and Pharmacology Jeanelle F. Jimenez RN, BSN, CCRN Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives Explain the purpose of the nursing process and methodology used to apply to the study of pharmacology State the five steps in the nursing process and describe them in terms of a problem-solving method used in nursing practice Describe the components of the assessment process Compare current methods used to collect, organize, and analyze information about the health care needs of patients and their significant others Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (cont’d) Define the term nursing diagnosis and discuss the wording used in formulating nursing diagnosis statements Define the term collaborative problem Differentiate between a nursing diagnosis and a medical diagnosis Differentiate between problems that require formulation of a nursing diagnosis and those categorized as collaborative problems, which may not require nursing diagnosis statements Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (cont’d) Identify the steps in the planning of nursing care Explain the process of prioritizing individual patient needs using Maslow’s hierarchy of needs Formulate measurable goal statements for assigned patients in the clinical practice setting State the behavioral responses around which goal statements revolve when the discharge of a patient is planned Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (cont’d) Identify the purposes and uses of a patient care plan Integrate outcome and classification system(s) and critical pathways into care plans Discuss the use of evidence-based practice in planning for nursing care Differentiate between nursing interventions and therapeutic outcomes Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (cont’d) Compare the types of nursing functions classified as dependent, interdependent, and independent, and give examples of each Describe the evaluation process used to establish whether patient behaviors are consistent with the identified short- or long-term goals Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives State the information that should be obtained as a part of a medication history Identify primary, secondary, and tertiary sources of information used to build a patient information base Define the problem Describe the process that is used to identify factors that could result in patient problems when medications are prescribed Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (cont’d) Practice developing short- and long-term patient education objectives and have them critiqued by the instructor Differentiate among dependent, interdependent, and independent nursing actions and give an example of each Describe the procedure for evaluating the therapeutic outcomes obtained from prescribed therapy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (cont’d) Review the content of several drug monographs to identify information that may result in patient problems from the medication therapy Identify steps used to plan nursing care in relation to a medication regimen prescribed for a patient Describe an acceptable method of organizing, implementing, and evaluating the patient education delivered Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

The Nursing Process Foundation for the clinical practice of nursing Involves: Assessment Nursing diagnosis Planning Nursing intervention or implementation Evaluating and recording therapeutic outcomes How does the nursing process relate to pharmacology? Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Holistic Care Needs Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Assessment First step in the nursing process Comprehensive collection of data, including: Physical examination Nursing history Medication history Professional observation Assessment is an ongoing process that starts with admission and continues until the patient is discharged from care Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Diagnosis A clinical judgment about individual, family, or community responses to actual or potential health problems/life processes (NANDA-I) Actual nursing diagnosis consist of a three-part statement that Uses a NANDA-I diagnostic label Has contributing factors Defines characteristics Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Five Types of Nursing Diagnosis Actual: based on human responses and supported by defining characteristics Risk/high-risk: patient may be more susceptible to a particular problem Possible: suspected problems requiring additional data Wellness: clinical judgment about a transition from one level to a higher level Syndrome: cluster signs and symptoms to predict certain circumstances or events Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Collaborative Problems Different from nursing diagnoses when the intervention used is to prevent or treat a problem and is worded with potential complication in the diagnosis Evidence-based practice uses research to impact nursing practice changes; the interventions used in the research findings can be implemented into care plans Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Phases of Planning Four phases of a nursing care plan Setting priorities Developing measurable goal/outcome statements Formulating nursing interventions Formulating anticipated therapeutic outcomes Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Phases of Planning (cont’d) Setting priorities: Identify problems and prioritize which ones are more important and must be attended to first, depending on patient needs Developing measurable goal statements: Write short- and long-term goals for the patient to be followed when providing care Formulating nursing interventions and anticipated outcomes: Plan which intervention to use based on anticipated patient behavior Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Intervention or Implementation Actual process of carrying out the established plan of care Nursing actions are suggested Dependent actions: performed by a nurse based on health care provider’s orders Interdependent actions: implemented with the cooperation of a team Independent actions: provided by nurse by virtue of education and license Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Evaluating and Recording Therapeutic and Expected Outcomes All care is evaluated against: Nursing diagnoses (goal statements) Nursing interventions Patient responses Evaluation process involves patient, family, and significant others who provide feedback and help determine goals. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Assessment Three reasons for obtaining a drug history To evaluate need for medication To obtain current and past use of over-the-counter medication To identify problems related to drug therapy Relies on three sources Primary source: produced by patient Secondary sources: relatives, significant others, medical records, lab reports Tertiary sources: literature to provide background information, diagnostic tests, diet Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Diagnosis and Pharmacology Nursing diagnoses often can be formulated based on the patient’s drug therapy Most commonly associated with drug treatment for a disease or adverse effects from drug therapy Also can originate from pathophysiology caused by drug interactions Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Planning Confirm recommended dosage and route of medication Check that scheduling of administration of medicine is based on the provider’s orders Teach patients to keep written response records Educate patients on techniques of self-administration if necessary Inform on proper storage and refilling of medications Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Intervention or Implementation Nurses prepare the prescribed medications using procedures to ensure patient safety Select correct supplies (syringes, etc.) Verify all aspects before preparation Collect appropriate data to serve as baseline for later assessments Administer medication by correct route Document all aspects of administration Implement actions to minimize expected side effects Educate patient as appropriate Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Evaluating Therapeutic Outcomes Evaluation procedure for determining therapeutic outcomes of drug therapy include: Assessing patient responses to medications Determining signs and symptoms of recurring illness Assessing any adverse effects Determining the patient’s ability to receive education and self-administer medication, as well as the potential for compliance Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.