1. The Nursing Process and Drug Therapy
Chapter 1
The Nursing Process and Drug Therapy
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2. The Quality and Safety Education for Nurses (QSEN) Project
Initiated in 2005
Preparing future nurses with the knowledge, skills, and attitudes (KSAs) needed to continuously improve the quality and safety of patient care within the health care system
KSAs flow out of the QSEN initiatives and are being integrated into nursing education curricula and clinical outcomes.
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3. Six Major Initiatives of QSEN
Patient-centered care
Teamwork and collaboration
Evidence-based practice (EBP)
Quality improvement (QI)
Safety
Informatics
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The Nursing Process
A research-based organizational framework for professional nursing practice
Ensures the delivery of thorough, individualized, and quality nursing care to patients
Requires critical thinking
Ongoing and constantly evolving process
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5. Five Steps of the Nursing Process
Assessment
Nursing diagnosis
Planning
Goals
Outcome criteria
Implementation, including patient education
Evaluation
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Assessment
Data collection, review, and analysis
Medication profile
Any and all drug use
Prescriptions
Over-the-counter medications
Vitamins, herbs, and supplements
Compliance and adherence
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7. Audience Response System Question
The nurse answers a patient’s call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first?
Check the orders and give the patient the requested pain medication.
Provide comfort measures to the patient.
Assess the patient’s pain and pain level.
Evaluate the effectiveness of previous pain medications.
Correct answer: C
Rationale: The nurse should always assess a patient before any intervention. Although the nurse will check the orders and possibly give the medication (and possibly even perform the actions in responses B and D), the first priority is assessment.
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8. North American Nursing Diagnosis Association International (NANDA-I)
Purpose of NANDA-I: increase the visibility of nursing’s contribution to the care of patients and to further develop, refine, and classify the information and phenomena related to nurses and professional nursing practice
See Box 1-2 for more information about the 2012 to 2014 NANDA-approved nursing diagnoses.
See Box 1-3 for a listing of NANDA-approved nursing diagnoses ( ) most relevant to drug therapy.
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Nursing Diagnoses
Nursing diagnoses are used to communicate and share information about the patient and the patient experience.
Common nursing diagnoses related to drug therapy include:
Deficient knowledge
Risk for injury
Noncompliance
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10. Nursing Diagnoses (Cont.)
Three-step process:
Human response to illness, injury, or significant change
Factors related to the response (“related to”)
Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”)
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Planning
Identification of goals and outcome criteria
Goals
Objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria
Outcome criteria
Concrete descriptions of patient goals
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12. Audience Response System Question
The patient’s medication administration record lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do?
Give the medications PO with a small sip of water.
Give the medications via the IV route because the patient is NPO.
Hold the medications until after the test is completed.
Call the health care provider to clarify the instructions.
Correct answer: D
Rationale: The dosage for the IV route would not be the same as for the PO route. Holding the medications may cause drug levels to drop and result in seizure activity, and giving the medications PO without consent may alter the test results. The nurse must never assume the route of medication administration and should consult the physician for clarification of the orders.
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Implementation
Initiation and completion of specific nursing actions as defined by the nursing diagnoses, goals, and outcome criteria
Independent, collaborative, and dependent
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14. The “Six Rights” of Medication Administration
Right drug
Right dose
Right time
Right route
Right patient
Right documentation
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15. Audience Response System Question
The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at What will the nurse do first to determine whether the medication was given?
Call the night nurse at home.
Check the medication administration record.
Call the pharmacy.
Review the nurse’s notes.
Correct answer: B
Rationale: The medication administration record is the legal documentation that the professional nurse uses to sign off medications that are given, so it should be checked first.
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Evaluation
Ongoing part of the nursing process
Determining the status of the goals and outcomes of care
Monitoring the patient’s response to drug therapy
Expected and unexpected responses
Clear, concise documentation
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17. Audience Response System Question
A nurse makes an error when administering medications to a patient. Which action by the nurse requires the supervising nurse to intervene? The nurse
completes an incident report.
informs the prescriber of the error.
documents adverse effects to the medication error.
records completion of an incident report in the medical chart.
Correct answer: D
Rationale: If there is a medication error, the nurse should complete an incident report with the entire event, surrounding circumstances, therapeutic response, adverse effects, and notification of the prescriber described in detail. However, the nurse should not record completion of an incident report in the medical chart.
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