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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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Assessment of the PatientAssessment of the Patient
• Subjective data—what patient describes• Objective data—physical assessment,
laboratory tests, other diagnostic sources
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Assessment of the PatientAssessment of the Patient
• Health history tailored to patient clinical condition– Includes use of all
medications/supplements taken• Physical assessment – objective data on
patient’s condition
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 6.1 Health History Assessment Questions Pertinent to Drug Administration
continued on next slide
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 6.1 (continued) Health History Assessment Questions Pertinent to Drug Administration
continued on next slide
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 6.1 (continued) Health History Assessment Questions Pertinent to Drug Administration
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Nursing Diagnoses for Drug Nursing Diagnoses for Drug AdministrationAdministration
• May focus on patient’s response to actual or potential health and life processes
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Risk Diagnosis Includes:Risk Diagnosis Includes:
• Diagnostic statement• Related factor or inferred cause
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Actual Diagnosis Includes:Actual Diagnosis Includes:
• Diagnostic statement• Related factor or inferred cause• Evidence to support statement
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 6.2 Common Nursing Diagnoses Applicable to Drug Administration
continued on next slide
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 6.2 (continued) Common Nursing Diagnoses Applicable to Drug Administration
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Goals for Patient Receiving Goals for Patient Receiving MedicationsMedications
• Goals focused on – Safe and effective administration– Therapeutic outcome– Treatment of side effects
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Implementation PhaseImplementation Phase
• Nurse applies knowledge, skills, and principles of nursing care to move patient toward desired goal and optimal wellness.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Aim of InterventionsAim of Interventions
• Patient returned to optimal level of wellness
• Safe and effective administration of medications
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Implementation Phase ActionsImplementation Phase Actions
• Administering medication• Continued assessment of patient• Monitoring drug effects• Documenting medications• Patient teaching
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Monitoring Drug Effects Is Primary Monitoring Drug Effects Is Primary InterventionIntervention
• Taking patient statements• Monitoring side or adverse effects
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Documentation of Medication Documentation of Medication AdministrationAdministration
• Administration of medication• Therapeutic and adverse effects• Patient statements• Objective assessment data
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
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.
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 6.3 Important Areas of Teaching for a Patient Receiving Medications
continued on next slide
Pharmacology for Nursing: A Pathophysiology Approach, Fourth EditionMichael Patrick Adams | Leland N. Holland | Carol Urban
Table 6.3 (continued) Important Areas of Teaching for a Patient Receiving Medications