Applying the Nursing Process to Drug Therapy

1. Applying the Nursing Process to Drug Therapy Role of the RN in Medication Assessment & Administration

2. Assessment of Client • Collect Subjective & Objective data: Client, Drug & Environment • Use current Drug handbook/text reference/ licensed pharmacist • Complete a drug history • Perform a Nursing Physical Assessment • Create a medication profile

3. Assessing 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)

4. Drug History (continued) • Herbals & homeopathic substances • Problems 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

5. The 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 fluids • swallow problems • Laboratory/diagnostic test value e.g. renal, liver panels, hgb/hct., protein, albumin levels.

6. Interview 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/when • List new meds ordered • Use holistic framework- identify emotional, physical, cognitive, cultural & socioeconomic factors impacting drug therapy & nursing process

7. Interview Process/med eval (cont.) • Check drugs adverse effects & contraindications, routes of administration, toxicity, therapeutic levels • Drug action • Are there any “age specific” developmental concerns • How does the cultural origin & racial/ethnic group of client influence the drug therapy

8. Medication Orders Orders must contain six elements: • Client’s name • Date & time order was written • Name of the medication • Dosage (includes size, frequency & number of doses) • Route of delivery • Signature of prescriber

9. Researching the medication ordered • Use current text/handbook Review: • classification, mechanism of action • doses, routes, side effects, contraindications, drug incompatibilities • interactions, precautions & nursing implications

10. Analysis 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; noncompliance • Diagnosis based on s/e or risk factors e.g.:. fatigue, constipation, impaired tissue perfusion, sexual dysfunction, sleep disturbance, urinary retention

11. Planning care: identifying goals & outcome criteria • Prioritize the nursing diagnosis • Specify objective, measurable, realistic goals • Establish a time period for achievement of outcomes • If order is in question- do not give- call physician for clarification/further instructions. • Document all information obtained!!

12. Implementation • Requires constant communication& collaboration with client& health care team • Follow the “six rights”: • Right drug • Right dose • Right time • Right route • Right client • Right documentation

13. Client/patient’s rights with regards to medication • Right to a “double check” • Right to proper storage/documentation • Right to accurate calculation& preparation • Right to careful checking of transcription of orders • Client safety- use of correct administration procedures • Right to accurate routes of administration

14. Client/patient rights –cont’d • Right to close consideration of special situations e.g.: difficulty with swallowing, client with NG tube or who is unconscious • Right to having all measures taken to prevent and report med errors if they occur • Right to individualized /complete client teaching • Right of accurate/cautious monitoring • Right to accurate documentation

15. Evaluation of drug therapy: an ongoing part of the nursing process • Monitor client responses to the drug • Monitor expected and unexpected responses • Monitor therapeutic (intended effects), side effects , adverse effects & toxic effects • Document !! Very important!!