Applying the Nursing Process to Drug Therapy

Role of the RN in Medication Assessment & Administration

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

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)

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 clients age and specific expectations( e.g. Erickson's stages of development) and task for each major group

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.

Interview process/Med eval

Consider clients 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

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

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

Researching the medication ordered

Use current text/handbook Review: classification, mechanism of action doses, routes, side effects, contraindications, drug incompatibilities interactions, precautions & nursing implications

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

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!!

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

Client/patients 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

Client/patient rights contd

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

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!!