NURSING PROCESS in DRUG THERAPY
NURSING PROCESS in DRUG THERAPY
Application of the nursing process with drug therapy ensures that the patient receives the best, safest, most efficient, scientifically
based, holistic care.
ASSESSMENT
A. PATIENT'S HISTORY
To promote safe & effective use of the drug.
Prevent adverse effects.
Identify clinically important drug–drug, drug–food, or drug–alternative therapy interactions & medication errors.
History of Allergies
= past exposure to a drug or other allergens can provoke a future reaction or necessitate the need for cautious use of the drug,
food, or animal product
Pattern of Healthcare
= knowing how a patient seeks health care provides the nurse with valuable information to include when preparing the patient’s
teaching plan
B. PHYSICAL EXAMINATION
To determine if any conditions exist that would be contraindicated to a drug.
To develop a baseline for evaluating the effectiveness of the drug and the occurrence of any adverse effects.
Weight
= to determine whether the recommended drug dose is appropriate
= the recommended dose is based on a 150-pound adult man
= patients who are much lighter or much heavier often need a dose adjustment
Age
= patients at the extremes of the age spectrum — children and older adults — often require dose adjustments based on the
functional level of the liver and kidneys, the responsiveness of other organs, & other existing medical conditions
= a child’s age & developmental level will also alert the nurse to possible problems with drug delivery, such as the ability to
swallow pills or follow directions related to other delivery methods
NURSING DIAGNOSIS
A statement of the patient’s status from a nursing perspective.
The nurse analyzes the info gathered during assessment to arrive at some conclusions that lead to a goal & a set of interventions.
It shows actual or potential alterations in patient function based on the assessment of the clinical situation.
Diagnoses that are related to drug therapy must be incorporated into a total picture of the patient.
IMPLEMENTATION
Interventions involve ensuring effective response to drug therapy, minimizing adverse effects, & understanding the drug regimen.
2. Comfort Measures
A patient is more likely to be compliant with a drug regimen if the effects of the therapy are not too uncomfortable or
overwhelming.
PLACEBO EFFECT
= the anticipation that a drug will be helpful has proved to have tremendous impact on the actual success of drug therapy
= the nurse’s attitude & support can be a critical part of drug therapy
LIFESTYLE ADJUSTMENT
= some medications & their effects require that a patient make changes in his or her lifestyle
= change in lifestyle can affect an individual’s ability to cope & comply with any medical regimen
EVALUATION
The patient is continually evaluated for therapeutic response, occurrence of adverse drug effects, and occurrence of drug–drug,
drug–food, drug–alternative therapy, or drug–laboratory test interactions.
The efficacy of the nursing interventions and the education program also are evaluated.
The nurse evaluates the patient simply by reapplying the beginning steps of the nursing process & then analyzing for changes, either
positive or negative.
The process of evaluation may lead to changes in the nursing interventions being used to provide better and safer patient care.
The proper and safe disposal of any biohazardous equipment such as used needles that the client uses for insulin and other
medications.
INFANTS
SYRINGE / DROPPER = for oral liquid medications
VASTUS LATERALIS / RECTUS FEMORIS / VENTROGLUTEAL MUSCLE SITES
= for IM injections
= not the deltoid / gluteus maximus muscles since they have not yet developed
TODDLERS
SPOON / CUP = for liquid oral medications are given with a spoon
VASTUS LATERALIS / RECTUS FEMORIS / VENTROGLUTEAL MUSCLE SITES = for IM injections
GLUTEUS MAXIMUS = can be used after the toddler has been walking for at least a year
ELDERLY
Dosages may be decreased because the normal physiological changes of the aging process make them more susceptible to side
effects, adverse drug reactions, & toxicity and over dosages.
RECORDING & REPORTING
Others use more sophisticated bar-coded entry systems to access controlled substances.
If there are any discrepancies, these are immediately addressed, explored, & corrected if it was a simple oversight or math error.
When the narcotics count cannot be corrected, a report must be filed according to the facility's policies and procedures.
If a controlled substance is wasted for any reason, either in its entirety or only partially, this waste must be witnessed or
documented by the wasting nurse and another nurse. Both nurses document this wasting.
Medications that are given, omitted, held, or refused by the patient must be documented.