Pharma 2 NSG Process

PHARMACOLOGY
and the
NURSING PROCESS
DR. Caridad D. Garcia

profcarrie68@yahoo.com
NURSING PROCESS
• CRUCIAL for safe drug
administration
CRUCIAL = of the greatest

significance in determining an outcome
NURSING PROCESS
• Draws together all the aspects of
the patient’s
• Physical
• Cultural
• Cognitive
• Spiritual
• Sexual
• Financial
• Recognizing these aspects allows for a
more holistic approach to patient care
NURSING PROCESS
• A research-based organizational
framework for professional practice
• Central to all nursing care
• Encompasses all steps taken by the
nurse in caring for a patient
• Ongoing & constantly evolving
process
• Critical Thinking
• Flexibility is important
NURSING PROCESS
• Assessment
• Nursing Diagnosis
•Planning
•Goals
• Outcome criteria
• Implementation
• Evaluation
NURSING PROCESS
Assessment
• Data collection
•Subjective, objective
•Accurate
• Data analysis
NURSING PROCESS: Assessment
• Current Health Hx (& Past)
• Symptoms
• Medications: dosage, frequency,
knowledge & expectations,
compliance, allergies, reactions,
OTC, herbal, vitamins, street
drugs
NURSING PROCESS: Assessment (cont)
• Client’s environment
• Language & communication needs
• Hx of compliance
• Knowledge of drug storage
• Availability, willingness, ability to administer or
assist in administration
• House members, s.o.; ages/roles
• Learning style preferences
• ADL, dietary patterns, cultural & economic
influences
• Financial resources
• Mental status
• Objective data
•Gross & fine motor control,
ROM, muscle strength, vision
•Laboratory tests, diagnostic
studies, Physical assessment
(baseline data)
• Compliance
1. What things help you take your
medicine as prescribed?
2. What things prevent you from
taking your medicine as
prescribed?
3. What would you do or what do
you do if you forgot to take a dose
of your medication?
Frequently cited factors for noncompliance
• Forgetfulness
• Knowledge deficit
• Side effects
• Low self esteem
• Family problems
• Lack of trust in the health care system
• Language barriers
• High cost of medication
• Anxiety
• Value systems (religious, etc)
• Lack of motivation
NURSING PROCESS
Nursing Diagnosis
• Decision about the need/problem
(actual or at risk for)
• NANDA format: Three parts
•Human response to illness
•“related to”
•“as evidenced by”
NURSING PROCESS
Nursing Diagnosis
•Critical thinking
•Creativity
•Accurate data collection
• It is a statement about the

patient’s status and will guide
nursing intervention
Nsg Dx (cont)
• Deficient knowledge about drug action,
adminsitration & side effects r/t
cultural/language barrier or speech
articulation problem.
• Pain (acute or chronic) r/t hesitancy in
taking prescribed medication due to
fear of addiction
• Ineffective health maintenance r/t not
having recommended preventive care
Nsg Dx (cont)
• Ineffective protection r/t effects of
anticoagulant medication on clotting
mechanism
• Ineffective therapeutic regimen management
• Noncompliance r/t forgetfulness
• Risk for injury r/t side effects amb dizziness
& drowsiness
• Ineffective therapeutic regimen management
r/t lack of finances or health care coverage to
purchase medication
NURSING PROCESS
Planning
• Identification of goals
•Patient-centered
• Outcome criteria
•SMART
• Prioritization
NURSING PROCESS: Planning (cont)
• Identification of possible interaction

• Client & family education
• Gather equipment, review
procedures, safety measures [timing
& frequency, storage]
This phase leads to the provision of safe

effective medication administration.
NURSING PROCESS
Implementation
• Initiation and completion of the
NCP as defined by the nursing
diagnoses and outcome criteria
•Dependent
•Independent
•Collaborative
• Client teaching
Client Education/Teaching
• Environment: free of distractions
• Tailor information to client’s interest &
level of understanding
•Readiness to learn, motivation,
attention span, level of frustration
• Establish a trusting relationship. Be an
active listener & observer
Client Education/Teaching (cont)
• Actively involve the client
•Interventions that stimulate
several senses
•Written instructions & other
teaching aids: colorful
charts/graphs; variety of media
• Encourage questions from patient &
family members
• Space instruction over several
sessions, if appropriate.
• Identify clients at risk for

nonadherence. Alert health care
provider & pharmacist to develop
plan to minimize number of drugs
& frequency of administration
• Evaluate client’s understanding of

medication regimen on regular
basis
• Empower the client to take

responsibility for managing
medications
Checklist for Health Teaching
• Comprehensive drug & health history
• Reason for medication therapy
• Expected results
• Side effects & adverse reactions
• When to notify health care providers or
pharmacist
• Drug-drug, drug-food, drug-laboratory,
drug-environment interactions
• Required changes in ADL
Checklist for Health Teaching (cont)
• Demonstration of learning:
listening, discussing, return
demonstration
• Medication schedule [associated
w/ ADL & drug level of action as
appropriate]
• Recording system
Checklist for Health Teaching (cont)
• Discussion & monitoring of access

to financial resources, medications
& equipment
• Development of support & backup
system
• Community resources
NURSING PROCESS: Implementation (cont)
• Maximizing therapeutic effect

• Minimizing adverse effects
•Provide comfort measures
•Help patient cope with
therapeutic or adverse effects
• Follow 6R’s of medicine
administration
NURSING PROCESS
Evaluation
• Ongoing
• Determining the status of the

goals and outcomes of care
NURSING PROCESS: Evaluation (cont)
• Monitoring patient’s
response(s) to drug therapy
•Expected outcome
•Unexpected outcome
NURSING PROCESS: Evaluation (cont)
•Review w/ the client &

family the need for follow-
up care, if required
•Encourage choices in ADL
•Refer to community
resources as necessary
Preventing Medication Errors
1. After administering a medication,
provide appropriate instructions to the
client regarding expected response.
Instruct the patient to report any
untoward or unexpected response.
2. Perform a focused assessment after medication
administration
􀂾 Always know the reason a patient is receiving a
medication.
􀂾 Know the expected therapeutic response and side
effects of each medication administered.
􀂾 Assessment should be completed 30 to 60 minutes
after oral administration, 15 to 30 minutes after
intravenous or subcutaneous administration, and
immediately after intravenous administration.
􀂾 Assessment should be repeated periodically
based on expected pharmacokinetics of
medication.
3. Always be aware of potential anaphylactic
response to any medication.
Allergic responses to medications
typically occur after repeated exposure to a
medication. Therefore a patient may
develop anaphylaxis to a medication not
reported as an allergy. To prevent severe
reaction, always administer intravenous
medications slowly and stay with the
patient for the first 5 to 10 minutes of any
intravenous infusion.
4. If an unexpected response to a medication
occurs:
• Immediately notify the patient’s physician.
• Reevaluate the patient’s medication profile
to determine potential cause of reaction and
possible medication error.
• Count medications in containers or
patient’s medication drawer, if able, to
determine possible medication error.
• Assess any infusions for potential cause of
adverse reaction and/or medication error.
Reporting Medication Errors
• Once a medication error has occurred, the
nurse’s responsibility shifts toward
reporting the error.
• Appropriately reporting medication errors not
only provides necessary health care to the
patient but also allows investigation of the
incident in an effort to prevent further
occurrences.
1. Once a medication error is discovered,
immediately assess the patient for
untoward effects.
2. Report the medication error to appropriate
personnel, including the nurse caring for
patient and the primary care provider
and/or physician who ordered the
medication.
3. Document the medication error according
to hospital policy. Usually this involves a
specific medication error reporting form as
well as a notation on the patient’s chart.
4. Continually reassess the patient as

necessary for any untoward effects.
5. Administer antidotes or
medications/interventions as appropriate
to prevent deleterious effects to the patient.
Avoid common pitfalls for not
reporting medication errors:
• “It’s not an error if I can correct it.”
For example, if a medication is omitted,

a nurse may change the timing of
subsequent doses to get the
medication and patient “back on
track.”
• “It’s not an error if it could not be
avoided.”
For example, a nurse may not

identify a medication error if the
medication was given late due to a
critical need of another patient.
• “It’s not an error if it’s not my
fault.”
For example, a nurse may give a

medication late because the
pharmacy did not deliver the
medication on time.
ANY
QUESTION

Pharma 2 NSG Process

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PHARMACOLOGY

DR. Caridad D. Garcia

CRUCIAL = of the greatest

• It is a statement about the

• Identification of possible interaction

This phase leads to the provision of safe

• Identify clients at risk for

• Evaluate client’s understanding of

• Empower the client to take

• Discussion & monitoring of access

• Maximizing therapeutic effect

• Determining the status of the

•Review w/ the client &

4. Continually reassess the patient as

For example, if a medication is omitted,

For example, a nurse may not

For example, a nurse may give a

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