Phases of the Nursing Process
1. Assessment
2. Diagnosis
3. Outcome Id & planning
4. implementation
5. Evaluation
Nursing process phase #1:
... [Show More] Assessment
Data is collected, reviewed, and analyzed from patient, family, group, and/or community sources.
Objective Data
any information gathered through the senses or that which is:
♥ seen
♥ heard
♥ felt
♥ or smelled
Objective Data may also be obtained from:
♥ Nursing Physical Assessment
♥ Nursing History
♥ Past and Present Medical History
♥ Results of Laboratory Tests,
♥ Diagnostic Studies or Procedures
♥ Measurement of Vital Signs
♥ Weight and Height
♥ Medication Profile
Subjective Data
includes information shared through the spoken word by any reliable source such as the
♥ Patient
♥ Spouse
♥ family member
♥ significant other
♥ or caregiver
Components of a prescription/medication Order:
Seven Elements:
1. Patient's name
2. Date the drug order was written
3. Name of drug(s)
4. Drug dosage amount
5. Drug dosage frequency
6. Route of administration
7. Prescriber's signature
(example in powerpoint)
Assessment about the specific drug involves the collection of specific information about prescribed, OTC, and herbal/complementary/alternative therapeutic drug use, with attention to the:
♥ drug's action
♥ signs symptoms of allergic reaction
♥ adverse effects
♥ dosages and routes of administration
♥ contraindications
♥ drug incompatibilities
♥ drug-drug interactions
♥ drug-food interactions
♥ drug-laboratory test interactions
♥ toxicities
♥ available antidotes
WHATS'S WRONG?
WHAT WOULD YOU DO?
Date of order: 9/13/15
Patient: John Doe
Physician: Dr. A. Jackson, M.D.
Order: Acetaminophen (Tylenol), 2 Tablets PO, every 4 hours as needed for fever
♥ Missing the dose
♥ Clarify temperature
♥ Call and get it clarified
♥ NEVER assume
Nursing process phase #2: Diagnoses
are the result of clinical judgement about a human response to health conditions and/or life processes, critical thinking, creativity, and accurate collection of data regarding the patient as well as the drug.
♥ Describes symptoms (notes)
Diagnoses-Problems pertaining to Drug Therapy:
♥ Knowledge deficit
♥ Risk for injury
♥ Noncompliance
- disturbances
- deficits
- excesses
- impairments of bodily functions
Formulation of nursing diagnoses: Part one of statement
The human response of the patient to illness, injury, or significant change.
May be:
♥ actual problem
♥ increased risk of developing problem
♥ opportunity to improve the human response by the patient, family, group, or community
Formulation of nursing diagnoses: Part two of statement
Defining characteristics and identifies the factor(s) related to the response, with more than one factor often named.
♥ connection between factor(s) and response
♥ (not necessarily cause-and-effect)
Formulation of nursing diagnoses: Part three of statement
Contains a listing of clues, cues, evidence, signs, symptoms, or other data that support the nurse's claim that this diagnosis is accurate
Assessment-Data Collection:
♥ Drug data
♥ Patient data
♥ Prescription/Medication order
Nursing diagnosis does not equal
Medical diagnosis
Shortness of breath does not mean someone has
COPD
Nursing process phase #3: Planning
Includes identification of outcomes
The major purpose of the Planning phase:
♥ Prioritize the nursing diagnoses
♥ Specify outcomes including the time frame for their achievement
Patient outcomes are _______ based.
and may be categorized into...
behavior based
♥ Physiologic
♥ Psychological
♥ Spiritual
♥ Sexual
♥ Cognitive
♥ Motor
♥ and/or other domains
Outcomes are...
♥ Objective
♥ measurable
♥ realistic with an established time frame for the patient's achievement
Define Outcome
the changes you expect to see after you intervene (opposite of the diagnosis/problem)
Nursing Process Phase #4: Implementation
Doing/active/intervening phase
Nine Rights of Medication Administration
1. Right drug
2. Right dose
3. Right time
4. Right route and form
5. Right patient
6. Right documentation
7. Right reason
8. Right response
9. patient Right to refuse
To check if you are giving medication to the right patient you must have them....
repeat their name and date of birth
Intervention define:
any treatment based on clinical judgement and knowledge and performed by a nurse to enhance outcomes
To ensure the right drug is given, the specific medication order must be checked against the medication label or profile....
three times before giving the medication.
Always confirm that the dosage amount is appropriate for the patient's...
age and size
For routine medication orders, the standard of care is to give the medications no more than
1/2 hour before or after the actual time specified in the prescriber's order.
Prescriber define:
Any health care professional licensed by the appropriate regulatory board to prescribe medication.
Outcomes define:
Descriptions of specific patient behaviors or responses that demonstrate meeting of or achievement of behaviors related to each nursing diagnoses. These statements are specific while framed in behavioral terms and are measureable.
Nursing process define:
An organizational framework for the practice of nursing. It encompasses all steps taken by the nurse in caring for the patient.
Compliance define:
Implementation or fulfillment of a prescriber's or caregiver's prescribed course of treatment or therapeutic plan by a patient.
Medication error define:
Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or my not cause the patient harm.
Noncompliance define:
An informal decision on the part of the patient not to adhere to or follow a therapeutic plan or suggestion.
Do not record completion of an incident report in the...
medical chart.
Right reason: Confirm the rationale for use of medication through...
♥ researching the patient's history
while also
♥ asking the patient the reason he or she is taking the drug
(Rights of Med administration) Right response:
Drug and its desired response
Nursing Process Phase #5: Evaluation
Occurs after the nursing care plan has been implemented but also needs to occur at each phase of the nursing process.
Nursing Process Evaluation includes:
♥ Monitoring the fulfillment of outcomes
♥ Monitoring the patients therapeutic response to the drug
♥ Monitoring the patients adverse effects response to the drug
♥ Monitoring the patients toxic effects response to the drug
♥ DOCUMENTATION
Nursing Process Evaluation Monitoring Effectiveness:
Example: Diuretic
♥ Were outcomes met?
♥ Is the patient responding to the drug(s)?
♥ See if drug is working, Patient should be peeing
The nursing process, as it relates to drug therapy involves:
the way in which a nurse
♥ gathers
♥ analyzes
♥ organizes
♥ provides
and acts upon data about the patient within the context of prudent nursing care and standards of care.
Drug:
Any chemical that affects the physiological process of a living organism.
Pharmacology:
The broadest term for the study or science of drugs.
Chemical name:
Complex terminology of chemical structure.
Generic name:
Universally accepted, less complicated
terminology, most commonly used. (lower case)
Trade name:
Assigned by the company marketing the drug.
Drug classification
Grouped together based on properties (NSAIDS)
and therapeutic use (analgesics, antipyretics).
Pharmaceutics:
The study of how various dosage forms influence the way in which the drug affects the body.
Pharmacokinetics:
Involves the processes of...
The study of what the body does to the drug.
♥ absorption
♥ distribution
♥ metabolism
♥ excretion
Pharmacodynamics:
Involves...
The study of what the drug does to the body.
♥ drug-receptor relationships
Pharmacotherapeutics:
Focuses on the clinical use of drugs to prevent and treat diseases.
drug actions:
The processes involved in the interaction between a drug and body cells (like the action of a drug on a receptor protein); a.k.a. mechanism of action.
toxicology:
The study of the adverse effects of drugs and other chemicals on living systems.
Toxic:
The quality of being poisonous (injurious to health or dangerous to life).
Pharmacognosy:
The study of drugs that are obtained from natural plant and animal sources.
Pharmacoeconomics:
The study of economic factors impacting the cost of drug therapy.
Three Phases of Drug Activity:
(Pharmacology Principles)
Dose of formulated drug
♥Administration
1st Pharmaceutical Phase: Disintegration of dosage form; dissolution of drug in body.
♥Drug available for absorption
2nd Pharmacokinetic Phase: Absorption, distribution, metabolism, excretion.
♥Drug available for action
3rd Pharmacodynamic Phase: Drug receptor interaction.
Effect
Pharmaceutics
Drug form impacts how quickly the onset of action occurs
Drug Absorption of Various Oral Preparations:
FASTEST--------------> SLOWEST
FASTEST
♥ Oral disintegration, buccal tablets, and oral soluble wafers
♥ Liquids, elixers, and syrups
♥ Suspension solutions
♥ Powders
♥ Capsules
♥ Tablets
♥ Coated tablets
♥ Enteric-coated tablets
SLOWEST
*liquids absorb quicker
*food impacts drug absorption
Enteric Coated Tablets
♥ are not meant to break down in the stomach
♥ could be toxic if broken down in the stomach
or...
♥ could possibly not work at all if broken down in the stomach
Pharmacokinetics
ABSORPTION:
Movement of drug from the administration into the blood stream.
Pharmacokinetics
ABSORPTION ROUTE
SLOWEST-------------> FASTEST
SLOWEST
♥ Enteral: absorbed through GI tract (oral, SL, buccal, rectal)
• tablets, capsules, elixirs, syrups, suppositories, etc.
• First pass effect: liver breaks down drug before it
reaches blood steam
♥ Topical: application/absorption through skin, eyes, ears,
nose, lungs, vagina, rectum
• aerosols, ointments, creams, pastes, inhalers,
suppositories
♥ Parenteral: Injections (IV, IM, Subcutaneous)
• solutions, suspensions, emulsions, powder for
reconstituting
FASTEST
Will absorption take longer with a
Pill
or
IV?
A PILL
Pill: has to go through liver
Injection: does not go through liver
Stomach-----> Liver
METABOLIZED
30 mg of oral morphine equals how many mg of IV morphine?
10 mg of IV morphine
*10 mg of oral morphine does not equal 10 mg of IV morphine
Pharmacokinetics
DISTRIBUTION:
The transport of a drug by the bloodstream to its site of action.
Heat and Ice v.s. Blood Vessels
Heat: Dialates Blood Vessels
Ice: Constricts Blood Vessels
Distribution cont.:
♥ Protein-binding
♥ Water vs. fat affinity
♥ Blood supply
-rapid distribution to
* heart
* liver
* kidneys
* brain
(major organs)
-slow distribution to
*muscle
*skin
*fat
More Albumin binding to drug means...
less dosage of drug for destination organ
Less Albumin binding to drug means...
more dosage of drug for destination organ
Drug attaches to Albumin and what's left over...
goes to the destination organ
Pharmacokinetics
METABOLISM:
biochemical alternation of a drug into a inactive metabolite, or a more/less potent active metabolite.
Metabolism Organs:
♥ Liver (primary)
♥ kidneys
♥ muscle
♥ lungs
♥ Intestines
***Cytochrome P-450 Enzymes:
aid in liver metabolism of fat-soluble drugs
Enzyme inhibitors:
drugs that delay metabolism
Enzyme inducers:
drugs that stimulate metabolism
Substrates:
Drugs that are specifically targeted by enzymes
Factors that decrease metabolism:
♥ Cardiovascular dysfunction
♥ Renal insufficiency
♥ Starvation
♥ Obstructive jaundice
♥ Genetics (Slow acetylator)
♥ P-450 enzyme inhibitors
♥ Drugs
Factors that increase metabolism:
♥ Genetics (Fast acetylator)
♥ Drugs (Barbiturate therapy)
♥ P-450 enzyme inducer
Pharmacokinetics
EXCRETION:
The elimination of drugs from the body.
Organs involved in excretion:
♥ Kidneys (major organ)
♥ Liver- Bile
♥ Bowel
Half-Life:
Time it takes for one half of the drug to be removed from the body.
*5 half-lives for removal
Example:
What is the half-life of the following?
100 mg @ 0800
50 mg @ 1200
What time and mg would the next two half-lives be?
4 hours
25 mg @ 1600
12.5 mg @2000
Narrow Therapeutic Window:
Small range from being therapeutic to being toxic.
Wide Therapeutic Window:
Would have to take a lot to be toxic.
Therapeutic Range
ONSET:
The time it takes for the drug to elicit a therapeutic response.
Therapeutic Range
PEAK:
The time it takes for a drug to reach its maximum therapeutic response.
Therapeutic Range
DURATION:
The time a drug concentration is sufficient to elicit a therapeutic response.
Therapeutic Drug Monitoring
PEAK LEVEL:
Highest concentration of drug in blood
Therapeutic Drug Monitoring
TROUGH LEVEL:
Lowest concentration of drug in blood
PHARMACODYNAMICS
Mechanisms of drug action in tissues
Natural chemical + Receptor site =
Normal response
Agonist drug + Receptor site =
Mimicked response
Natural chemical + Antagonist drug + Receptor site =
Blocked response
Example: Heart & Adrenalin
If body is low on natural drug...
1. Agonist would:
2. Antagonist would:
1. (drug that takes place of enzyme) Make heart beat faster
2. Blocks receptor site (blocks bodies natural response from occurring) *EX: beta blocker makes heart slow
Pharmacotherapeutics:
Clinical use of
drugs to prevent or treat disease/illness
Pharmacotherapeutics types
ACUTE THERAPY:
Treatment for quick onset of illness
Pharmacotherapeutics types
MAINTENANCE THERAPY:
Prevents chronic progression of illness
Pharmacotherapeutics types
SUPPLEMENTAL/REPLACEMENT THERAPY:
Supplies substance to body to maintain function
Pharmacotherapeutics types
PALLIATIVE THERAPY
Comfort from symptoms
Pharmacotherapeutics types
SUPPORTIVE THERAPY:
Maintains body function during illness
Pharmacotherapeutics types
PROPHYLACTIC THERAPY:
Prevents illness/outcome of planned event [Show Less]