PHARMACOLOGY AND THE NURSING PROCESS

PHARMACOLOGY AND THE NURSING PROCESS Nursing Process - A decision-making approach that works as a framework to guide health care deliver. - Purpose is to identify, diagnose, and treat human responses to health and illness. - Components are assessment, diagnosis, planning, implementation, and evaluation. Assessment - Involves collecting data (both subjective and objective) about the patient, which are used to identify actual and potential health problems. - Patient interview, medical/drug histories, physical examination, patient observation, and lab testing. - Data collection should detail the patient's symptoms and target the organs most likely to be affected by drug therapy Subjective Data - Based on verbal information from the patient, family members, friends, and other sources, including symptoms described by, and apparent to, the patient. - Examples collected that are related to the drug regimen º Current health history (e.g., difficulty swallowing) º Patient signs/symptoms º Current drugs, including OTC drugs, herbal remedies, and nutritional supplements; doses/frequency of drugs º Ability to pay/access prescribed drugs º Medical/surgical history º Patient's environment and support system Objective Data - Signs that are directly measured/detected by a HCP regarding the patient's health. - Examples that are related to the drug regimen º Data from physical health assessment º Lab/diagnostic tests º Data from the HCP's notes º Vital signs º The patient's body language Pre-Administration Assessment - 2 - - Allows HCP's to establish the baseline data needed to individually tailor drug therapy. - By identifying variables that can affect an individual's responses to drugs, nurses can modify treatment in an attempt to maximize benefit and minimize harm. - Four basic goals. First 3 are specific to a particular drug, 4th applies to all drugs but may be more critical for some drugs than others 1. Establish Baseline Measurements 2. Anticipate Adverse Effects 3. Identify High-Risk Patients 4. Determine self-care capacity Establish Baseline Measurements -Drugs are administered to achieve a desired response. ____ of the parameters the drug is being used to modify need to be determined to evaluate whether this response is achieve. - Example: º Taking a patient's BP before administering Lisinopril, an angiotensin-convening enzyme (ACE) inhibitor prescribed to control hypertension, will help determine whether the drug is effective. Anticipate Adverse Effects - All drugs can produce side/adverse effects. - Usually, the side effects that a drug can produce are known. - Baseline measurements can help HCPs determine whether a side/adverse effect has occurred - Example: º Furosemide, a diuretic, can lower a patient's potassium level. Checking the potassium level before administration of the drug will help the nurse determine whether this side effect has occurred. Identify High-Risk Patients - Individual characteristics may put a patient at higher risk for experiencing a side/adverse effect. - The individual characteristics that predispose a patient to an adverse drug effect depend on the drug under consideration. - To identify an at-risk patient, the nurse must understand the pharmacology of the drug. - Example: º African Americans have a higher incidence of angioedem and cough when prescribed ACE inhibitors (e.g., Lisinopril) for hypertension than non-African Americans. Knowing this information helps the nurse prepare for potential side/adverse effects. Determine Self-Care Capacity - 3 - - For drug therapy to be successful in the outpatient setting, the patient must be willing/able to self-administer the drug as prescribed. - If the nurse determines that the patient is unable to do so, alternative arrangements must be made. - A thorough assessment will identify these factors, thereby allowing the nurse to account for them when formulating nursing diagnoses and a plan of care - Example: º Dulaglutide, for treatment of type 2 diabetes, is only available as an injection; if the patient is not able to self-administer the dulaglutide injection each week, another drug available in a different route must be prescribed. Which statements are classified as objective data? - "Temperature 97.4°F." (Objective data are signs that are directly measured or detected by a health care provider regarding the patient's health, including vital signs such as a temperature of 97.4°F.) - "Facial expression does not match body language." (Objective data are signs that are directly measured or detected by a health care provider regarding the patient's health, including data concerning the patient's body language and facial expression.) - "Coughing up yellow phlegm." (Objective data are signs that are directly measured or detected by a health care provider regarding the patient's health, including data from a health assessment such as a patient coughing up yellow phlegm.) Information from which sources would be classified as subjective data? -Friends (Subjective data include verbal information from the patient, family members, friends, or other sources, including symptoms described by, and apparent to, the patient.) -Family members (Subjective data include verbal information from the patient, family members, friends, or other sources, including symptoms described by, and apparent to, the patient.) -Patient (Subjective data include verbal information from the patient, family members, friends, or