Unit: The Nursing Process and Introduction to Pharmacology

Content: Overview of the nursing process, levels of care, prioritization and pharmacology
in nursing
Readings: Harkreader Chapters 5 (pp 83-93), Chap 9, 10. Lilley Chapters 1,2,3.
Resources: On line drug math basic resources (Kaplan drug math modules), Podcast on
introduction to pharmacology

The student will be able to:

1. Describe the five interwoven phases of the nursing process (pg. 91, Figure 5-6)
• Assessment – a process of discovering and making decisions about the nature of the client’s problems or needs.
Includes gathering of data through present/past health history and interview, through physical exam, and
through a review of functional health patterns for subjective and objective data
• Nursing Diagnosis – a clinical judgment about individual, family, or community responses to actual and
potential health problems or life processes. Three types: wellness diagnoses, risk diagnoses, and actual
diagnoses with etiologies and related factors specified
• Planning – establishment of desired and achievable outcomes, validation of expected outcomes with the client,
and selection of interventions to achieve the outcomes
• Nursing Intervention – any treatment based upon clinical judgment and knowledge, that a nurse performs to
enhance patient/ client outcomes; includes direct care, teaching, counseling, coordination, prevention, health
maintenance, etc.
• Evaluation – the process of determining both the client’s progress toward attainment of expected outcomes and
the effectiveness of nursing care. Includes data gathering to confirm that the problem has been resolved. If the
problem hasn’t been resolved, reassess for the cause, redefine the problem, redefine the outcomes, and change
the interventions.

2. Explain how the nursing process utilizes critical thinking and clinical judgment
3. List the habits and skills of critical thinking

Habits of the Mind:

• Confidence – Assurance of one’s reasoning abilities
• Contextual perspective – Considering everything relevant
• Creativity – Intellectual inventiveness, used to generate discover, or restructure ideas; imaging alternatives
• Flexibility – Capacity to adapt, accommodate, modify, or change thoughts, ideas, and behaviors.
• Inquisitiveness – Eagerness to know by seeking knowledge and understanding through observation and thoughtful
questioning to explore possibilities and alternatives
• Intellectual integrity – Seeking the truth through science and honest processes, even if the results are contrary to prior
assumptions and beliefs
• Intuition – Insightful sense of knowing without conscious use of reason
• Open-mindedness – A viewpoint characterized by being receptive to divergent views and sensitive to one’s biases
• Perseverance – Pursuit of a course with determination to overcome obstacles
• Reflection – Contemplation on a subject, especially assumptions and thought processes, for the purposes of deeper
understanding and self-evaluation
Skills:
• Analyzing – Separating or breaking a whole into parts to discover their nature, function, and relationships
• Applying standards – Judging according to established personal, professional, or social rules or criteria
• Discriminating – Recognizing differences and similarities among things or situations and distinguishing carefully as to
category or rank
• Information seeking – Searching for evidence, facts, or knowledge by identifying relevant sources and gathering
objective, subjective, historical, and current data from those sources
• Logical reasoning – Drawing inferences or conclusions that are supported or justified by evidence
• Predicting – Envisioning a plan and its consequences
• Transforming knowledge – Changing or converting the conditions, nature, form, or function of concepts among
contexts

4. Explore the stages of skill acquisition (Benner) in the development of critical thinking.
5. Identify the components of a nursing diagnosis
Each nursing diagnosis has 5 factors: a label, a definition, a set of defining characteristics (signs and symptoms), a
group of related factors, and risk factors. Example: “Urge urinary incontinence related to decreased bladder capacity
secondary to history of pelvic inflammatory disease”.
6. Describe the process of diagnostic reasoning and starting a nursing diagnosis
7. Describe types of planning for individual clients
• Initial Planning – begins at nurse’s first contact with patient. Takes into account the history and physical exam, and
allows the nurse to form impressions about the pt’s most acute problems; then nurse develops care plan
• Ongoing Planning – the planning and care during a patient’s stay in a health care facility; changes requiring
adjustments to the care plan may be rapid (acute care setting) or subtle (long-term care)
• Discharge Planning – to prepare the client to move from one level of care to another level of care, which may occur
within or outside the current health care facility; may include arranging home health care, fitting for prosthesis, or
physical therapy
• Collaborative Planning – facilitates the continuity and coordination of care among the team of care providers which
may include, the patient, family members, nurses, physicians, social workers, etc.
• Care Plan Conferences – the action of a group conferring of consulting together to plan care for the client (long-term
care facilities have regularly scheduled conferences for their clients)

8. Describe planning and prioritizing nursing diagnoses and establishing outcomes.

9. Discuss the skills and types of interventions included in the implementation phase of the nursing
process.
Skills of Intervention (pg 214):
• Teaching – educating the client about their treatment plan and allowing them to participate in the decision-making
process; safety improves when client knows benefits and risks of care
• Collaborating – getting help from other health care providers to ensure best care for client
• Managing – delegating responsibilities (but not accountability!)
• Coordinating – when multiple health team members are involved in the client’s care, coordinating is vital
• Monitoring – detect complications, evaluate effectiveness of interventions, and ensure that the interventions are
carried out correctly
• Assisting – providing direct physical care (like helping client out of bed, etc.)
• Supporting – providing motivation and encouragement when the client lacks will-power, resilience, or motivation for
self-care
• Protecting – preventing harm; providing safe environment
• Sustaining – maintaining life and physical function

Types of Interventions (pg 215-216, Boxes 10-3, -4, and -5):

• Direct Care Nursing Interventions – “a treatment performed through interaction with the client”. Includes both
physiological and psychosocial nursing actions to improve health and/or prevent disease
• Indirect Care Nursing Intervention – “a treatment performed away from the client but on behalf of a client or group of
clients”. Examples – delegation of care, emergency cart checking, telephone consultations, etc.
• Nurse-Initiated Intervention – “an intervention initiated by the nurse in response to a nursing diagnosis”. Example –
helping the client get dressed after determining that they can’t do it alone
• Physician-Initiated Intervention – “a treatment initiated by a physician in response to a medical diagnosis but carried
out by a nurse in response to a doctor’s orders”. (Could also include orders from pharmacists or physician’s assistants,
etc)

10. Given a phase of the nursing process, identify an appropriate action for that phase.
11. Describe the nurse’s role in medication administration.
• The nurse is legally, morally, ethically responsible for each medication administered.
• Responsible for safe and effective medication administration of meds
• Maintain effective relationship with patient to ensure medication is taken appropriately
12. Discuss the impact of U. S. drug legislation on medications today.
13. Compare the five different levels of controlled substances for medications, and give an example
of each.
• C-I: High Abuse Potential: No accepted medical use (Ex: heroine, LSD)
• C-II: High Abuse Potential: Accepted Medical Uses (Ex: Demoral, Morphine, Methadone)
• C-III: May lead to moderate or low physical or high psychological dependence (Ex: Anabolic Steroids, Hydrocodone
and Codeine when paired with an NSAID, and Ketamine
• C-IV: Low abuse potential; may lead to limited physical/psychological dependence (Ex: Xanax, Valium,
Phenobarbital)
• C-V: Low abuse potential; may or may not come with prescription; subject to state or local regulation; (Ex: couch
suppressants with small amounts of codeine or medicines with small amounts of opium)
14. List and describe at least five variables that influence drug actions.
15. List and describe the four subprocesses for pharmacokinetic actions.
 A: Absorption – process of a drug entering the blood circulation (depends on things like bioavailability, acid-base
environment, etc.)
D: Distribution – the dispersion or dissemination of substances throughout the fluids and tissues of the body (depends
on factors such as blood flow and drug’s protein-binding ability)
M: Metabolism - the irreversible transformation of parent compounds into daughter metabolites (depends on factors
such as liver and kidney function
E: Excretion/Elimination - the elimination of the substances from the body (depends on factors such as active tubular
secretion vs. passive tubular secretion, etc.)

16. Describe the following terms:

a. bioavailability,
b. side effects,
c. adverse drug reactions,
d. drug-drug interaction,
e. food-drug interaction,
f. agonist,
g. antagonist, and
h. synergist
17. Provide examples of different routes of medication administration and provide rationale for
why each route may be chosen in particular circumstances.
Injected: bypasses GI tract
• Intravenous – absorbed directly into bloodstream
• Intramuscular – absorbed from blood supply of muscles
• Subcutaneous – absorbed through capillaries
Ingested: Movement of drug from GI tract to body tissues by: diffusing across cell membranes assisted by carrier enzymes or
proteins, then engulfed by cellular membranes (pinocytosis)

18. Describe why the following populations of patients are very susceptible to medications:
a. Elderly
b. Pregnant
c. Fetus
d. Children
e. Patients with compromised immune systems
f. Patients with chronic diseases
19. List at least five issues that may occur with patients who require medications and provide
rationale for each.
20. Given a phase of the nursing process, identify an appropriate action for that phase.
21. Describe how patient teaching is used in the nursing process for those receiving medications.

Patients Need to Know:

• What does the drug do?
• What is the drug for/what does it treat?
• Dosage?
• How often is it taken?
• How is it stored?
• Are there any side effects?
• Interactions?
These Enhance Patient Learning:
• Active participation and return demonstrations
• Reinforcement of learning; repetition
• Immediate feedback
These Prohibit Learning:
• Teaching before learner is ready
• Too much information, too quickly
• Distractions
• Decreased level of consciousness (due to medications, anesthesia, illness, etc)