Module 4 The Nursing Process and Pharmacology

Objectives: 1) Utilize nursing process in medication management of clients in the following manner a) Assess client's conditions in relation to age, weight, health-illness status (especially renal and cardiovascular function), lifestyle habits, and use of overthe-counter (OTC) drugs and prescription drugs. b) Obtain a medication history. c) Formulate nursing diagnoses specific to problems of medication management. d) Set goals or outcomes on which evaluation is based. e) Perform nursing interventions in medication management. f) Evaluate the client's status in terms of stated outcomes. 2) Safely calculate drug medication orders. 3) Discuss considerations in drug therapy in children, women who are pregnant or breast feeding, and the elderly. 4) Discuss psychological responses that can influence the effectiveness of a drug. 5) Identify cultural aspects of beliefs about health and illness that may affect drug therapy among the following ethnic groups: African Americans, Mexican Americans, Asian Americans, Native Americans, and European Americans. Course Content: 1) Nursing process in medication administration 2) Administering medications a) Medication math calculation using dimensional analysis i) Convert apothecary, household and metric measurement systems. ii) Pediatric dosage calculation by body weight and body surface area (BSA) iii) Calculate drug dosages using one, two and three factor problems. b) Ten rights of medication administration c) Drug preparation and dosage forms d) Medication orders e) Common abbreviations f) Administration of medications correctly by various routes

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Module 4 The Nursing Process and Pharmacology

g) Prevention of medication errors i) Causes of medication errors ii) Medication systems iii) Drug administration in healthcare institutions and homecare 3) Lifespan considerations in drug therapy a) Pediatric patients i) Reasons for drug sensitivities in the very young ii) Medication administration in pediatric patients iii) Considerations in neonates, breast-fed and non-breast fed infants b) Maternal drug therapy i) Benefits and risks of drug prescription during pregnancy ii) Teratogens iii) Dose changes needed during pregnancy iv) Drug behavior crossing the placenta v) Drug behavior in breast milk vi) Categories by FDA to classify drug risks to the fetus c) Geriatric Patients i) Pharmacokinetic and pharmacodynamic alterations in aging ii) Factors that promote drug misuse iii) Factors that increase complications in drug therapy iv) Nursing management of geriatric clients Reading: Karsh, Chapter 1 Karsh, Chapter 4 CAI: Avoiding Medication Errors: A Critical Thinking Approach Avoiding Medication Errors: Geriatric Avoiding Medication Errors: Pediatric Math Magic for Meds (Dimensional Analysis Nursing Math Tutorial) Nurse Pro Calc (Practice med math problems and math test) Video: Administering IV Medications (#88); Avoiding Medication Errors (#41 or #42 or #43) 25

Module 4 The Nursing Process and Pharmacology

Handout to accompany lecture: The Nursing Process What is the Nurses Responsibility? The Whole Person Physical Emotional Intellectual Social Spiritual The family The community Society The Nursing Process Assess Plan Intervene Evaluate Repeat as necessary Assessment Assessment never ends The body is in a dynamic, ever-changing state Drug therapy is complex and important

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Module 4 The Nursing Process and Pharmacology

So what to assess? Chronic conditions Drug use Allergies Level of education Level of understanding Social supports Financial support Patterns of health care Weight Height Age Physical Parameters Baseline Disease related physical findings Drug related physical findings Changes Analyzation What is a Nursing Diagnosis? A statement about the patients condition from a nursing perspective Organize data Analyze data Must be incorporated into overall picture of the plan of care

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Module 4 The Nursing Process and Pharmacology

Interventions Giving the meds Right Medication Right Time Right Dose Right Patient Right Route Also Right Reason Right Use Right Length of Therapy Right Education Right Results Proper Drug Administration Drug Storage Route Dosage Preparation Timing Recording Comfort Measures Placebo effect Anticipating and managing adverse effects Lifestyle adjustments Specific measures for specific drugs

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Module 4 The Nursing Process and Pharmacology

Education Nurses responsibility! Nurses held accountable by society Nurses held liable by the law Education Patient Family OR Caregiver Who is responsible for medication administration? Points to Follow Name, dose and action of the drug Timing of administration Special storage and preparation instructions Specific OTC drug to avoid Special comfort and safety measures Safety measures Specific points about drug toxicity Specific warnings about drug discontinuance Evaluation Evaluation is a continual process Therapeutic response Adverse drug effects Interactions Efficacy The nursing process Education Drug levels 29

Module 4 The Nursing Process and Pharmacology

Adverse effects are undesired effects that may be unpleasant or dangerous Signs and Symptoms of Adverse Drug Reactions Primary Actions Secondary Actions Hypersensitivity Allergies Dermatological reactions Stomatitis Superinfections Blood Dyscrasia Toxic Hepatic Injury Toxic Renal Injury Poisoning Changes in glucose metabolism Electrolyte imbalances Sensory effects Neurological effects Drug-drug Interactions Absorption Distribution Biotransformation Excretion At the site of action Drug-food Interactions Absorption Chemically

End of Section 1 Section 1 Exam 30