Nursing Process

Created by Amanda McBride 1

Nursing Process in Nursing Process in Drug TherapyDrug Therapy


AssessmentAssessment Collecting data Collecting data

ObservingObserving InterviewingInterviewing Lab resultsLab results Diagnostic resultsDiagnostic results

Initial assessment or baseline Initial assessment or baseline assessmentassessment

Ongoing assessment of effect, adverse Ongoing assessment of effect, adverse reactions.reactions.


Initial AssessmentInitial Assessment

ALLERGIESALLERGIES Head to toeHead to toe Vital signs, pain 5Vital signs, pain 5thth vital sign vital sign Symptoms, c/oSymptoms, c/o Previous meds and reactionsPrevious meds and reactions


After collection of data, they need to After collection of data, they need to be analyzed for their relevance to the be analyzed for their relevance to the pts current condition and nursing pts current condition and nursing care needs.care needs.


Planning/GoalsPlanning/Goals

Involving identifying the expected Involving identifying the expected outcomes of prescribed drug outcomes of prescribed drug therapy.therapy.

The outcomes should be very The outcomes should be very specific, clear and written with specific, clear and written with objective criteria in a clearly objective criteria in a clearly measurable way.measurable way.

Examples???Examples???


InterventionsInterventions

Implementing planned activities.Implementing planned activities. Teaching about medicationsTeaching about medications Solving problems related to drug Solving problems related to drug

therapytherapy Promoting compliancePromoting compliance Identifying barriers to complianceIdentifying barriers to compliance Resources to facilitate therapy goalsResources to facilitate therapy goals


General InterventionsGeneral Interventions

Promoting healthPromoting health Preventing or decreasing need for Preventing or decreasing need for

drugsdrugs Non-drug measures to enhance Non-drug measures to enhance

therapeutic effects or decrease therapeutic effects or decrease adverse effects, examples?adverse effects, examples?


Patient TeachingPatient Teaching

Nurse must know to be able to teach Nurse must know to be able to teach the patientthe patient

Early dischargesEarly discharges


EvaluationEvaluation

Evaluating pt’s status in relation to Evaluating pt’s status in relation to stated goals and expected outcomesstated goals and expected outcomes

May initiate re-assessment, May initiate re-assessment, examples?examples?

Compliance issuesCompliance issues Home therapyHome therapy


Drug and Dose SelectionDrug and Dose Selection

Use as few drugs as possibleUse as few drugs as possible Least amount of least potent drug for Least amount of least potent drug for

desired effectdesired effect Drugs may be given in a loading Drugs may be given in a loading

dose and then maintenance dosedose and then maintenance dose Dosages based on 150lb person, may Dosages based on 150lb person, may

have to decreased because of renal have to decreased because of renal or hepatic impairmentor hepatic impairment


Drug therapy in ChildrenDrug therapy in Children

Special considerations because of size, Special considerations because of size, developmental level and organ developmental level and organ functionfunction

Less predictable than in adultsLess predictable than in adults Most drug use is empiric because of Most drug use is empiric because of

few studies in childrenfew studies in children Doses extrapolated from those Doses extrapolated from those

established for adultsestablished for adults Wt and BSA often used to doseWt and BSA often used to dose


AdministrationAdministration

Child cooperationChild cooperation IM injectionIM injection

Infants- thighInfants- thigh >18 months- deltoid>18 months- deltoid > 3yrs- ventrogluteal> 3yrs- ventrogluteal EMLA patch 1 hour prior to injectionEMLA patch 1 hour prior to injection


Drug Therapy in Older AdultsDrug Therapy in Older Adults

Adverse effects may be d/t Adverse effects may be d/t physiologic changes assoc with physiologic changes assoc with aging.aging.

Organ function more important than Organ function more important than physiological age.physiological age.

Cumulative effectsCumulative effects PolypharmacyPolypharmacy


Drug selection and dosageDrug selection and dosage

Least potent, least dose, least Least potent, least dose, least amount of time to attain therapeutic amount of time to attain therapeutic effect.effect.

Frequent reassessment.Frequent reassessment.


Drug AdministrationDrug Administration

VisionVision Non child proof.Non child proof. Schedules, charts, dosed containers.Schedules, charts, dosed containers. Family and friends assistance.Family and friends assistance.


Renal ImpairmentRenal Impairment

Pts with diabetes, HTN, HF may have Pts with diabetes, HTN, HF may have renal insufficiency.renal insufficiency.

RF may develop from hypovolemia, RF may develop from hypovolemia, shock d/t sepsis or blood loss.shock d/t sepsis or blood loss.

ARF results from renal blood flow or ARF results from renal blood flow or function is impaired.function is impaired.

CRF results from disease process CRF results from disease process that destroy renal tissue.that destroy renal tissue.


Alter dosages for renal failure.Alter dosages for renal failure. Monitor pt for worsening renal Monitor pt for worsening renal

failure.failure. I/O, increasing fluids.I/O, increasing fluids. Avoid nephrotoxic drugs.Avoid nephrotoxic drugs.


Medications that frequently cause Medications that frequently cause ARF include amphotericin B, ARF include amphotericin B, aminoglycosides, ACEIs, Lithium, IV aminoglycosides, ACEIs, Lithium, IV contrast dyes, and NSAIDs. Dosages contrast dyes, and NSAIDs. Dosages of all potentially nephrotoxic of all potentially nephrotoxic medications should be adjusted for medications should be adjusted for renal function and ultimately renal function and ultimately substituted for after consultation substituted for after consultation with the physician. with the physician.


Hepatic ImpairmentHepatic Impairment

Primary liver disease, cirrhosis, Primary liver disease, cirrhosis, hepatitishepatitis

Impaired blood flowImpaired blood flow HFHF ShockShock TraumaTrauma Major surgeryMajor surgery

Hepatotoxic drugsHepatotoxic drugs


Close monitoring during drug therapy for signs of Close monitoring during drug therapy for signs of increasing liver failure.increasing liver failure.

Liver function tests, or LFTs, include tests for Liver function tests, or LFTs, include tests for bilirubin, a breakdown product of hemoglobin, bilirubin, a breakdown product of hemoglobin, and ammonia, a protein byproduct that is and ammonia, a protein byproduct that is normally converted into urea by the liver before normally converted into urea by the liver before being excreted by the kidneys. LFTs also being excreted by the kidneys. LFTs also commonly include tests to measure levels of commonly include tests to measure levels of several enzymes, which are special proteins that several enzymes, which are special proteins that help the body break down and use (metabolize) help the body break down and use (metabolize) other substances. Enzymes that are often other substances. Enzymes that are often measured in LFTs include gamma-glutamyl measured in LFTs include gamma-glutamyl transferase (GGT); alanine aminotransferase (ALT transferase (GGT); alanine aminotransferase (ALT or SGPT); aspartate aminotransferase (AST or or SGPT); aspartate aminotransferase (AST or SGOT); and alkaline phosphatase (ALP). LFTs also SGOT); and alkaline phosphatase (ALP). LFTs also may include prothrombin time (PT), a measure of may include prothrombin time (PT), a measure of how long it takes for the blood to clot.how long it takes for the blood to clot.


Drug Selection and DosageDrug Selection and Dosage

Least potent, least dose, least amount Least potent, least dose, least amount of time for therapeutic effect.of time for therapeutic effect.

ETOH is toxic to liver and increases the ETOH is toxic to liver and increases the risks of hepatotoxicity when on meds.risks of hepatotoxicity when on meds.

Drugs affecting hepatic blood flow can Drugs affecting hepatic blood flow can aggravate liver impairment.aggravate liver impairment.

At risk for drug toxicity because of At risk for drug toxicity because of inability to metabolism. No 1inability to metabolism. No 1stst pass thru pass thru liver.liver.


Drug Therapy at HomeDrug Therapy at Home

Assess compliance.Assess compliance. Herbal remediesHerbal remedies Safety of environment.Safety of environment. Assess pts ability to take meds.Assess pts ability to take meds. Assess understanding of medications Assess understanding of medications

and regime.and regime. Teach med info, including adverse Teach med info, including adverse

effects, therapeutic effects, effects, therapeutic effects, precautions, instructions.precautions, instructions.

Nursing Process

Health & Medicine

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