Lilley: Pharmacology and the Nursing Process, 9th Edition

Chapter 01: The Nursing Process and Drug Therapy

Key Points

Overview of the Nursing Process

 The nursing process is an ongoing, constantly changing, and evolving framework for
professional nursing practice. It may be applied to all facets of nursing care, including
medication administration.
 The five phases of the nursing process include assessment; development of nursing
diagnoses; planning with outcome identification; implementation, including patient
education; and evaluation.
 Safe, therapeutic, and effective medication administration is a major responsibility of
professional nurses as they apply the nursing process to the care of their patients.
 Critical thinking is a major part of the nursing process and involves the use of the mind
and thought processes to gather information and then develop conclusions, make
decisions, draw inferences, and reflect on all aspects of patient care.
 A contemporary trend includes the implementation of Quality and Safety Education for
Nurses (QSEN) initiatives in nursing education. The six major initiatives include the
following: patient-centered care, teamwork and collaboration, evidence-based practice
(EBP), quality improvement (QI), safety, and informatics.
 Another trend is the development of the Interprofessional Education Collaborative
(IPEC), aimed at improving the education of health care professionals and patient care
outcomes through collaborative education.

 Assessment

 Performing a comprehensive assessment allows you to formulate a nursing diagnosis
related to the patient’s needs—specifically, needs related to drug administration.
 Methods of data collection include interviewing, direct and indirect questioning,
observation, medical records review, head-to-toe physical examination, and a nursing
assessment. Data are categorized into objective and subjective data.
 Medication profiles include, but are not limited to, any and all drug use, including home
or folk remedies and herbal and/or homeopathic treatments, plant or animal extracts, and
dietary supplements; intake of alcohol, tobacco, and caffeine; current or past history of
illegal drug use; use of over-the-counter (OTC) medications; use of hormonal drugs; past
and present health history and associated drug regimen(s); family history and racial,
ethnic, and/or cultural attributes with attention to different responses to medications;

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Key Points 1-2

growth and developmental stage; and issues related to the patient’s age and medication
regimen.
 Assessment also includes collecting information about a specific drug’s action; signs and
symptoms of allergic reactions; adverse effects; dosages and routes of administration;
contraindications; drug incompatibilities; drug–drug, drug–food, and drug–laboratory test
interactions; and toxicities and available antidotes.
 Assess whether there are any issues with compliance.
o Compliance is the implementation or fulfillment of a prescriber’s or caregiver’s
prescribed course of treatment or therapeutic plan by a patient.
o Adherence is perceived as implying a more collaborative and active role between
patients and their providers.
o Noncompliance is an informed decision on the part of the patient not to adhere to
or follow a therapeutic plan or suggestion.
 During assessment, consider the traditional, nontraditional, expanded, and collaborative
roles of the nurse and remain current on legal regulations.
 A prescriber is any health care professional licensed by the appropriate regulatory board
to prescribe medications.


Planning

 The major purposes of the planning phase are to prioritize the nursing diagnoses and
specify goals and outcome criteria, including the time frame for their achievement.
 Patient goals reflect objective, realistic, and measurable changes in behavior through
nursing care and are developed in collaboration with the patient with an established time
period for achievement.
 Outcome criteria are concrete descriptions of specific patient behaviors or responses that
demonstrate meeting of or achievement of goals related to each nursing diagnosis.
 Outcomes are verifiable, framed in behavioral terms, measurable, and time specific.
 The ultimate aim of outcome identification, pertinent to drug therapy, is the safe and
effective administration of medications.

 Implementation

 Implementation is guided by the assessment, nursing diagnoses, and planning.
 Statements of interventions include frequency, specific instructions, and other
information.
 Nurses are responsible for safe and prudent decision-making in the nursing care of their
patients, including the provision of drug therapy.

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Key Points 1-3

 “Nine Rights” of medication administration have been identified as additional standards

of care as related to drug therapy, as well as legal and ethical standards related to
medication administration and documentation.
 The registered nurse is responsible for checking all medication orders and/or
prescriptions.
 To ensure that the right drug is given, check the specific medication order against the
medication label or profile three times before giving the medication.
 Always check for the right dose and confirm that it is appropriate for the patient’s age and
size, and also check the prescribed dose against the available drug stocks and against the
normal dosage range.
 Medications are to be administered at the right time. Check the health care agency policy
regarding routine medication administration times. Give the medications no more than ½
hour before or after the actual time specified in the prescriber’s order. Nursing judgment
may lead to some variations in timing, however, any change with the rationale for change
must be documented and the prescriber contacted.
 A complete medication order includes the right route and form of administration. If a
medication order does not include the route, never assume the route of administration;
ask for clarification.
 Be certain that you are administering the drug to the right patient by asking the patient to
state his or her name, and then checking the patient’s identification band to confirm the
patient’s name, identification number, age, and allergies. With newborns and in labor and
delivery situations, the mother and baby have identification bracelets with matching
numbers, which must be thoroughly and repetitively checked before giving medications.
 Perform the right documentation. Assess the medical record for the following
information: date and time of medication administration, name of medication, dose,
route, and site of administration. Documentation of drug action may also be made in the
regularly scheduled assessments for changes in symptoms the patient is experiencing,
adverse effects, toxicity, and any other drug-related physical and/or psychological
symptoms.
 Right reason or indication refers to the appropriateness in use of the medication to the
patient.
 Right response refers to the drug and its desired response. Continually assess and
evaluate the achievement of the desired response as well as any undesired response.
 The ninth “right” is the right of the patient to refuse. If refusal of a medication occurs,
always respect the patient’s right (to refuse), determine the reason, take appropriate action
including notifying the prescriber. Document the refusal and a brief, concise description
of the reason for refusal.
 A medication error is defined as any preventable event that may cause or lead to
inappropriate medication use or patient harm while the medication is in the control of the
health care professional, patient, or consumer.

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Key Points 1-4


 Evaluation

 Evaluation occurs after the nursing care plan has been implemented and is a systematic,
ongoing, and dynamic phase of the nursing process as related to drug therapy. It includes
monitoring the fulfillment of goals and outcome criteria, as well as monitoring the patient’s
therapeutic response to the drug and its adverse effects and toxic effects.

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