Nursing Process

in
Pharmacology
 Objectives
At the end of the term, the students will be able to:
Identify the components of the assessment process for patients
receiving medications, including collection and analysis of
subjective and objective data.

Discuss the evaluation process as it relates to the administration of

medications and as reflected by goals and outcome criteria.
Develop a nursing care plan that is based on the nursing
process as it relates to medication administration.
Briefly discuss the “Ten Rights” associated with safe
medication administration.
Discuss the professional responsibility and standards of
practice for the professional nurse as related to the medication
administration process.
Nursing Process
a decision-making problem-solving process - to
provide efficient and effective care. Application
of nursing process with drug therapy ensures
that the patient receives the best, safest, most
efficient, scientifically based holistic care.
Assessment

is an information - gathering phase to

complete a database of information about a
patient.
 Assessment
A. Past History
 Chronic condition -take the patient’s history of illnesses which can influence
the drug to be taken
 Drug Use – use of other drugs than one prescribed by the doctor
 Allergies – past exposure to a drug or allergen can provoke a future reaction
or provide a caution for the use of a drug, food, animal product.
 Level of education
 Level of understanding of a disease and therapy
 Social supports
 Financial support
 Pattern of health care
Assessment

B. Physical Assessment

Weight
Age
Physical parameters related to disease or drug
effects
 Problem identification and Diagnosis
- simply a statement of the patient’s status from a nursing perspective.
Focuses on the identification of a patient’s actual and potential health
problems. It consists of - three elements - the problem
(P), its etiology (E), and its signs and symptoms (S) such as:
a. Noncompliance related to inability to accept diagnosis and treatment
regimen, evidenced by not taking the medication as ordered.
b. Anxiety related to hair loss, secondary to chemotherapy as evidenced
by restlessness, facial tension, and insomnia.
 Planning
includes effective planning for the responsible delivery of nursing care. It
includes care-related goals and objectives-based diagnosis, which take
into consideration the patient’s physical, psychological, and sociocultural
lifestyle needs. A drug regimen is the systematic plan for drug therapy. It
states:
a. What drugs have been ordered,
b. When they are to be given, and
c. Route of administration to be used
 Implementation
consists of actual nursing interventions used to meet the expected outcomes. They are
identified during the planning phase and result in a set of instructions.
 Proper Drug Administration - the nurse must consider twelve points, or “rights,” to
ensure safe and effective drug administration.
 Comfort Measures - a patient is more likely to be compliant with a drug regimen if
the effects of taking drugs are not too uncomfortable.
 Placebo Effect - the anticipation that a drug will be helpful has proved to have
tremendous impact on the actual success of drug therapy.
 Patient and family education - patients to become more responsible with their own
care, they should have all the information necessary to ensure safe and effective drug
therapy.

7 Rights of Safe Medication

1. Right Medication - This means that

the medication that is given is the right
medication.
2.Right Patient

Giving the medication to the the

patient for whom it was intended.
3. Right Dosage

This means that the patient is given

the dose that was ordered and the
dose is appropriate for the patient.
4. Right Route

The medication is given only the

route that was ordered and that
the route s safe and appropriate
for the patient.
5. Right Time

This means that the drug was

given at the correct time as
ordered or according to agency
policy.
6. Right Reason

This is important to make sure

the right medication was
ordered.
7. Right Documentation

Nurses need to document the

delivery of the medication soon
after it is given so medications are
not given again.
Remember the W's when documenting
medication administration on the patient
chart:
When (time)
Why (include assessment,
symptoms/complaints, lab values)
What (medication, dose, route)
Where (site)
Was (the medication tolerated and if known,
helpful to the patient)
 Patient and Family Education
Key elements in any drug
education
program
1. Name, dose, and action of drug: Ensure that patients
know this information.
Many patients see more than one health care provider;
this knowledge is crucial to
ensuring safe and effective drug therapy and avoiding
drug–drug interactions.
2. Timing of administration:
-Teach patients when to take the
drug with respect to frequency, other
drugs, and meals.
3. Special storage and
preparation instructions.
-Inform patients about any special
handling or storing required.
4. Specific OTC drugs or
alternative therapies to
avoid
-Prevent possible interactions
between prescribed drugs and
other drugs or remedies the
patient may be using
or taking.
5. Special comfort
measures
-Teach patients how to cope with
anticipated adverse
effects to ease anxiety and avoid
noncompliance with drug therapy.
6. Safety measures:
Instruct all patients to keep
drugs out of the reach of
children.
7. Specific points about
drug toxicity:
Give patients a list of warning signs of
drug
toxicity. Advise patients to notify their
health care provider if any of these
effects
occur.
8. Specific warnings about
drug discontinuation
-Remember that some drugs with a
small margin of safety and drugs with
particular systemic effects cannot be
stopped abruptly without dangerous
effects
 Evaluation
-Determine if goals have been met satisfactorily. It should be done not
only at the end of the process, but should go on from the start of
assessment and initial interview with the patient. The following are the
questions that can be used in evaluation:
a. Does the patient exhibit signs that medication is effective?
b. Are there any secondary effects?
Are there drug interactions that may lead to toxicity?
d. Is the patient taking the medication as ordered?
Nursing Responsibilities

The nurse utilizes the nursing process

when administering medications.
These nursing responsibilities must be
observed by the nurse in the administration
of medication.
 A. Before Administration

 Check drug potency: color, consistency and characteristics.

 Compare stock with the medication ticket or MAR
 Check expiration date.
 Dilute with the right amount of distilled water for injectables.
 Roll vials in between hands to mix the contents of liquid medications.
 Shake bottle to mix (suspensions).
 Prepare needed materials: cotton balls with 70% alcohol, dry cotton
balls, etc.
 B. During Administration
 Identify client. Check arm band.
 Inform / Explain to the client what you will administer.
 Oral (get a glassful of water); Tablets: Instruct to swallow
whole except for chewable tablets.
 Prepare the site for parenteral injections:cleanse the area.
 Parenteral: Inject slowly observing aseptic technique.

 C. After Administration

 Check and monitor’s patient's reaction to the drug.

 Give health teachings.
 Instruct client and watchers to report unusualities like : difficulty of
breathing, pruritus, hives and nausea; these are signs of allergic reaction
 Check IVF regulation and regulate properly.
 Return used materials (p.o.).
 Document by signing the medication sheet.
 Return medication ticket to proper place (next timing).
DOSAGE CALCULATIONS

Learning Outcomes:
At the end of the lesson, the students will be able to:
a.Compute accurately dosages of oral drugs;
b.Compute IV drugs as ordered; and
c. Determine the importance of administering drug
dosages.
 MEASURING SYSTEMS
Solid measure Liquid measure

Gram (g) Liter (L)

1 milligram = 0.001g 1 milliliter (ml) = 0. 001L
1 microgram (mcg) = 0. 000001 g 1 ml = 1 cubic centimeter = 1 cc
1 kilogram (kg) = 1000 g 1 oz. = 30ml
1 kg = 2.2 lbs. 1 tsp = 5 ml
1. Metric system is based on the decimal 1 tbsp
system, so all= 15ml
units are determined as multiples of 10.
 Solid measure Liquid measure

Grain (gr) Minim (min)

60 gr = 1 dram (dr) 60min = 1 fluidram (f dr)
8 dr = 1 ounce (oz) 8 f dr = 1 fluidounce (f oz)

 Apothecary system uses the minim as the basic unit of liquid measure and the grain as the basic
unit of solid measure.
 Solid measure Liquid measure

Pound (lb) Pint (pt)

1lb = 16 ounces (oz) 2 pt = 1 quart (qt)
2.2lb = 1 kg 4qt = 1 gallon(gal)
3 tablespoons (tbsp) = 1 pt.
3 teaspoons( tsp) = 1tbsp
60 drops (gtt) = 1 tsp

 Household system is a measuring system found in recipe books. The system uses teaspoon as the
basic unit of fluid measure and the pound as the basic unit of solid measure.