Chapter 4

Nursing Management

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 Nursing Responsibility

• Assessment

• Administration of ordered medications and therapy

• Assessment of reaction/outcome to medications

• Teaching

• Evaluation of teaching effectiveness

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 Nursing Process
• Assessment
– Gather data: history and physical assessment
• Nursing diagnosis
– Draw a conclusion from the assessment data that
was gathered
• Intervention
– Formulate a plan of care that includes actions to
improve or maintain the patient’s health
• Evaluation
– Determine if the plan of care was effective at either
maintaining or improving the patient’s health
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 Assessment
• History
– Medical
▪ Certain conditions prevent patients’ use of some
medications
– Surgical
▪ May require new medications as a result of surgery
– Social
▪ Level of education, social support, financial means
• Medications
– Drug-to-drug interactions
• Allergies
– Patients may have cross-sensitivity to medications
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Physical Assessment

• Head-to-toe assessment

• Weight

• Age

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 Nursing Diagnosis

• Based on the data collected in the assessment

phase of the nursing process

• The nursing diagnosis is a statement of the

patient’s status from the nursing perspective

• This statement is the basis for the care provided

by the nurse

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 Nursing Diagnosis (cont.)

• Insert box 4.2

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 Interventions

• Nursing actions that guide the care provided to

the patient by the nurse

• Interventions can be dependent, interdependent,

or independent

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Proper Drug Administration
(The Rights)
• Drug
• Storage
• Route
• Dosage
• Preparation
• Timing
• Recording
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 Promoting Drug Therapy
• Placebo effect

• Managing adverse effect interventions directed at decreasing the impact of the anticipated adverse
effects (temp, light) environmental control; safety (avoiding driving, sun using side rails, skin care, laxatives, frequent meals)

• Lifestyle adjustment diuretics, MAOIs

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 Patient and Family Education

• Cornerstone of drug therapy

• Nurses are the primary educators about

medications

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 Elements of Patient Teaching

• Name, dose, and action of drug

• Timing of administration

• Special storage and preparation instructions

• Specific OTC drugs or alternative therapies to avoid

• Special comfort or safety measures

• Specific points about drug toxicity

• Specific warnings about drug discontinuation

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 Patient History
• Chronic conditions
• Drug use
• Allergies
• Level of education
• Level of understanding of disease and therapy
• Social support
• Financial support
• Patterns of health care
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 Physical Assessment
• Weight
– Determine whether recommended dose is
appropriate
• Age
– Extremes often require dosage adjustments
• Physical parameters related to disease or drug
effects
– Provide a baseline level for future assessments

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 Medication Order—Hospital
• Date and time of order
• Patient name and identifiers (medical record
number, date of birth)
• Drug
• Dosage
• Route
• Frequency
• Special administration instructions
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Medication Order—Community
• Patient name
• Patient date of birth
• Drug
• Drug dosage
• Drug route
• Drug frequency
• Any special instructions
• Amount of medication to dispense
• Number of refills
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 Drug Administration
• Assessment of patient
– Includes history, allergies, physical assessment
• Assessment of drug
– Proper medication procedure
• Teaching
• Administration of medication
• Assessing for therapeutic or adverse effect
• Documentation
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Yes Ma Chapter 5 na kita!!!

Copyright © 2008 Lippincott Williams & Wilkins.