Pharmacology ❖ PLANNING

2yr - 1st sem, midterms ✔ SMART

✔ Client-centered (what the pt can do or
NURSING PROCESS achieved)
✔ GOAL: provision of safe and effective
medication administration.
ASSESSMENT OF CLIENT
◻ Identification of client's knowledge, possible
✓ Collect Subjective & Objective data: Client,
drug interaction
Drug, & Environment.
◻ Client and family education, compliance
✓ Complete drug history
NURSING PROCESS IN
✓ Perform a Nursing PA
PHARMACOLOGY
✓ Create a medication profile
❖ IMPLEMENTATION
❖ ASSESSMENT
✔ Patient teaching
PROBLEM
✔ Proper medication administration
➪ Collect Subjective & Objective data: Client,
◼ Maximizing therapeutic effect
Drug, & Environment.
◼ Minimizing adverse effects
ALLERGIES
◻ 10 Rights of medication administration
➪ History of allergies to FOOD or DRUGS,
❖ EVALUATION
Adverse Effects
✔ Patient's response to the therapy
HPPI
◻ Expected outcome
➪ Pattern of healthcare experiences/ History of
◻ Unexpected outcome
Past and Present Illness
❖ DRUG HISTORY
10 RIGHTS OF DRUG ADMINISTRATION
OTC MEDS
1. RIGHT DRUG
➪ vitamins, minerals, dietary supplements,
➢ The patient has the right to receive the right drug
NSAIDS, laxatives, antacids
prescribed.
PRESCRIPTION MEDS
Prescribed by:
➪ birth control pills, hormone replacements,
1. Licensed healthcare provider
maintenance meds
a. Physicians
HERBAL MEDS
b. Dentists
➪ commercially available herbal meds and
c. Veterinarians
homeopathic meds
*Prescription → written on prescription pads
USE OF ILLICIT DRUGS
*Drug orders → written on an Order Sheet (patient's
➪ MJ, shabu, cocaine, ecstasy, etc
chart)
PERSONAL AND SOCIAL
❖ MEDICATION ORDER
➪ Caffeine intake, tobacco use, alcohol intake
◆ 6 ELEMENTS OF AN ORDER
❖ NURSING DIAGNOSIS
1. Client's name
✔ NANDA approved
2. Date and Time the order was
✔ based on human response to illness ACTUAL
made
needs and problems, and potential (RISK)
3. Name of the medication
health and life process
4. Dosage (Includes amount,
SAMPLE:
frequency, and number of
◦ Deficient knowledge
doses)
◦ Risk for injury
5. Route of administration
◦ Non-compliance
6. Signature of prescriber

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 ❖ RESEARCHING THE MEDICATION
ORDERED
*Use a current/updated Drug handbook
REVIEW:
1. Classification, mechanism of action
2. Doses, routes, side effects,
contraindications, drug
incompatibilities
3. Interactions, precautions, & nursing
implication
❑ MEDICATION CARD
❑ COMMON SYMBOLS
❖ CLASSIFICATIONS
1. Standing Order
- called after an Ongoing Order
- maybe given for specific
number of doses/ days
- includes Pro Re Nata (PRN)
orders "as needed"
- exclude STAT dose
2. PRN Order
- "as needed"
- given per patient's request
(pain relievers), or on
healthcare practitioners
judgment or discretion.
3. STAT Orders
- one-time order
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- given immediately - "NOW"
4. Single dose
- given 1 time ONLY.
❖ 3 CHECKS
✓ At the time of contact with the
medicine (ampule, vial, bottle,
pills/container.)
✓ Before preparing the medication.
✓ After preparing the medication &
before giving it to the patient.
2. RIGHT DOSE
➢ The right amount of drug to be given.
↳ Institution policy to take height and weight of
the patient (for proper computation of dose
esp. in PEDIA)
↳ KNOW the formula. (Compute dose with
other nurse if in doubt)
❑ COMMON SYMBOLS
3. RIGHT TIME
➢ Proper time at which the medication should be
administered
↳ Give meds affected by foods, BEFORE MEALS
↳ Give irritant meds, c MEALS or AFTER
MEALS
↳ Beware of pending diagnostic procedures that
may contraindicate a certain medicine.
↳ NOTE of the drug EFFECTS to determine
proper time of giving
 ○ Diuretics → not given at night to
promote rest
○ Antihistamines → not given during the
day to promote activities
❖ Actual Practices
⬩ If two or more IV medicines are to be
given at the same time, make sure to
have at least 30 minutes of interval
between 2 meds.
⬩ Oral meds can be delayed if patients are
resting or sleeping.
❑ COMMON SYMBOLS
❑ MEDICATION CARD FREQUENCY AND
COLORS
▫ Swab site with cotton balls with alcohol
(inner to outer in a rotating motion)
❑ COMMON SYMBOLS
5. RIGHT PATIENT
➢ Verify and identify correct patient to receive the
medication
▣ DATA PRIVACY ACT of 2012 (RA 10173)
■ charts are confidential
▣ IDENTIFIERS
■ photo on chart
■ hospital bracelet
PHILIPPINES: Verify with relatives
or ask patient his/her name

6. RIGHT DOCUMENTATION
➢ Proper and complete recording of information on
patient's medications
"If not documented, it was not done."
CHART UPDATE :
◦ Standing Order
◦ Medication/Treatment Sheet
4. RIGHT ROUTE
◦ Nurses Progress Notes
➢ Necessary for adequate drug absorption
◦ Kardex
▣ ORAL
■ Assess ability to swallow, gag reflex
CHART UPDATE :
■ Diet (NPO, progressive)
◦ Medication/Treatment Sheet
NOT RECOMMENDED:
DUTY SHIFT :
▫ Crushing and mixing with other
◦ AM (6am -2pm) - black ink
substances
◦ PM (2pm - 10pm) - blue ink
▫ Mixing with sweet substances to trick
◦ N (10pm -6am) - red ink
pedia clients
▫ Mixing with infant's milk formula
■ Stay with patient and make sure oral meds are
taken.
▣ PARENTERAL
■ INVASIVE standard precaution
CHART UPDATE :
▫ HAND HYGIENE (HW, hand
◦ Nurses' Progress Notes
disinfectant)
Apply FDAR format of documentation

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 Nursing Action :
◦ Explain the risk, Reinforce reason
◦ Acquire waiver duly signed
◦ Proper referral and notification of managers
and AP

12 Rs in Medication Administration update

Documentation
Evaluation
CHART UPDATE : Assessment
◦ Kardex Reason
Tool for summarizing the care of patient used during
handover (endorsement) Patient
7. RIGHT ASSESSMENT Time
➢ Appropriate and pertinent data must be acquired
before drug administration Route, Refuse
○ SAMPLE Expiry date, Education
◦ pains scale score → when giving Drug, Dose
analgesia
◦ level of Anxiety → anxiolytics GENERAL GUIDELINES
◦ Hx of allergies ❖ PREPARATION
◦ LMP → women within child-bearing 1. Hand Hygiene
age 2. Check med card against order
8. RIGHT TO EDUCATION 3. Check label (expiry date, drug facts)
➢ Requires that patients receive accurate information 4. Calculate dose, verify with co-nurse
regarding his/her treatment. 5. FOCUS (don't be distracted)
*Coincides with Informed Consent 6. REMEMBER: "Ask when in doubt"
Nursing Consideration : ❖ ADMINISTRATION
◦ Assess readiness 1. Give only meds you prepared
◦ Assess level of understanding 2. Do not prepare meds to be given by another
◦ Speak in layman's term nurse
Client teaching should include : 3. Properly identify your patient.
◦ Reason of the treatment 4. Oral meds (PEDIA)
◦ possible S/E a. can give ice chips first to numb tongue
◦ Diet/ Lifestyle restrictions b. give bad-tasting meds before
◦ skill of administration good-tasting meds
◦ diagnostics while on treatment 5. Assist client to comfortable position of
9. RIGHT EVALUATION administration
➢ Requires effectiveness of medication by determining 6. Stay with the client for quite some time after
client's response to treatment. giving the meds
➢ Determine expected and unexpected outcomes, and 7. Parenteral meds :
progress of treatment. - Slow IV administration (prevent speed
10. RIGHT TO REFUSE shock)
➢ Respect to Autonomy, client can refuse from - IM - not more than 2.5-3ml
receiving medicines or treatment in general. - SC - not more than 1 ml of solution

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 - ID - not more than 1ml
8. Never recap needles → (needle-stick injury) do
the "scoop technique"
9. Syringes should be single used → proper
disposal of needles and sharps

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