INTRODUCTION TO CLINICAL
PHARMACOLOGY
EDMUNDS 7TH EDITION
NURSING PROCESS
 ASSESSMENT
 DIAGNOSIS
 PLANNING
 IMPLEMENTATION (of interventions)
 EVALUATION
 THINK:
AD-PIE
The Nursing Process
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Responsibilities
 Dictated by licensure and experience
RN: licensure and authority to carry out all
steps of the nursing process
LPN/LVN: works under the supervision of
the RN; can assess, implement, and evaluate
with guidance
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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ASSESSMENT
 SUBJECTIVE DATA
 INFORMATION GIVEN BY THE PT OR FAMILY
(information cannot be measured)
 PATIENT HISTORY
 SOCIAL INFORMATION
EX: I can’t breathe very well; I need my inhaler.
 OBJECTIVE DATA (obtained through observation;
information that is observed or could be verified by another)




INSPECTION – accessory muscles used
PALPATION
PERCUSSION
AUSCULTATION – rales noted
FURTHER ASSESSMENTS
 SIGNS AND SYMPTOMS – RR 32
 CURRENT MEDICATION USAGE
 CONTRAINDICATIONS FOR DRUG THERAPY
 ALLERGIES
 SIDE EFFECTS
 METABOLIC INCOMPATABILITIES
 INTOLERANCES
 G6PD
 PKU
 MIGRAINE TRIGGERS
Question 1
The nursing process is followed when administering
medications to the patient. The first step is:
1.
2.
3.
4.
Planning.
Assessment.
Evaluation.
Implementation.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Question 2
Which of the following is an example of objective data?
1. Chief problem
2. Laboratory results
3. Medical history of patient
4. Review of body systems
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Diagnosis
A conclusion about the patient's problems, based on his or her
signs and symptoms:
 The physician makes a medical diagnosis.
 The nurse makes a nursing diagnosis.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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DIAGNOSIS
 BASED ON ASSESSMENTS
 PRIORITIZED
 INDIVIDUALIZED TO THE PATIENT
 NANDA APPROVED (nursing)
 EX: Impaired gas exchange related to poor gas exchange as
evidenced by 90% O2 saturation
Diagnosis (cont.)
To make a nursing diagnosis, ask:
 What are the major problems for the patient?
 What procedures or medications will the patient require?
 What special knowledge or equipment is required to give these
medications?
 What special concerns or cultural beliefs does the patient have?
 What does the patient understand?
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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PLANNING
 DETERMINE THE PATIENT PRIORITY NEED
 SET A PATIENT CENTERED GOAL
 Decide the reason each med is given
 Know action, classification, safe dosage range, parameters for
holding the drug, interactions and side effects
 Plan for special procedures
 Develop a patient teaching plan
Four Steps of Planning
1.
2.
3.
4.
Determine the reason for each medication to be given.
Learn information about the medication.
Plan for special storage, techniques, or equipment.
Develop a patient teaching plan.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Four Steps of Planning (cont.)
Prior to medication administration,
critical thinking is essential to:
 Verify the accuracy of the medication by checking the medication
record against the physician’s original order.
 Determine whether the type of medication and the dosage are
appropriate for the patient.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Planning
If the nurse determines that:
 the medication order is unclear or appears incorrect or
 the patient’s condition would decline with the medication or
 the physician did not have all the relevant information needed
before writing the order or
 there is a change in patient condition
The medication is HELD until the order is
clarified.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Question 3
The student LPN is preparing to administer morning
medications. Before giving the patient the medication, the
student should: (Select all that apply)
1.
2.
3.
4.
Ask the roommate to verify the patient’s name.
Ask the patient his or her name.
Check the patient’s identification bracelet.
Check the nameplate on the door.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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IMPLEMENTATION
 Following the care plan
 Give the medication accurately and safely
 It is your responsibility to know:
 1. why each drug was ordered
 2. what each drug’s action is
 3. know how to safely administer it
KNOW THE 7 RIGHTS OF DRUG
ADMINISTRATION
 1. DRUG – CHECK 3 TIMES!!!
 2. TIME
 3. DOSE
 4. PATIENT
 5. ROUTE
 6. DOCUMENTATION
 7. REASON
NEVER
EVER, EVER, EVER GIVE A
DRUG
YOU DID NOT PREPARE
YOURSELF, EVEN IF
YOU REALLY, REALLY TRUST
THE PERSON
EVALUATION
 WATCH THE PATIENT FOR A RESPONSE TO THE
INTERVENTION
 Therapeutic, side effects or allergic responses
 LIKE AN END ASSESSMENT OF THE PATIENT
RESPONSE TO TREATMENT
 EX: THERAPEUTIC RESPONSE OF RESPIRATORY
INHALER WOULD BE A DECREASE IN ACCESSORY
MUSCLE USE AND RESPIRATORY RATE
CHAPTER 2
PATIENT TEACHING AND LITERACY
TERMS
 COMPLIANT – PLAN OF CARE IS FOLLOWED
 NONCOMPLIANT – DOES NOT FOLLOW THE PLAN OF
CARE
 CONCORDANCE – THE TEAM WORKS TOGETHER
 LITERACY – ABILITY TO READ, WRITE, AND SPEAK
ENGLISH; do math and solve problems at the level needed to
function on the job/ in society
 HEALTH LITERACY – ABILITY TO UNDERSTAND AND USE
INFORMATION TO REMAIN HEALTHY
% ASKING FOR INFORMATION
 7% SOUGHT INFORMATION ABOUT THEIR
MEDICATIONS
 19% RELIED ON PHARMACIST
 40% RELIED ON PHYSICIAN
 34% ARE UNINFORMED
PATIENT TEACHING PROCESS
 ASSESS WHAT THE PATIENT KNOWS
 ASSESS THE PATIENT’S SPECIFIC NEEDS TO LEARN
 WILLINGNESS TO LEARN
 DECIDE WHAT NEEDS TO BE TAUGHT
 SELECT A TEACHING METHOD
 ASSESS RETENTION OF KNOWLEDGE
 USE A VARIETY OF TEACHING METHODS
KEY INFORMATION
 DRUG NAME
 INTENDED USE AND ACTION
 ROUTE, DOSE, FORM, AND TIME TO TAKE
 STORAGE OR PREPARATION INSTRUCTION
 COMMON SIDE EFFECTS (& what to do)
 INTERACTIONS (food, drug, etoh)
 HOW TO REFILL/ CALL MD
 WHAT TO DO IF MISS A DOSE
 HOW WILL PATIENT KNOW IF DRUG IS WORKING
WELL
TEACHING PLAN
 PTS ARE ABLE TO REMEMBER 3 MAJOR THINGS /
SESSION (researched data)
 VERBAL EDUCATION –discussion
 WRITTEN INFORMATION – labels, pamphlets, handouts,
books, internet
 AUDIOVISUAL – video, TV ads, DVD, CD-ROM
Question 1
Research has shown that patient education materials should
be written at which grade level?
1. Third- to fifth-grade level
2. Fifth- to seventh-grade level
3. Seventh- to ninth-grade level
4. Ninth- to eleventh-grade level
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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WRITTEN INFORMATION
 BE SURE GOALS ARE STATEDTO
 ONE – TWO OBJECTIVES
 FOCUS ON BEHAVIOR TO BE ACHIEVED
 USE CLEAR HEADINGS, PHOTOS, SPACE
 USE COMMON FAMILIAR WORDS
 ASK PATIENT TO WRITE/ DO/ SAY/ OR SHOW THEIR
UNDERSTANDING
 USE ONE/ TWO SYLLABLE WORDS
 HAVE PATIENT CHOOSE WHICH PHAMPLET LEVEL
OF INFORMATION THEY ARE ABLE TO UNDERSTAND
(LITERACY)
Ways to Enhance Learning





Plan for frequent nurse-patient contact
Fit the plan to patient’s needs and culture
Provide feedback and encouragement
Encourage active patient involvement in care
Employ behavioral contract between patient and nurse
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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DEMONSTRATION OF LEARNING
 HAVE PATIENT RESTATE THE INFORMATION
 GIVE A SHORT TEST
 HAVE THE PATIENT DEMONSTRATE THE DRESSING,
INJECTION, MEDICATION DELIVERY, ETC
 SUMMARIZE, REPEAT, & KISS,,,,,
Question 2
1.
2.
3.
4.
Which of the following is the best statement related to
medication teaching?
“All patients can learn about medications in the same
setting.”
“The method and pace for teaching must be designed for
each patient.”
“Using a single teaching method is most effective.”
“Encourage all family members to be present for each
session.”
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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Question 3
The nurse is developing a medication teaching plan. To
make the plan more effective, it is important to: (Select all
that apply)
1. Teach all the information in one visit.
2. Use only one style of providing the information.
3. Assess the patient’s readiness to learn.
4. Request that the patient repeat back information.
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
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 QUESTIONS?