Lilley’s Pharmacology for Canadian Health Care Practice, 4th Canadian
Edition
Chapter 01: Nursing Practice in Canada and Drug Therapy
Chapter Summary
OVERVIEW OF THE NURSING PROCESS
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The nursing process is an ongoing, constantly changing, and evolving organizational
framework for the practice of nursing, encompassing all steps taken by the nurse in
caring for a patient.
The phases of the nursing process include assessment; development of nursing
diagnoses; planning, with establishment of goals and outcome criteria;
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.
ASSESSMENT
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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 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 medications; use of hormonal
drugs; past and present health history and associated drug regimen(s); family history
and ethnic or cultural attributes, with attention to different responses to medications;
growth and developmental stage; and issues related to the patient’s age and
medication regimen.
Assessment also includes the collecting of information about a specific medication’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.
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 provider licensed by the appropriate regulatory board
to prescribe medications.
Copyright © 2021 by Elsevier Inc. All Rights Reserved.
Chapter Summary
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NURSING DIAGNOSES
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Nursing diagnoses are formulated based on objective and subjective data and help to
drive the nursing care plan by suggesting specific goals and outcomes.
Nursing diagnoses have been developed through a formal process conducted by
NANDA International (NANDA-I) and are constantly updated and revised.
Use of compliance versus adherence and noncompliance versus nonadherence is
supportive of the terms used in the current listing of NANDA-I nursing diagnoses.
Nursing diagnoses are the result of critical thinking, creativity, and accurate
collection of data regarding the patient as well as the drug.
Nursing diagnoses related to drug therapy will most likely grow out of data associated
with the following: deficient knowledge; risk of injury; nonadherence; various
disturbances, deficits, excesses, or impairments in bodily functions; and other
problems or concerns related to drug therapy.
Formulation of nursing diagnoses is usually a three-step process:
o Part One is the human response of the patient to illness, injury, or change.
o Part Two identifies factor(s) related to the response.
o Part Three contains a listing of clues, cues, evidence, or other data that support the
nurse’s claim that this diagnosis is accurate.
PLANNING
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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 behaviour through
nursing care and are developed in collaboration with the patient and with an
established time period for achievement.
Outcome criteria are concrete descriptions of specific patient behaviours or responses
that demonstrate the meeting or achievement of goals related to each nursing
diagnosis.
Outcome criteria reflect each nursing diagnosis and serve as a guide to the
implementation phase of the nursing process.
Outcomes are verifiable, framed in behavioural terms, measurable, and time specific.
IMPLEMENTATION
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Implementation is guided by assessment, nursing diagnoses, and planning.
Statements of interventions include frequency data, specific instructions, and other
information.
Nurses are responsible for safe and prudent decisions in the nursing care of their
patients, including the provision of drug therapy. This requires adherence to the Five
Rights of medication administration—expanded to the Ten Rights—and to the legal
and ethical standards of medication administration and documentation.
Nurses are responsible for checking all medication orders and prescriptions.
Copyright © 2021 by Elsevier Inc. All Rights Reserved.
Chapter Summary
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1. To ensure that the right medication is given, check the specific medication
order against the medication label or profile three times before giving the
medication to the patient.
2. Always check for the right dose and confirm that it is appropriate for the
patient’s age and size. Also, check the prescribed dose against the available
drug stocks and against the normal dosage range.
3. Administer medications at the right time. Check the health care agency policy
on routine medication administration times. Give the medications no more
than one half hour before or after the actual time specified in the prescriber’s
order. Nursing judgement may lead to some variations in timing; any change
must be documented, along with the rationale for the change.
4. A complete medication order includes the route of administration. Never
assume the route of administration; if a medication order does not include the
route, ask for clarification.
5. Be certain that you are administering the drug to the right patient by asking
the patient’s name and then checking the patient’s identification band to
confirm the patient’s name, identification number, age, and allergies.
6. Right reason refers to the appropriateness of the medication to the patient’s
condition. This requires prior knowledge of the medication’s actions and
adverse effects.
7. Be sure to have the right documentation. Assess the patient’s chart 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 or psychological symptoms.
8. Right evaluation (or right assessment) refers to the drug and to the desired
response. Continually assess and evaluate the desired response, as well as any
undesired response.
9. The nurse must ensure that the patient has received the right patient
education regarding the medication being administered, the reason for its
administration, and what to expect in terms of the drug’s effects and possible
adverse effects
10. The tenth Right is the right of the patient to refuse medication. If a patient
refuses medication, always (1) respect the patient’s right to refuse, (2)
determine the reason for the refusal, and (3) take appropriate action, including
Copyright © 2021 by Elsevier Inc. All Rights Reserved.
Chapter Summary
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notifying the prescriber. Document the refusal and include a brief, concise
description of the reason for refusal.
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A medication error is any preventable adverse drug event involving the inappropriate
use of a medication by a patient or a health care provider; it may or may not cause the
patient harm.
EVALUATION
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Evaluation is done after the nursing care plan has been implemented. Evaluation 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 medication and monitoring the
medication’s adverse and toxic effects.
Copyright © 2021 by Elsevier Inc. All Rights Reserved.