Transcript Chapter I
Chapter 1 Pharmacology and the Nursing Process in LPN Practice Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1 Learning Objectives List the five steps of the nursing process Identify subjective and objective data Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 Five Steps of the Nursing Process 1. 2. 3. 4. 5. Assessment Diagnosis Planning Implementation Evaluation Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3 The Nursing Process Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4 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. 5 Assessment Gathering information to develop a database, or record, from which all nursing process plans develop Requires skill and expertise of the nurse Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6 Assessment (cont.) Two types of data Subjective data: obtained through questioning; information that cannot be measured Objective data: obtained through observation; information that is observed or could be verified by another Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7 Sources of Information Patient Family Medical Records History Health Care Providers Lab Reports Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8 Sources of Information (cont.) Techniques used to obtain objective data Inspection = close observation Palpation = feeling Percussion = detecting differences in vibrations through the skin Auscultation = listening with a stethoscope Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 9 Drug History Assessment Helpful information to be used in planning drug therapy Symptoms, signs, or diseases that explain the need for medication Current (and sometimes past) use of medications and drugs Problems with drug therapy Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10 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. 11 Question 2 Which of the following is an example of objective data? 1. 2. 3. 4. Chief problem Laboratory results Medical history of patient Review of body systems Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12 Learning Objectives Discuss how the nursing process is used in administering medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 13 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. 14 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. 15 Diagnosis (cont.) Once the nursing diagnosis is made, a plan of care is initiated that includes patient and nurse involvement. Goals are established. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 16 Planning Patient goals Help the patient learn about a medication and how to use it properly Nursing goals Help the nurse plan what equipment or procedures are needed to administer a medication Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 17 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. 18 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. 19 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. 20 Question 3 The student LPN/LVN 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. 21 Chapter 1 Lesson 1.3 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 22 Learning Objectives List specific nursing activities related to assessing, diagnosing, planning, implementing, and evaluating the patient's response to medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 23 Implementation Six Rights of Medication Administration 1. 2. 3. 4. 5. 6. Right drug Right time Right dose Right patient Right route Right documentation Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 24 Right Drug Drug label is verified three times 1. Before taking the drug from the unit dose cart or shelf 2. Before preparing the prescribed dose 3. Before replacing the medication on the shelf or before administering it to the patient Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 25 Right Time Considerations: Action of the medication Hospital policies Patient routines Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 26 Right Dose Considerations: Age Weight Health status Recent changes in health status Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 27 Right Patient It is critical to identify patients using objective data such as ID number, name, and date of birth. Many patients are at risk for misidentification, particularly those unable to effectively communicate with the nurse (for example, pediatric, geriatric, critically ill, confused, nonEnglish-speaking patients). Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 28 Right Route Routes alter effects of medications. Nurses must not alter the route prescribed for a medication without a physician’s order. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 29 Right Documentation If it isn’t documented, it wasn’t given. Nurses should only document what they have given. Document accurately after the medication is administered. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 30 Evaluation Have therapeutic effects from the medication been seen? Have any side effects from the medication been seen? Have any allergic responses from the medication been seen? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 31