2. Pharmacology and the
Nursing Process
The Nursing Process
is crucial for safe medication
administration.
“Crucial = of the greatest significance in determining an
outcome”
2
3. Pharmacology and the
Nursing Process
Nursing Process draws together all of the aspects of the patient:
Physical
Cultural
Cognitive
Spiritual
Sexual
Financial
Recognizing these aspects allows for a more holistic approach to
patient care
3
4. The Nursing Process
• A research-based organizational framework for
professional nursing practice
• Central to all nursing care
• Encompasses all steps taken by the nurse in caring for
a patient
• Ongoing and constantly evolving process
Critical thinking
Flexibility is important 4
7. Nursing Process
Nursing diagnosis
• Decision about the need/problem
(actual or at risk for)
Three parts
• Human response to illness
• “related to”
• “as evidenced by”
7
8. Nursing Process
Nursing diagnosis
• critical thinking
• creativity
• accurate data collection
• It is a statement about the patient’s status and
will guide nursing interventions
8
12. The Nursing Process and
Medication Administration
Assessment
1. Health- 3. Diagnostic Tests, lab values
allergies
4. Medication History
pattern of health care – Prescriptions
experiences/ illnesses
– OTCs
level of education – Herbals
understanding of the disease – Responses to medications
process (therapeutic and adverse
financial support responses)
2. Physical assessment –
age and weight
social support at home
chronic conditions
12
13. The Nursing Process and
Medication Administration
Nursing Diagnosis
• Human response to illness (actual or risk)
– drug therapy may only be a small part of
the total pt picture
– or, at times it may be an all consuming
factor in the patient’s life
• Drug therapy is incorporated into the total
picture
13
14. The Nursing Process and
Medication Administration
Planning
1. Identification of possible interactions
knowledge of the prescribed medication
over-the-counter (OTC) drugs, herbs
2. Client and family education
level of patient understanding of disease
level of education
3. Gather equipment, review procedures, safety measures
timing and frequency of drugs
storage of drugs
This phase leads to the provision of safe effective
medication administration 14
15. The Nursing Process and
Medication Administration
Implementation
1. Maximizing therapeutic effect
2. Minimizing adverse effects
provide comfort measures and help pt.
cope with the therapeutic or adverse
effects of a drug
3. 10 rights of medication administration
15
16. The Nursing Process and
Medication Administration
Evaluation
• Monitoring the patient’s response to drug
therapy
1. Expected outcome
2. Unexpected outcome
16
17. The Five Rights of
Medication Administration
• Right drug
• Right dose
• Right time
• Right route
• Right patient
Medication errors are a major problem in health care
today 17
18. Plus Five Rights of
Medication Administration
• Right documentation
• Right assessment
• Right to education
• Right evaluation
• Right to refuse
18
19. 1. RIGHT DRUG
• Pt should receive the drug that was prescribed.
• Medication orders may be prescribed by:
– Physician
– Dentist
– Podiatrist (foot doctor)
– Licensed health care provider
• Prescription = written on prescription pad
• Drug orders = written in “order sheets” included
in pt’s chart
19
21. Six Elements of a Drug Order
1. Name of the patient
2. Date order is written (start/ stop dates may be ordered)
3. Name of medication
4. Dosage includes size, frequency, and number of doses
5. Route of delivery
6. Signature of the prescriber
21
22. Medication Card
Bed # Ward
Name of Patient
Medication
Frequency
Date ordered Signature
22
23. January 16, 2012 at 3:30pm
Patient Juan Dela Cruz is admitted at Ward F bed # 2. The
patient is hooked with 1 L D5LR at 30 gtts/min, on left
cephalic vein. Start cefuroxime 750mg, q8h, ANST.
F2 Ward F
12 Dela Cruz, Juan
8
Cefuroxime (Zinacef) 750 mg
4
q 8 h ANST (+/- )
1/16/12 lmn
23
24. DRUG ORDERS
4 categories:
3. Standing Order
– Maybe an ongoing order
– Maybe given for a specific # of doses/days
– May have special instructions
– May include PRN orders
24
28. DRUG ORDERS
Nursing Implications:
3. Check that the medication order is
complete and legible.
5. Know the reason why the drug is being
administered to client.
28
29. 3 CHECKS before drug administration:
•At the time of contact with the drug
bottle/container
•Before pouring/preparing the drug
•After pouring/preparing the drug
29
30. DRUG ORDERS
4. Medication card of Kardex should include the
date the medication was ordered and any last
date.
– Ex. Controlled drugs that need to be renewed q 48h
– Anticoagulant & antibiotics renewed after 7 days
– Cancellation of drugs when the client gpes to surgery.
30
31. DRUG ORDERS
5. The 1st dose, one time and “as needed”
medication orders should be checked
against original orders.
6. Be aware of certain drugs that sound
alike and are spelled similarly.
31
32. 2. RIGHT DOSE
• Dose prescribed for a particular
client
Nursing Implications:
4. Calculate dose correctly. When in
doubt, it should be calculated and
checked by another nurse.
6. Check references (PPDR, drug
package insert) for recommended
range of specific drug doses.
32
33. 3. RIGHT TIME
• Time at which the prescribed dose
should be administered.
Nursing Implications:
• Administer at specific time.
33
35. Nursing Implications:
3. Administer that can irritate the
stomach with food.
4. Drug administration schedule
maybe adjusted to fit the
client’s lifestyle, activities,
tolerances or preferences.
35
36. Nursing Implications:
5. It is the nurse’s responsibility
to check whether the client is
scheduled for any diagnostic
procedures that would
contraindicate the
administration of
medications.
36
37. Nursing Implications:
6. Check the expiration
date.
Discard the medication or
return it to the
pharmacy if the date
has passed.
37
38. Nursing Implications:
7. Antibiotics should be
administered at even
intervals throughout a 24-
hr period so that
therapeutic blood levels
are maintained.
38
39. 4. RIGHT ROUTE
• Necessary for adequate
absorption
Nursing Implications:
1. Assess ability to swallow
before administration.
39
40. Nursing Implications:
2. Do not crush/mix medications in
other substances without
consulting the pharmacist.
• Don’t mix with sweet substances
to “trick” children.
• Don’t mix in an infant’s formula
feeding.
40
41. Nursing Implications:
3. Use aseptic technique when
preparing and administering
drugs.
Sterile technique is required
with parenteral route.
41
43. Nursing Implications:
6. If it is necessary to combine medication
with another substance, explain this to the
client.
43
44. 5. RIGHT PATIENT
• Nurse must verify the client’s identity
before any drug administration
Nursing Implications:
4. Verify by checking the identification
bracelet.
– Some institutions put the client’s photo on
his/her health record.
44
45. Nursing Implications:
2. Distinguish between 2
clients with same last
name
– Have warnings highlighted in
bright color on ID tools, such
as medication cards,
bracelet or Kardex.
45
46. Nursing Implications:
3. Some institutions have
ID bracelets coded for
allergy status.
– Nurse must be aware of
this policy.
46
47. 6. Right Documentation
• Requires the nurse immediately record the
appropriate information about the drug
administered.
– Name of drug
– Dose and route of administration
– Time and data of administration
– Nurse’s initial/signature
– Response to medication, including
unexpected reactions, should also be
recorded, accdg to institution policy
47
49. 7. Right Assessment
• Requires appropriate
data must be collected
before administration
of the drug.
49
50. 8. Right to Education
• Requires that client receive accurate and
thorough information about the medication
And how it relates to his or her particular
situation.
50
51. 8. Right to Education
• Client teaching should
include:
– Therapeutic purpose
– Possible SE
– Any diet/lifestyle restrictions
– Skill of administration
– Lab monitoring
51
52. 8. Right to Education
• Coincides with the principle of
informed consent
– Based on the individual having
the knowledge necessary to
make a decision.
52
53. 9. Right Evaluation
• Requires effectiveness of the medication
be determined by the client’s response to
the medication
• Appropriate to determine the extent of side
effects and adverse effects, if any.
53
54. 10. Right to Refuse the Medication
• Client can and do refuse to take a
medication.
• It is the nurse’s responsibility to determine,
when possible, the reason for refusal and
to take reasonable measures to facilitate
the client’s taking of medication.
54
55. Nursing actions when client refuses to take
medications:
3. Explain the risk of refusing to take the medication,
and reinforce the reason for the medication.
5. When the medication is refused, this refusal
should be documented immediately.
7. Inform the nurse manager or health care provider
when an omission and refusal to take medication
pose a specific threat to the client.
55
56. Patient’s Rights
• In addition to the 10 medication
“rights”……
DO YOU THINK PATIENTS HAVE
OTHER MEDICATION “RIGHTS”?
• What additional systems would you like to
see in place to ensure safe drug
administration? 56
57. Association of Nursing Service
Administrators of the Philippines, inc
(ANSAP)
10 Golden Rules for Administering Drugs Safely:
3. Right drug
5. Right drug to the right patient
7. Right dose
9. Right drug by the right route
11. Right drug at the right time
57
58. Association of Nursing Service
Administrators of the Philippines, inc
(ANSAP)
10 Golden Rules for Administering Drugs Safely:
3. Document each drug you administer.
5. Teach your patient about the drugs he is receiving.
7. Take a complete patient drug history
(risk of adverse drug reactions when a number of drugs are
taken/when pt is taking alcohol drinks)
10. Find out if the patient has any allergies.
12. Be aware of potential drug-drug or drug-food interactions.
58
59. General Guidelines for Correct
Administration of Medications
Preparation:
3. Wash hands before
preparing medications.
5. Check for drug allergies,
check the assessment hx
and Kardex.
59
60. General Guidelines for Correct
Administration of Medications
Preparation:
3. Check medication order with
health care provider’s orders,
Kardex, medication sheets and
medication card.
4. Check label on container 3x.
5. Check expiration date on drug
label, card; use drug only if
date is current.
60
61. General Guidelines for Correct
Administration of Medications
Preparation:
6. Recheck drug dose
calculation with another
nurse.
7. Verify doses of drugs that
are potentially toxic with
another nurse/pharmacist.
61
62. General Guidelines for Correct
Administration of Medications
Preparation:
8. Pour tablet/capsule into the cap of the
drug container. With unit dose, open
packet at bedside after verifying client
identification.
9. Pour liquid at eye level. Meniscus, the
lower curve of the liquid, should be at
the line of the desired dose.
10. Dilute drugs that irritate gastric mucosa
(aspirin, potassium) or give with meals.
62
63. General Guidelines for Correct
Administration of Medications
Administration:
3. Administer only those drugs
that you have prepared.
Do not prepare medications
to be administered by
another.
63
64. General Guidelines for Correct
Administration of Medications
Administration:
2. Identify the client by ID band, ID photo
and name tag/band.
64
65. General Guidelines for Correct
Administration of Medications
Administration:
3. Offer ice chips to numb
taste buds when giving
bad-tasting drugs.
65
66. General Guidelines for Correct
Administration of Medications
Administration:
4. When possible, give bad-
tasting medication first,
followed by pleasant-tasting
liquids.
66
67. General Guidelines for Correct
Administration of Medications
Administration:
5. Assist the client to
appropriate position,
depending on the route of
administration.
6. Provide only liquids allowed
on the diet.
67
68. General Guidelines for Correct
Administration of Medications
Administration:
7. Stay with the client until the medications
are taken.
68
69. General Guidelines for Correct
Administration of Medications
Administration:
8. Administer no more than 2.5-3mL of
solution IM at 1 site.
Infants receive no more than 1 mL of
solution IM at 1 site and no more than
1 ml SQ.
Never recap needles (universal
precaution), use the “fishing method”
instead.
69
70. General Guidelines for Correct
Administration of Medications
Administration:
9. When administering drugs to a group of
clients, give drug last to clients who need
extra assistance.
70
71. General Guidelines for Correct
Administration of Medications
Administration:
10. Discard needles and syringes in
appropriate containers.
11. Drug disposal is dependent on
agency policy.
Controlled substances must be
returned to the pharmacy. Some
disposals need signature of witness.
71
72. General Guidelines for Correct
Administration of Medications
Administration:
12. Discard unused solutions for
ampules.
13. Appropriately store (some
require refrigeration) unused
stable solutions from open
vials.
72
73. General Guidelines for Correct
Administration of Medications
Administration:
14. Write date and time opened,
and your initials on label.
15. Keep narcotics in a double-
lock drawer or closet.
medication carts must be
locked at all times when a
nurse is not in attendance.
73
74. General Guidelines for Correct
Administration of Medications
Administration:
16. Keys to the narcotics drawer must
be kept by the nurse and not stored
in a drawer or closet.
17. Keep narcotics in a safe place, out
of reach of children and others in the
home.
18. Avoid contamination of one’s own
skin or inhalation to minimize
chances of allergy or sensitivity dev’t.
74
75. General Guidelines for Correct
Administration of Medications
Recording:
3. Report drug error immediately to client’s
health care provider and to the nurse
manager.
Complete incident report.
75
76. General Guidelines for Correct
Administration of Medications
Recording:
2. Charting: record the drug given,
time, route and your initials.
3. Record drugs promptly after
given, especially STAT doses.
4. Record effectiveness and results
of medications administered, esp
PRN medications.
76
77. General Guidelines for Correct
Administration of Medications
Recording:
5. Report to health care provider
and record drugs that were
refused with reason for refusal.
6. Record amount of fluid taken
with medications in input and
output chart.
77
78. General Guidelines for Correct
Administration of Medications
What to avoid during drug
administration:
3. Do not be distracted when
preparing medications.
5. Do not give drugs prepared by
others.
7. Do not pour drugs from
containers with labels that are
difficult to read/whose labels are
partially removed/fallen off. 78
79. General Guidelines for Correct
Administration of Medications
What to avoid during drug
administration:
4. Do not transfer drugs from one
container to another.
5. Do not give medications for which the
expiration date has passed.
6. Do not guess about drugs and drug
doses. Ask when in doubt.
79
80. General Guidelines for Correct
Administration of Medications
What to avoid during drug administration:
7. Do not use drugs that have sediment, are
discolored, or are cloudy (should not be)
8.Do not leave prepared medications out of sight.
9. Do not give drugs id the client says he/she has
allergies to the drug or drug group.
80
81. General Guidelines for Correct
Administration of Medications
What to avoid during drug administration:
10. Do not call the client’s name as the sole
means of identification.
11. Do not give drug if the client states the
drug is different from the drug he or she
has been receiving. Check the order.
81
82. General Guidelines for Correct
Administration of Medications
What to avoid during drug administration:
12. Do not recap needle, use universal
precaution.
13. Do not mix drug with large amount of
food or beverage or foods that are
contraindicated.
82