The Nursing Process in Drug Therapy and Patient Safety

Chapter 4: The Nursing Process in Drug Therapy and Patient Safety
Glossary of Key Terms
 assessment: information gathering regarding the current status of a particular patient, including evaluation
of past history and physical examination; provides a baseline of information and clues to effectiveness of
therapy
 evaluation: part of the nursing process; determining the effects of the interventions that were instituted for
the patient and leading to further assessment and intervention
 implementation: actions undertaken to meet a patient’s needs, such as administration of drugs, comfort
measures, or patient teaching
 nursing: the art of nurturing and administering to the sick, combined with the scientific application of
chemistry, anatomy, physiology, biology, nutrition, psychology, and pharmacology to the particular clinical
situation
 nursing diagnosis: statement of an actual or potential problem, based on the assessment of a particular
clinical situation, which directs needed nursing interventions
 nursing process: the problem-solving process used to provide efficient nursing care; it involves gathering
information, formulating a nursing diagnosis statement, carrying out interventions, and evaluating the
process
NURSING : ART AND SCIENCE
Nursing is a unique and complex science, as well as a nurturing and caring art.
NOTE: a nurse is a key health care provider who is in a position to assess the whole patient, to administer therapy as
well as medications, to teach the patient how best to cope with the therapy so as to ensure the most favorable
outcome, and to evaluate the effectiveness of the therapy. Nurses accomplish these tasks by integrating knowledge
of the basic sciences (anatomy, physiology, nutrition, chemistry, pharmacology), the social sciences (sociology,
psychology), education, and many other disciplines and applying the nursing process.
THE NURSING PROCESS
- A decision- making, problem-solving process-to provide efficient and effective care.

- Application of it in drug therapy ensures that the patient receives the best, safest, most efficient,
scientifically based, holistic care.
A. Assessment (gathering information)

 Is the first step of the nursing process.
 This involves systematic, organized collection of data about the patient. Because the nurse is
responsible for holistic care, data must include information about physical, intellectual,
emotional, social, and environmental factors.
 When viewed together, this information provides the nurse with the facts needed to plan
educational and discharge programs, arrange for appropriate consultations, and monitor the
physical response to treatment or to disease.
 Drug therapy is a complex and important part of health care, and the principles of drug therapy
must be incorporated into every patient assessment plan.
 The particular information that is needed varies with each drug, but the concepts involved are
similar.
 Two major aspects associated with assessment are the patient’s history (past illnesses and the
current problem) and examination of his or her physical status.
a. History – it can influence a drug’s effect
 Chronic conditions (can affect the pharmacokinetics and pharmacodynamics of a
drug)
 Drug use (prescription drugs, over-the-counter (OTC) drugs, street drugs, alcohol,
nicotine, alternative therapies, and caffeine)
 Allergies
 Level of education and understanding (provides a baseline from which the nurse
can determine the appropriate types of teaching information to use with the
patient.)
 Social supports
 Financial supports
 Pattern of health care (provides insight into conditions that the patient may have
but has not reported or medication use that has not been stated)
b. Physical Examination
 Weight (helps to determine whether the recommended drug dose is appropriate)
 Age
 Physical Parameters Related to Disease or Drug Effects
B. Nursing Diagnosis
 Is simply a statement of the patient’s status from a nursing perspective.
 The nurse analyzes the information gathered during assessment to arrive at some conclusions
that lead to a particular goal and set of interventions.
 A nursing diagnosis shows actual or potential alterations in patient function based on the
assessment of the clinical situation. Because drug therapy is only a small part of the overall
patient situation, nursing diagnoses that are related to drug therapy must be incorporated into a
total picture of the patient.
C. Implemention
 Involves taking the information gathered and synthesized into nursing diagnoses to plan the
patient care.
 This process includes setting goals and desired patient outcomes to assure safe and effective
drug therapy.
 These outcomes usually involve ensuring effective response to drug therapy, minimizing adverse
effects, and understanding the drug regimen.
 Three types of nursing interventions are frequently involved in drug therapy: drug
administration, provision of comfort measures, and patient/family education.
i. Proper Drug Administration
The nurse must consider seven points, or “rights,” to ensure safe and effective drug
administration. These are correct drug and patient, correct storage of drug, correct and
most effective route, correct dose, correct preparation, correct timing, and correct
recording of administration.
ii. Comfort Measures
Nurses are in a unique position to help the patient cope with the effects of drug therapy.
A patient is more likely to be compliant with a drug regimen if the effects of the regimen
are not too uncomfortable or overwhelming.
 Placebo effect – nurse’s attitude and support can be a critical part of drug
therapy. For example, a back rub, a kind word, and a positive approach may be
as beneficial as the drug itself.
 Managing adverse effects - interventions can be directed at promoting patient
safety and decreasing the impact of the anticipated adverse effects of a drug.
Such interventions include environmental control (e.g., temperature, light),
safety measures (e.g., avoiding driving, avoiding the sun, using side rails), and
physical comfort measures (e.g., skin care, laxatives, frequent meals).
 Lifestyle adjustment - some medications and their effects require that a patient
make changes in his or her lifestyle.
iii. Patient and Family Education
With patients becoming increasingly responsible for their own care, it is essential that
they have all of the information necessary to ensure safe and effective drug therapy at
home.
D. Evaluation
 Is part of the continuing process of patient care that leads to changes in assessment, diagnosis,
and intervention.
 The patient is continually evaluated for therapeutic response, the occurrence of adverse drug
effects, and the occurrence of drug–drug, drug–food, drug–alternative therapy, or drug–
laboratory test interactions.
 Some drug therapy requires evaluation of specific therapeutic drug levels. In addition, the
efficacy of the nursing interventions and the education program also are evaluated.
 In some situations, the nurse evaluates the patient simply by reapplying the beginning steps of
the nursing process and then analyzing for changes, either positive or negative.
 The process of evaluation may lead to changes in the nursing interventions being used to
provide better and safer patient care.
PREVENTION OF MEDICATION ERRORS
NOTE: In 2000, the Institute of Medicine published a large-scale study of medication errors in the United States,
entitled To Err Is Human: Building a Safer Health System. It reported that 44,000 reported deaths in hospitals each
year occurred from medication errors, and that the number could probably be closer to 98,000. The study brought to
light the many places in the system where a medication error could occur and suggested methods for improving the
problem.
NOTE: Often the nurse is the fi nal check in the process because the nurse is the one who administers the drug and is
the one responsible for patient education before the patient is discharged to home.
A. Nurse’s Role
B. The Patient’s Role

The following teaching points help to reduce the risk of medication errors in the home setting:
• Keep a written list of all medications you are taking, including prescription, OTC, and herbal medications.
Keep this list with you at all times in case you are in an emergency situation and to keep your health care
providers up to date. This list can be essential if you are traveling and need to refill a prescription while away
from home.
• Know what each of your drugs is being used to treat. If you know why you are taking each drug, you will
have a better understanding of what to report, what to watch for, and when to report to your health care
provider if the drug is not working.
• Read the labels, and follow the directions. It is easy to make up your own schedule or to just take
everything all at once in the morning. Always check the labels to see if there are specific times you should be
taking your drugs. Make a calendar if you take drugs on alternating days. Using a weekly pillbox may also
help to keep things straight.
• Store drugs in a dry place, away from children and pets. Humid and hot storage areas (like the bathroom)
tend to cause drugs to break down faster. Storing drugs away from children and pets can prevent possible
toxic effects if these drugs are inadvertently ingested by children or your family pet.
• Speak up. You are the most important member of the health care team, and you have information to share
that no one else knows.
When teaching parents about their children’s drug regimens, be sure to include the following instructions:
• Keep a list of all medications you are giving your child, including prescription, OTC, and herbal
medications. Share this list with any health care provider who cares for your child. Never assume that a
health care provider already knows what your child is taking.
• Never use adult medications to treat a child. The body organs and systems of children, primarily their
livers and kidneys, are very different from those of an adult. As a result, children respond differently to
drugs.
• Read all labels before giving your child a drug. Many OTC drugs contain the same ingredients, and you
could accidentally overdose your child if you are not careful. In addition, some OTC drugs are not to be used
with children younger than a certain age. Doses also may differ for children.
•Measure liquid medications using appropriate measuring devices. Never use your flatware teaspoon or
tablespoon to measure your child’s drugs. Always use a measured dosing device or the spoon from a
measuring set.
• Call your health care provider immediately if your child seems to get worse or seems to be having
trouble with a drug. Do not hesitate; many drugs can cause serious or life-threatening problems with
children, and you should act immediately.
• When in doubt, do not hesitate to ask questions. You are your child’s best advocate.

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Chapter 4: The Nursing Process in Drug Therapy and Patient Safety

Glossary of Key Terms

NURSING : ART AND SCIENCE

THE NURSING PROCESS

- A decision- making, problem-solving process-to provide efficient and effective care.

A. Assessment (gathering information)

PREVENTION OF MEDICATION ERRORS

B. The Patient’s Role

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