Nursing Management

Nursing Responsibility

• Assessment
• Administration of ordered medications and therapy
• Assessment of reaction/outcome to medications
• Teaching
• Evaluation of teaching effectiveness

Nursing Process

• Assessment
  • Gather data: history and physical assessment
• Nursing diagnosis
  • Draw a conclusion from the assessment data that was gathered
• Intervention
  • Formulate a plan of care that includes actions to improve or maintain the patient’s health
• Evaluation
  • Determine if the plan of care was effective at either maintaining or improving the patient’s health

Assessment

• History
  • Medical
    • Certain conditions prevent patients’ use of some medications
  • Surgical
    • May require new medications as a result of surgery
  • Social
    • Level of education, social support, financial means
• Medications
  • Drug-to-drug interactions
• Allergies
  • Patients may have cross-sensitivity to medications

Physical Assessment

• Head-to-toe assessment
• Weight
• Age

Nursing Diagnosis

• Based on the data collected in the assessment phase of the nursing process
• The nursing diagnosis is a statement of the patient’s status from the nursing perspective
• This statement is the basis for the care provided by the nurse
• Insert box 4.2

Interventions

• Nursing actions that guide the care provided to the patient by the nurse
• Interventions can be dependent, interdependent, or independent

Proper Drug Administration(The Rights)

• Drug
• Storage
• Route
• Dosage
• Preparation
• Timing
• Recording

Promoting Drug Therapy

• Placebo effect
• Managing adverse effect
• Lifestyle adjustment

Patient and Family Education

• Cornerstone of drug therapy
• Nurses are the primary educators about medications

Elements of Patient Teaching

• Name, dose, and action of drug
• Timing of administration
• Special storage and preparation instructions
• Specific OTC drugs or alternative therapies to avoid
• Special comfort or safety measures
• Specific points about drug toxicity
• Specific warnings about drug discontinuation

Patient History

• Chronic conditions
• Drug use
• Allergies
• Level of education
• Level of understanding of disease and therapy
• Social support
• Financial support
• Patterns of health care

Physical Assessment

• Weight
  • Determine whether recommended dose is appropriate
• Age
  • Extremes often require dosage adjustments
• Physical parameters related to disease or drug effects
  • Provide a baseline level for future assessments

Medication Order—Hospital

• Date and time of order
• Patient name and identifiers (medical record number, date of birth)
• Drug
• Dosage
• Route
• Frequency
• Special administration instructions

Medication Order—Community

• Patient name
• Patient date of birth
• Drug
• Drug dosage
• Drug route
• Drug frequency
• Any special instructions
• Amount of medication to dispense
• Number of refills

Drug Administration

• Assessment of patient
  • Includes history, allergies, physical assessment
• Assessment of drug
  • Proper medication procedure
• Teaching
• Administration of medication
• Assessing for therapeutic or adverse effect
• Documentation