nursing process in drug therapy and safety & challenges to effective drug therapy

nursing process

• ADPIE

• assess: collect data before giving meds

  • history - illness, allergies, all meds

  • physical = age, weight, VS

  • supp and understanding = PT’s ability to manage and comprehend med uses

  • purpose = ID factors that may affect how drug works/create risk for adverse reactions

• planning: analyze assessment data to develop safe meds goal

  • set PT centered outcomes: effective therapeutic response, few or manageable side FX, PT demonstrates understanding

• intervention: perform nursing action to ensure safety and effective med use

  • teach PT and family - explain purpose, dosing sched, what to report

  • supp lifestyle changes - reinforce behavior that will enhance effectiveness

    • diet, exercise, smoking cessation

  • manage side fx = monitor, treat, report adverse FX promptly

  • give meds safely: 7 rights (includes record and storage)

  • provide comfort care (address discomfort)

• evaluation

  • check if therapeutic goals were met

  • monitor drug and side fx

  • adjust plan of care if the ideal outcome is not achieved

planning

• planning: analyze assessment data to develop safe meds goal

  • set PT centered outcomes: effective therapeutic response, few or manageable side FX, PT demonstrates understanding

intervention

• intervention: perform nursing action to ensure safety and effective med use

  • teach PT and family - explain purpose, dosing sched, what to report

  • supp lifestyle changes - reinforce behavior that will enhance effectiveness

    • diet, exercise, smoking cessation

  • manage side fx = monitor, treat, report adverse FX promptly

  • give meds safely: 7 rights (includes record and storage)

  • provide comfort care (address discomfort)

evaluation

• evaluation

  • check if therapeutic goals were met

  • monitor drug and side fx

  • adjust plan of care if the ideal outcome is not achieved

PTs role in safety

• keep current med list

• know purpose of each med

• follow directions exactly as prescribed

• store meds safely (away from heat, moisture, children, pets)

• ask Q’s

children and med safety

• never give adult drugs to kids

• use proper measuring device

• keep meds out of reach

• call provider asap if there’s a bad reaction

• never call meds candy

error reporting

• report immediately

• use ISMP institute for safe medicine practices and FDA MedWatch

issues that influence PT use of meds

• basics: challenges including social changes, technology, cost, safety concerns

• healthcare changes:

  • PT wants more info and choices in their treatments

  • alt therapies: herbal supplements more avail

  • early hospital d/c → pt recovers at home → depend on PT and family

  • new concerns

    • terrorism

    • street drugs

    • environmental contamination

    • covid 19

media influence

• company has to say risk and side fx, but company only mention benefits 👀 if they don’t mention the purpose of the med they can lwk say whatever

• media headlines simplify medical info

• people have partial/incomplete details from TV or socials → nurse clarifies misconception

internet health info

• online sources vary in reliability

• .gov, .edu, .org → safe

• nurses should teach PT how to check

  • who wrote it (are they qualified)

  • when was it last updated

  • does it match other reliable sources

  • reference and funding transparency

OTC drugs: easily available but not risk free

• basics:

  • hides symptoms of serious illness

  • interacts w RX’d drugs

  • toxicity if misused or overtaken

• nurses emphasize:

  • careful labelreading

  • consult w provider before combining OTC drugs with RXs

cost and insurance issues

• rising medication and drug cost affect adherence

• HMO plan may offer lowest cost, but limits provider choices

• shorter hospital stay → more self care at home

• nurses teach safe med mgmt and monitor for affordability barrier

home care safety issues

• early d/c → pt recover at home

• nurses are teachers, assessors, advocates

• teaching responsibilities: PT must understand:

  • correct dosing

  • storage

  • when to call for help or report adverse fx

money and medication safety issues

• some PT skip or split dose to save money → treatment failure

• generic drugs safe and cost effective

• caution buying drugs online → unsafe or counterfeit

• nurses: assess cost concerns and guide PT toward safe and affordable options

bioterrorism and pandemics

• ongoing concern for bio and chem weapon exposure

• CDC provides emergency response and vax guidelines

• COVID 19 pandemic emphasized

  • telehealth, emergency preparedness, flexible care delivery

drug abuse and opioids

• street drugs and opioid misuse - major Public health problem

• addiction changes lives and treatment response

• education and prevention: nursing care that reduces misuse and stigma

environment and drug

• pharmaceuticals: in water system; safe but needs monitoring

• FDA advice: proper med disposal (never flush unless instructed)

• nurses: teach PT to discard expired or unused meds