chapter four

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

Overview of Nursing Responsibilities

  • Nurses are tasked with assuming increasing responsibilities in patient care.
  • Nursing is recognized as both an art and a science.
  • The nurse plays a key role as a health care professional, integrating knowledge from multiple disciplines, which include:
    • Basic sciences
    • Social sciences
    • Education
    • Other relevant fields of study
  • The nursing process is fundamental in applying this integrated knowledge effectively.

Assessment in Nursing

Assessment #1: Patient History
  • Key factors to consider:
    • Past Medical History: Chronic conditions, previous drug use, and allergies.
    • Level of Education: Understanding patient comprehension of their disease and therapy.
    • Social Support: Evaluation of available social and financial support resources.
    • Health Care Pattern: Examination of the patient's interaction with health care services.
Assessment #2: Physical Examination
  • Important parameters assessed:
    • Weight: Indicators of health status and medication dosing.
    • Age: Affects drug metabolism and treatment responses.
    • Physical Parameters: Relevant to the specific disease state or known effects of drug therapy.

Nursing Conclusions and Planning

  • The nurse synthesizes the information gathered during assessment to:
    • Provide a statement regarding the patient’s current status from a nursing perspective.
    • Analyze the collected data to prioritize the information for planning patient care.
  • This includes setting goals and desired outcomes for the patient, which typically involve:
    • Ensuring an effective response to drug therapy.
    • Minimizing potential adverse effects from medications.
    • Enhancing patient understanding of their drug regimen.

Interventions in Nursing

  • Nursing interventions are directed towards achieving the established goals:
    • Types of Interventions:
    • Drug Administration.
    • Comfort Measures such as:
      • Placebo effects.
      • Managing adverse effects from medications.
      • Lifestyle adjustments outlined in Box 4.3.
    • Patient and Family Education as detailed in Box 4.4.

Evaluation in Nursing

  • Evaluation is a fundamental component of the ongoing patient care process, ensuring:
    • Continuous assessment of patient responses.
    • Evaluation of the efficacy of nursing interventions.
    • Assessment of the success of educational programs provided to the patient.

Medication Errors

  • There is an increasing risk of medication errors, highlighted by the To Err is Human Study.
  • The drug regimen process is equipped with a series of checks designed to catch potential errors before medication is administered.

Nurse’s Role in Medication Safety

  • The following 'rights' must be adhered to during medication administration:
    • Right patient
    • Right drug
    • Right storage
    • Right route
    • Right dose
    • Right preparation
    • Right time
    • Right recording of administration

Patient’s Role in Medication Safety

Patient’s Role #1
  • Patients should maintain an accurate list of all medications:
    • Prescription (Rx), Over-The-Counter (OTC), and herbal medicines.
  • It is essential to know the purpose of each drug being taken.
  • Patients must:
    • Read labels carefully and adhere to instructions.
    • Store medications properly—away from dampness and children's reach.
    • Speak up regarding their treatment and medication usage.
Patient’s Role #2: Care for Children
  • Parents should keep a detailed list of their children's medications, including:
    • Prescription, OTC, and herbal drugs.
  • Never use adult medications for children.
  • Always read labels and follow proper dosages:
    • Use appropriate measuring devices for liquid medications.
    • Store medications out of reach, avoiding terms like “treat” or “candy.”
  • Parents should act quickly if the child worsens or encounters difficulties with medication and ask healthcare providers any questions relevant to care.

Reporting of Medication Errors

  • Reporting systems exist at both national and institutional levels:
    • National reporting programs facilitated by the U.S. Pharmacopeia.
    • Nurses should be familiar with policies at their institutions for reporting medication errors, including:
    • ISMP Medication Error Reporting Program
    • FDA MedWatch Program

Assessment Question

Question #1
  • What information is required in a provider’s order for a patient to enable the nurse to implement the “rights of safe administration” when giving medication?
    • Possible options:
    • Patient’s weight
    • Patient’s drug history
    • Patient’s name
    • Patient’s address
Answer to Question #1
  • Correct Answer: C. Patient’s name
  • Rationale: The provider’s order requires essential details that enable the nurse to administer medication correctly by following the seven “rights” of safe and effective administration:
    • Correct drug and patient
    • Correct storage of drug
    • Correct route
    • Correct dose
    • Correct preparation
    • Correct time
    • Correct recording of administration