Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 1 Pharmacology and the Nursing Process in LPN.

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Chapter 1Chapter 1

Pharmacology and the Nursing Process in LPN Practice

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Chapter 1

Lesson 1.1

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Learning ObjectivesLearning Objectives

• List the five steps of the nursing process

• Identify subjective and objective data

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Five Steps of the Nursing Process

Five Steps of the Nursing Process

1. Assessment

2. Diagnosis

3. Planning

4. Implementation

5. Evaluation

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The Nursing ProcessThe Nursing Process

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ResponsibilitiesResponsibilities

• Dictated by licensure and experience

RN: licensure and authority to carry out allsteps of the nursing process

LPN/LVN: working under the supervision ofthe RN; assess, implement, and evaluatewith guidance

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AssessmentAssessment

• Gathering information to develop a database, or record, from which all nursing process plans develop

• Requires skill and expertise of the nurse

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Assessment (cont.)Assessment (cont.)

• Two types of data:

Subjective data: obtained through questioning; information that cannot be measured

Objective data: obtained through observation; information that is observed or could be verified by another

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Sources of InformationSources of Information

• Patient

• Family

• Medical Records

• History

• Health Care Providers

• Lab Reports

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Sources of Information (cont.)Sources of Information (cont.)

• Techniques used to obtain objective data:Inspection = close observation

Palpation = feeling

Percussion = detecting differences in

vibrations through the skin

Auscultation = listening with a stethoscope

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Drug History AssessmentDrug History Assessment

• Helpful information to be used in planning drug therapy:– Symptoms, signs, or diseases that explain

need for medication– Current (and sometimes past) use of

medications and drugs– Problems with drug therapy

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Chapter 1

Lesson 1.2

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Learning ObjectivesLearning Objectives

• Discuss how the nursing process is used in administering medications

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DiagnosisDiagnosis

A conclusion about what the patient’s

problems are.

• The physician makes a medical diagnosis.• The nurse makes a nursing diagnosis.

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Diagnosis (cont.)Diagnosis (cont.)

To make a nursing diagnosis ask:– What are the major problems for the patient?– What procedures or medications will the

patient require?– What special knowledge or equipment is

required to give these medications?– What special concerns or cultural beliefs does

the patient have?– What does the patient understand?

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Diagnosis (cont.)Diagnosis (cont.)

• Once the nursing diagnosis is made, a plan of care is initiated that includes patient and nurse involvement.

• Goals are established.

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PlanningPlanning

• Patient goals– Help the patient learn about a medication

and how to use it properly.

• Nursing goals– Help the nurse plan what equipment or

procedures are needed to administer a medication.

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Four Steps of Planning Four Steps of Planning

1. Determine the reason for each medication to be given.

2. Learn information regarding the medication.

3. Plan for special storage, techniques, or equipment.

4. Develop a patient teaching plan.

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Four Steps of Planning (cont.) Four Steps of Planning (cont.)

Prior to medication administration,

critical thinking is essential to:– Verify the accuracy of the medication by

checking the medication record against the physician’s original order.

– Determine whether the type of medication and dosage are appropriate for the patient.

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PlanningPlanning

If the nurse determines: – the medication order is unclear or appears

incorrect– the patient’s condition would decline with the

medication– the physician did not have all the relevant

information needed before writing the order– there is a change in patient condition

The medication is HELD until the order isclarified.

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Chapter 1

Lesson 1.3

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Learning ObjectivesLearning Objectives

• List specific nursing activities related to assessing, diagnosing, planning, implementing, and evaluating the patient's response to medications

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ImplementationImplementation

• Six Rights of Medication Administration1. Right drug

2. Right time

3. Right dose

4. Right patient

5. Right route

6. Right documentation

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Right DrugRight Drug

• Drug label is verified three times1. Before taking the drug from the unit dose

cart or shelf

2. Before preparing the prescribed dose

3. Before replacing the medication on the shelf or before administering it to the patient

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Right TimeRight Time

Considerations:– Action of the medication– Hospital policies– Patient routines

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Right DoseRight Dose

Considerations:– Age– Weight– Health status– Recent changes in health status

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Right PatientRight Patient

• It is critical to identify patients using objective data such as ID number, name, date of birth.

• Many patients are at risk for misidentification; for example, those unable to effectively communicate with the nurse (pediatric, geriatric, critically ill, confused, non-English speaking patients).

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Right RouteRight Route

• Routes alter effects of medications.

• Nurses must not alter the route prescribed for a medication without a physician’s order.

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Right DocumentationRight Documentation

• If it isn’t documented, it wasn’t given.

• Nurses should only document what they have given.

• Document accurately after the medication is administered.

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EvaluationEvaluation

• Have therapeutic effects from the medication been seen?

• Have any side effects from the medication been seen?

• Have any allergic responses from the medication been seen?