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What are the four phases of the nursing process and how are they important in drug therapy?
- Assessment: Subjective and Objective Data
- Nursing Diagnosis:
- Planning: Implementation/Interventions
What assessment data would be important when considering medication administration?
- a. Subjective: Probs w/swallowing, pt symptoms, current meds including OTC, herbs and supplements, past health hx, pts environment
- b. Objective: Physical health assessment: limitations in gross and fine motor control, hand & joint ROM, hand and finger muscle strength, visual impairment, ability to read labels and correctly measure. Lab test results & diagnostic studies: baseline data essential for comparison
What are the most common nursing diagnoses related to drug therapy?
- Pain (acute or chronic) related to hesitancy in taking prescribed pain medications because of fear of addiction
- Ineffective health maintenance related to not having recommended preventive care
- Ineffective protection related to effects of anticoagulant medication on clotting mechanism
- Noncompliance related to forgetfulness
- Risk for injury related to side effects of drug (e.g., dizziness, drowsiness)
- Ineffective therapeutic regimen management related to lack of finances or health care coverage to purchase medications
- Therapeutic regimen management, readiness for enhanced
- Readiness for enhanced knowledge
What qualities are included in effective goal setting?
- Client-centered; clearly states the expected change
- Acceptable to both client and nurse (dependent on client's decision-making ability)
- Realistic and measurable
- Shared with other health care providers
- Realistic deadlines
- Identifies components for evaluation
What is included in the implementation phase of medication administration?
Nurse provides education, administers med, pt care and other interventions needed to help pt reach goals
How is the implementation of patient teaching related to pharmacotherapeutics?
The nurse uses an outline format for pt education
What would be included in a teaching plan for client medication?
- General: take as prescribed
- Self-administration: pts psychomotor skills are crucial
- Diet: foods to add & foods to avoid
- Side effects: report symptoms immediately; tell expected changes in stool and urine etc
- Cultural considerations: culturally sensitive nurse is one who is aware of implications of culture for pt & family
What additional teaching tips would be important in client education?
- Establish trusting relationship
- Stress importance of bringing med list (including OTC, herbs and vitamins) or med to all appointments
- Provide written instructions
- Use colorful charts and graphs
- Use variety of media including audio and video
- Encourage questions; do not rush
- Use materials & language appropriate for pts level of understanding; provide med info in diff languages and reading levels
- Space instruction over several sessions if appropriate
- Collaborate w/pt & family & health care staff and agencies to mobilize resources to meet needs
- Identify pts at risk for noncompliance w/regimen; alert dr and pharmacy so they can develop plan to minimize number of drugs & times administered
- Evaluate pts understanding of med regimen on regular bais
- Empower pt to tke responsibility for managing med
In what ways can the nurse be culturally sensitive when providing education (Box 11-1)?
- Flexibility in timing appointments may be necessary for those who have a circular sense of time, such as American Indian/Alaskan Natives and some Hispanic/Latino populations, rather than a linear sense of time.
- Use videos and literature in the client's preferred language with pictures of that group to enhance adherence with health interventions when language and cultural barriers exist.
- Make reminder calls for appointments, and encourage the client about the importance of timeliness.
- Decrease language barriers by decoding the jargon of the health care environment. Avoid acronyms & abbreviations
- Allow adequate time for information processing. Failure to do this may result in an inaccurate response or no response. Allow time for people to respond to questions, especially for those who have language barriers. Speak clearly and slowly, giving time for translation.
- Consider use of an interpreter or language line.
- Do not assume that lack of eye contact means the client is not listening or does not care. It might indicate respect. Although more traditional and older individuals in some cultures do not maintain eye contact, the acculturated and more educated usually do maintain eye contact.
- Do not misunderstand loud voice volume as necessarily reflecting anger among some African Americans and Arabs, who may be merely expressing their thoughts in a dynamic manner.
- Discuss the ethnicity of the interpreter as well as the language desired when translation is needed. Provide an interpreter with the same ethnic background and gender if possible, especially with sensitive topics. Do not rely on family members, who may not fully disclose because of honor or shame.
- Speak slowly and clearly with exaggerated mouthing or use a loud voice volume, which changes the tone of words. Even though the client may appear to understand the fundamentals of the English language, provide an interpreter if in doubt.
- Do not give directions such as take one "blue" pill at a specified time. Instead, provide the name and dosage of the medication.
- Ask open-ended questions, and have clients demonstrate, rather than verbalize, their understanding of treatments. Because politeness and saving face may be important, do not assume that a positive response means a definite yes.
- Use simple and clear instructions. Ask family members to assist with translation only if an interpreter is not available.
- Do not take offense from a casual touch on the arm or shoulder or if clients stand closer than you are accustomed to. Do not assume that prolonged eye contact is a sign of anger.
- Ask indirectly whether the Asian client understands instructions and have the client or family member do a return demonstration of a procedure or repeat an instruction rather than question his or her comprehension. Speak clearly and slowly. Allow time to respond to questions, giving time for translating the dialect into English. Asking if the person understands may elicit a positive response because of cultural reluctance to say no.
- Emphasize that medications need to be taken as prescribed. Medications are ordered specifically for each ailment. Unused drugs should be discarded. Use of medications by individuals other than the intended may have serious consequences.
- Use both hands to show respect when offering a prescription, instructions, or pamphlets to Asians and Pacific Islanders.
- To establish trust among Hispanics/Latinos or Appalachians, it is necessary to demonstrate an interest in the client's family and other personal matters, to drop hints instead of giving orders, and to solicit the client's opinions and advice.
- Consider verbal instructions and education with reinforcement from videos rather than printed communications.
What would be helpful and healthful points for clients to remember regarding their medications (Box 11-2)?
- Take meds as prescribed
- Keep meds in original labeled container & store as instructed
- Keep out of reach of children
- Before using OTC check w/dr
- Bring all meds to dr appoints
- Know purpose of each med and when to notify dr
- Do not drink alcohol around time to take meds, it may alter absorption of med
- Smoking also alters absorption of meds
What would be the top ten tips for successful teaching sessions? Be able to recognize these described in a scenario.
- Be focused
- Assess the pt
- Listen to the pt
- Keep it simple
- Know the pts motivation
- Consider time constraints
- Pick the appropriate strategy
- Know your resources
- Document your teaching
- Trust yourself
Describe a checklist for health teaching in drug therapy. (Box 11-3)
- -Comprehensive drug and health history
- -Reason for medication therapy
- -Expected results
- -Side effects and adverse reactions
- -When to notify provider or pharmacist
- -Drug-drug, drug-food, drug-lab, and drug-environment interactions
- -Required changes in ADLs
- -Demonstration of learning; may take several forms, such as listening, discussing, or return demonstration of psychomotor skills (e.g., insulin administration)
- -Medication schedule, associated with ADLs and drug level of action as appropriate
- -Recording system
- -Discussion and monitoring of access to finances, med, and associated equipment
- -Community resources
How would the nurse evaluate if health teach about drug therapy has been effective?
Specific outcomes must be articulated w/pt and family to determine if they have been met.
What would the nurse do if the goals in the nursing process related to drug therapy has not been met?
The nurse should collaborate w/pt & family to determine reasons & revise plan. Includes additional assessment data and setting new goals