What are the 5 Rights of Nursing Pharm?
- 1) Right Rx
- 2) Right Pt.
- 3) Right Route: Do not crush or alter route in any way unless Dr. approved.
- 4) Right Dose
- 5) Right Time: Timing can and will affect Rx interactions, either positively or negatively, ie if pt is taking 2 drugs which interact with each other, they should be administered at different times (2 hours apart?) to minimize risk and effect of interactions.
What are 5 Additional Rights in Nursing Pharm?
- Right reason
- Patient’s Right to refuse: If pt. refuses, DOCUMENT!
- Must display respect, competence, confidence, affability, integrity, etc. Will go a long way to avoiding pt. refusing treatment.
- Right assessment: What do I need to know prior, during, and after administering the Rx? ie Do not give Rx for lowering BP if BP is already low or normal. Also, anticipation of drug reaction both benefits and harms
- Right patient education: Pt. needs to know what Rx is, what it’s for, how to evaluate it, how to take it, when to determine whether or not it is working.
- Right evaluation
Pharmacology and the Nursing Process
- A cyclic procedure that has five basic steps: Continuous (cyclic), and can be entered at any point in the cycle.
- Analysis ~ NursingDiagnosis
Nursing Process; Assessment
- Collection of baseline data
- Identification of high-risk patients
- Contraindication: DON’T GIVE Rx!
- Precaution: Rx can be given, but pt. needs to be monitored and alternative treatments or contingencies should be planned before hand.
- Assessment of patient’s capacity for self-care, ie can pt be depended on to swallow, remember, read, vision, adequate strength to open bottle.
Nursing Process; Assessment of Drug History
- Drug History: Does physician know about Rxs being taken?
- Prescription drugs
- Over-the-counter drugs
- Herbal remedies
- Caffeine usage
- Nicotine usage
- Birth control?
- Alcohol/tobacco usage
- Illicit drug use
- Drug allergies: What kind of response do you have? How often? How severe?
- Adverse drug reactions
Nursing Process; Assessment of High Risk Pt.
- Liver dysfunction
- Kidney dysfunction
- Genetic factors: Rxn in family members can indicate possible rxn in pt.
- Drug allergies
Analysis and Nursing Diagnosis
When analyzing Drug Therapy one must:
- Judge the appropriateness of of the prescribed regimen
- Identify potential health problems that drug might cause: opioids--> constipation.
- Identify patient’s capacity for self-care: see above.
Nursing Process: Planning
- Defining Goals: Short term vs. long term.
- short term: goals achievable before d/c.
- long term: self explanatory.
- Setting Priorities
- Identifying Interventions
- Establishing Criteria for Evaluation
Nursing Process: Implementation
- Standard order
- PRN administration (as needed)
- Patient Education
- Interventions to promote therapeutic effectiveness
- Interventions to minimize adverse effects: ie fiber, stool softeners, movement, etc. for opioids to avoid constipation.
Nursing Process: Implementation (Pt Education)
What should the patient know?
- Drug name
- Dosage size
- Schedule of administration
- Technique (route) of administration
- Duration of drug use
- Drug storage: Sunlight, temp, child access, humidity are all concerns, ie amber container=light deterioration. Clear=not light sensitive.
- Drug disposal? Every CO county has a drug disposal day and location. Most pharmacies will disposal as well. Can also be crushed, mixed with cat litter, placed in plastic bag, and thrown away.
- Contact Person: Inform the pt who they need to call if they suspect a problem with the Rx. (Dr., advice nurse, pharmacist, etc)
- Promoting Therapeutic Effects
- Patient should know when the medication will work and how it will work
- Tell them when to contact Health care provider
- Teach non-drug measures to promote drug effectiveness
- There is a Zen to giving drugs. Pt. will respond better to assurances than basic info?
Minimizing Adverse Effects
- Potential adverse effects: Pt. needs to know because he/she needs to know what is normal for this drug.
- drug-drug interactions:
- drug-food interactions: Grapefruit juice!
- When to notify Health care provider
Nursing Process: Evaluation
- Therapeutic response: Is the Rx doing what it’s supposed to do and nothing else?
- Adverse drug reactions and interactions
- Toxicity: Any signs?
- Adherence to prescribed regimen: If not, why not? Is there an alternate route or compromise?
- Pt.'s Satisfaction with treatment: Pt. should be satisfied with treatment or they will not adhere to it. Also, pt should be reminded that a satisfactory outcome does not necessarily mean continued treatment to maintain that outcome.