THE NURSING PROCESS It is important before beginning drug therapy,

this will promote safe and effective use of the

Nurses use the nursing process – a decision-
drug and prevent adverse effects.
making, problem-solving process – to provide
efficient and effective care. Application of the  Chronic conditions – affects the
nursing process with drug therapy ensures that pharmacokinetics and
the patient receives the best, safest, most pharmacodynamics of a drug; for
efficient, scientifically based, holistic care. example, certain conditions (e.g. renal
disease, heart disease, diabetes, chronic
 Assessing
lung disease) may be contraindicated to
o Collect data
the use of a drug
o Organize data
 Drug use – prescription drugs, OTC
o Validate data drugs, street drugs, alcohol, nicotine,
o Document data alternative therapies, and caffeine may
 Diagnosing have an impact on a drug’s effect
o Analyze data  Allergies
o Identify health problems, risks,  Level of education
and strengths  Level of understanding of disease and
o Formulate diagnostic statements therapy
 Planning  Social supports
o Prioritize problems/diagnoses  Financial supports
o Formulate goals/desired  Pattern of health care
outcomes
o Select nursing interventions Physical examination
o Write nursing interventions It is done to determine if any conditions exist
 Implementing that may have an adverse reaction to drug use.
o Reassess the patient
 Weight – helps to determine whether the
o Determine the nurse’s need for
recommended drug dose is appropriate
assistance
because the recommended dose is
o Implement the nursing
typically based on a 150-pound adult
interventions
man, patients who are much lighter or
o Supervise delegated care
heavier often need a dose adjustment
o Document nursing activities
 Age – patients at the extremes of the age
 Evaluating spectrum, children and older adults,
o Collect data related to outcomes often require dose adjustments based on
o Compare data with outcomes the functional level of the liver and
o Relate nursing actions to patient kidneys and the responsiveness of other
goals/outcomes organs
o Draw conclusions about  Physical parameters related to disease or
problem status drug effects
o Continue, modify, or terminate The specific parameters that need to be
the patient’s care plan assessed depend on the disease process
being treated an on the expected
ASSESSMENT
therapeutic and adverse effects of drug
The first step of the nursing process involves therapy. Assessing these factors before
systematic, organized collection of data about drug therapy begins provides a baseline
the patient. Because the nurse is responsible for level of which future assessments can be
holistic care, data must include information compared to determine the effects of
about physical, intellectual, emotional, social, drug therapy.
and environmental factors.
DIAGNOSIS
Past history
A nursing diagnosis is simply a statement of the
patient’s status from a nursing perspective.
When applied to pharmacotherapy, the diagnosis
phase of the nursing process addresses three
main areas of concern:
 Promoting therapeutic drug effects
 Minimizing adverse drug effects and
toxicity
 Maximizing the ability of the patient for
self-care, including the knowledge,
skills, and resources necessary for safe
and effective drug administration
Nursing diagnoses that focus on drug
administration may address actual problems,
such as the treatment of pain; focus on potential
problems, such as a risk for deficient fluid
volume; or concentrate on maintaining the
patient’s current level of wellness. Two of the
most common nursing diagnoses for medication
administration are: deficient knowledge and
noncompliance.
PLANNING
The planning phase of the nursing process
prioritizes diagnoses, formulates desired
outcomes, and selects nursing interventions that
can assist the patient to establish an optimum
level of wellness. Short or long-term goals are
established that focus on what the patient will be
able to do or achieve, not what the nurse will do.
With respect to pharmacotherapy, the planning
phase involves two main components:
 Drug administration
 Patient teaching
The overall goal of the nursing plan of care is
the safe and effective administration of
medication. To achieve this, the nurse focuses
on safe medication administration and
monitoring of the patient’s condition and
planning for patient teaching needs related to the
drugs prescribed.
INTERVENTION
The primary role of the nurse in drug
administration is to ensure that prescribed
medications are delivered in a safe manner.
Responsibilities of the nurse in drug
administration
Whether administering drugs or supervising the
use of drugs by their patients, nurses are
expected to understand the pharmacotherapeutic
principles for all medications. The nurse's
responsibilities include knowledge and
understanding of the following:
 What drug is ordered
 Name (generic and trade) and drug
classification
 Intended or proposed use
 Effects on the body
 Contraindications
 Special considerations (e.g. how age,
weight, body fat distribution, and
individual pathophysiological states
affect pharmacotherapeutic response)
 Side effects
 Why the medication has been prescribed
for this particular patient
 How the medication is supplied by the
pharmacy
 How the medication is to be
administered, including dose ranges
 What nursing process considerations
related to the medication apply to this
patient
The professional nurse can routinely avoid many
serious adverse drug effects in patients by
applying experience and knowledge of
pharmacotherapeutics to clinical practice. Some
adverse effects, however, are not preventable. It
is vital that the nurse be prepared to recognize
and respond to potential adverse effects of
medication.
An allergic reaction is an acquired hyper
response of body defenses to a foreign substance
(allergen). Signs of allergic reactions vary in
severity and include skin rash with or without
itching, edema, runny nose, or reddened eyes
with tearing.
Anaphylaxis is a severe type of allergic reaction
that involves the massive, systemic release of
histamine and other mediators of inflammation
that can lead to life threatening shock.
IMPLEMENTATION/INTERVENTION
The implementation phase is when the nurse
applies the knowledge, skills, and principles of
nursing care to help move the patient toward the
desired goal and optimal wellness.
Implementation (in general) involves action on
the part of the nurse or patient: administering a
drug, providing patient teaching and initiating
other specific actions identified by the plan of
care.
What are the responsibilities of the nurse
prior to administration?
When applied to pharmacotherapy, the
implementation phase involves:
 Routes/administering the medication
 Continuing to assess the patient (WHO)
 Monitoring drug effects (WHO)
 Carrying out the interventions
developed in the planning phase to
maximize the therapeutic response and
prevent adverse events
  Providing patient education to ensure
safe and effective home use of the
medications
Routes of drug administration
Nurse responsibility prior adm (admission).
The three broad categories of routes of
administration as the implementation phase in
pharma are:
 Enteral
 Topical
 Parenteral
Enteral drug administration
The enteral route includes drugs given orally and
those administered through nasogastric or
gastrostomy tubes (buccal is between the cheek
and the gums). Oral 1 hour before and 2 hours
after meals.
 Oral drug administration
o Is the most common, most
convenient, and usually the least
costly of all routes
o Safest route because the skin
barrier is not compromised
o In cases of overdose,
medications remaining in the
stomach can be retrieved by
inducing vomiting
o Oral preparations are available
in tablet, capsule, and liquid
forms
o Medications administered by the
enteral route take advantage of
the vast absorptive surfaces of
the oral mucosa, stomach, or
small intestine
o The enteric coated tabs are
designed to dissolve in the
alkaline environment of the
small intestine
o Sublingual under the tongue,
buccal between cheek and gums
 Nasogastric and gastrostomy drug
administration
o A nasogastric (NG) tube is a
soft, flexible tube inserted by
way of the nasopharynx with the
tip lying in the stomach
o A gastrostomy (G) tube is
surgically placed directly into
the patient’s stomach
o Generally, NG tube is used for
short-term treatment, whereas
the G tube is inserted for
patients requiring long-term
care
Topical drug administration
Topical drugs are those applied locally to the
skin or the membranous linings of the eye, ear,
nose, respiratory tract, urinary tract, vagina, and
rectum.
 Transdermal delivery system
o The use of transdermal patches
provides an effective means of
delivering certain medications
o Examples include nitroglycerin
for angina pectoris and
scopolamine (Transderm-Scop)
for motion sickness
o Drugs to be administered by this
route avoid the first-pass effect
in the liver and bypass digestive
enzymes.
 Ophthalmic administration
o Used to treat local conditions of
the eye and surrounding
structures
o Common indications include
excessive dryness, infections,
glaucoma, and dilation of the
pupils during eye examinations
o Ophthalmic drugs are available
in the form of eye irrigations,
drops, ointments, and medicated
discs
 Otic administration
o Used to treat local conditions of
the ear, including infections and
soft blockages of the auditory
canal
o Otic medications include
eardrops and irrigations, which
are usually ordered for cleaning
purposes
 Nasal administration
o Used for both local and
systemic drug administration
o The nasal mucosa provides an
excellent absorptive surface for
certain medications
o Advantages of this route include
 ease of use and avoidance of the
first-pass effect and digestive
enzymes
 Vaginal administration
o Used to deliver medications for
treating local infections and to
relieve vaginal pain and itching
o Vaginal medications are
inserted as suppositories,
creams, jellies, or foams
 Rectal administration
o A safe and effective means of
delivering drugs to patient who
are comatose or who are
experiencing nausea and
vomiting
o Appropriate alimentary route
when passage through the liver
is lessened
Parenteral drug administration
It refers to the dispensing of medications by
routes other than oral or topical. The parenteral
route delivers drugs via a needle into the skin
layers, subcutaneous tissue, muscles, or veins.
 Intradermal administration
o Injection into the skin delivers
drugs to the blood vessels that
supply the various layers of the
skin
o Drugs may be injected either
intradermal or subcutaneous, the
major difference of which is the
depth of injection
o ID injection is usually employed
for allergy and disease
screening or for local anesthetic
delivery
o Usual sites for ID injections are
the non-hairy skin surfaces of
the upper back, over the
scapulae, the high upper chest,
and the inner forearm
 Subcutaneous administration
o Delivered to the deepest layers
of the skin
o Body sites ideal for
subcutaneous injection includes:
 Outer aspect of the
upper arms, in the area
above the triceps
muscles
 Middle two thirds of the
anterior thigh area
 Subscapular areas of the
upper back
 Upper dorsogluteal and
ventrogluteal areas
 Abdominal areas, above
the iliac crest and below
the diaphragm, 1.5 to 2
inches out from the
umbilicus
 Intramuscular administration
o IM injection delivers medication
into specific muscles
o Because muscle tissue has rich
blood supply, medication moves
quickly into blood vessels to
produce a more rapid onset of
action than with oral, ID, or
subcutaneous administration
o Injection sites must be located
away form bone, large blood
vessels, and nerves
  Intravenous administration
o IV medications and fluids are
administered directly into the
bloodstream and are
immediately available for use
by the body
o Used when a very rapid onset of
Four common sites for intramuscular action is desired
injections: o As with other parenteral routes,
o Ventrogluteal site IV medications bypass the
 Preferred site for IM enzymatic process of the
injections digestive system and the first-
 Provides the greatest pass effect of the liver
thickness of gluteal Three basic types of IV administration:
muscles o Large-volume infusion
 contains no large blood  For fluid maintenance,
vessels or nerves replacement, or
 sealed off by bone and supplementation
contains less fat than  Compatible drugs may
the buttock area, thus be mixed into a large-
eliminating the need to volume IV container
determine the depth of with fluids such as
subcutaneous fat normal saline or
 suitable site for children Ringer’s lactate
and infants over 7 o Intermittent infusion
months of age  Small amount of IV
o Deltoid site solution that is arranged
 Site used in well- in tandem with or
developed teens and piggybacked to the
adults for volumes of primary large-volume
medication not to infusion
exceed 1ml because the  Used to instill adjunct
radial nerve lies in close medications, such as
proximity antibiotics or
o Dorsogluteal site analgesics, over a short
 Used for adults and time period
children who have been o IV bolus (push)
walking for at least 6 administration
months  Concentrated dose
 Rarely used due to delivered directly to the
potential for damage to circulation via syringe
the sciatic nerve to administer single-
o Vastus lateralis site dose medications
 Usually thick and well-  Bolus injections may be
developed in both adults given through an
and children intermittent injection
 The middle third of the port or by direct IV
muscle is the site for IM push
injections Effectiveness of IV meds is monitored 10-15
minutes after administration.

MEDICATION ORDER
A medication order is written directions
provided by a practicing practitioner for a
specific medication to be administered to an
individual. The prescribing practitioner may also
give a medication order verbally to a licensed
person such as a pharmacist or a nurse.  Single order – for a drug that is to be
Examples of some different types of medication given only once, and at a specific time,
orders are: such as a preoperative order
 Copy of a written prescription  Standing order – protocols derived
 Written order on a consultation form, from guidelines created by health care
signed by the practitioner providers for use in specific settings,
 Written list of medication orders, signed for treating certain diseases or sets of
by the practitioner symptoms
 Copy of a pharmacy call-in order, given  Standard order – may be an ongoing
to you by the pharmacist order, may be given for a specific
 A verbal order given to a licensed number of doses or days, may include
person PRN orders
 Electronic prescriptions signed  PRN medication orders – given on an
electronically via a secured system “as needed” basis for specific signs and
Medication orders symptoms
 STAT order
o This order refers to any
medication that is needed
immediately and is to be given
only once.
o It is often associated with
emergency medications that are
needed for life-threatening
situations
o Comes from statim, Latin word
meaning “immediately”
o The health care provider
normally notifies the nurse of
any STAT order so it can be
obtained from the pharmacy and
administered immediately
o The time between writing the
order and administering the
drug should be 5 minutes or less
 ASAP order
o As soon as possible
o Should be available for
administration to the patient
within 30 minutes of the written
order

PARTS OF PRESCRIPTION
An ideal prescription should have the following
parts:
 Date
 Superscription
 Inscription
 Subscription
 Transcription
 Signature