Chapter 2 Reading: Formulating Nursing Diagnoses

Chapter 2 Reading Chapter 2 discusses the application of pharmacology in nursing practice and emphasizes the importance of understanding drugs beyond just their administration. The nurse's responsibility extends to anticipating and responding to possible reactions and interactions between the drug and the patient. The chapter also emphasizes the need for nurses to acquire a broad knowledge of pharmacology to effectively contribute to patient care. Bullet points Formulating Nursing Diagnoses ● ● Nursing diagnoses are statements of actual or potential health problems nurses are qualified and licensed to treat Nursing diagnoses consist of statements of the patient's health problem, the probable cause or risk factors, and the signs, symptoms, or evidence Planning Interventions ● ● ● Nurses delineate specific interventions to solve or prevent identified problems The plan must be individualized for each patient Minimizing adverse interactions is important, such as avoiding hazardous drug-drug and drug-food interactions Implementation of Interventions ● ● ● Nurses carry out the interventions identified during planning Some interventions are collaborative, requiring a healthcare provider's order, while others are independent Implementation involves coordinating the actions of other members of the healthcare team Modification of the Nursing Process ● The nursing process is an ongoing process that must be modified as new data is gathered and the patient's situation changes Review of the Nursing Process ● ● ● ● ● ● The nursing process involves several steps: assessment, diagnosis, planning, implementation, and evaluation Assessment involves collecting data to tailor drug therapy to the individual Diagnosis helps identify potential risks and adverse effects Planning involves determining interventions that should be continued or discontinued Implementation involves carrying out the planned interventions Evaluation is performed to determine the outcomes of treatment Applying the Nursing Process in Drug Therapy ● ● ● ● Preadministration Assessment: Establishes baseline data needed to tailor drug therapy to the individual Collection of baseline data: Needed to evaluate therapeutic effects and adverse effects Identification of high-risk patients: Certain individuals may be at higher risk for adverse responses to specific drugs Assessment of the patient's capacity for self-care Factors Affecting Drug Response ● ● Several factors can affect an individual's response to a drug, including age, body composition, pregnancy, diet, genetic heritage, other drugs being used, and underlying medical conditions Factors that put the patient at extremely high risk are contraindications, while factors that put the patient at moderate or low risk are precautions Methods of data collection ● Important methods of data collection include interviewing the patient and family, observing the patient, performing a physical examination, checking the results of laboratory and radiologic tests, and taking the patient's medical and drug histories Precautions and precautions against adverse reactions ● ● A precaution can be defined as a condition that significantly increases the risk for an adverse reaction to a particular drug, but not to a degree that is life-threatening A precaution may require giving the drug along with other drugs or measures to decrease the severity of the allergic reaction Baseline data for evaluating therapeutic effects ● ● Baseline measurements of the parameter that therapy is directed at changing are needed to evaluate therapeutic effects For example, if a drug is given to lower blood pressure, the patient's blood pressure before treatment should be known to determine the effectiveness of the drug Assessment of the patient's capacity for self-care ● ● The patient's capacity for self-care must be determined to ensure they are willing and able to self-administer medication as prescribed If the patient is incapable of self-medication, alternative care must be arranged Baseline data for evaluating adverse effects ● ● All drugs have the ability to produce undesired effects, and in most cases, these adverse effects are known In some cases, baseline data are needed to determine whether an adverse effect is caused by the drug Factors affecting capacity for self-care and medication adherence ● Factors such as reduced visual acuity, limited manual dexterity, limited intellectual ability, severe mental illness, lack of understanding or motivation, financial constraints, and individual or cultural attitudes toward drugs can affect the patient's capacity for selfcare and the probability of adhering to the prescribed regimen Analysis and Nursing Diagnoses ● ○ Judge the appropriateness of the prescribed regimen ○ Identify potential health problems that the drug might cause ○ Determine whether the patient's capacity for self-care is impaired Nursing diagnosis applicable to almost every patient is "knowledge deficit related to the drug regimen" Planning ● ● Planning consists of defining goals, establishing priorities, identifying specific interventions, and establishing criteria for evaluating success Good planning allows promoting beneficial drug effects and anticipating adverse effects Defining Goals ● The goal of drug therapy is to produce maximum benefit with minimum harm Setting Priorities ● ● Highest priority is given to life-threatening conditions Less severe problems are relegated to lower positions when prioritizing care Identifying Interventions ● The heart of planning is identifying interventions Nursing interventions for adverse drug effects: ● ● Knowledge of adverse drug effects can help identify nursing interventions Nursing interventions can be divided into four major groups: Examples of nursing diagnoses derived from knowledge of adverse drug effects: ● ● ● ● ● ● ● ● ● ● ● ● Amphetamine: CNS stimulation - Disturbed sleep pattern related to drug-induced CNS excitation Aspirin: Gastric erosion - Pain related to aspirin-induced gastric erosion Atropine: Urinary retention - Urinary retention related to drug therapy Bethanechol: Stimulation of GI smooth muscle - Bowel incontinence related to a druginduced increase in bowel motility Cyclophosphamide: Reduction in white blood cell counts - Risk for infection related to drug-induced neutropenia Digoxin: Dysrhythmias - Ineffective tissue perfusion related to drug-induced cardiac dysrhythmias Furosemide: Excessive urine production - Deficient fluid volume related to drug-induced diuresis Gentamicin: Damage to the eighth cranial nerve - Disturbed sensory perception: hearing impairment related to drug therapy Glucocorticoids: Thinning of the skin - Impaired skin integrity related to drug therapy Haloperidol: Involuntary movements - Low self-esteem related to drug-induced involuntary movements Propranolol: Bradycardia - Decreased cardiac output related to drug-induced bradycardia Warfarin: Bleeding - Risk for injury related to drug-induced bleeding Facilities for managing reactions and rapid intervention should be available when administering a drug ● ● Delayed reactions can be minimized or avoided with proper planning Methods of evaluating adherence include measuring plasma drug levels, patient interviews, and pill counting Patient education and satisfaction ● ● ● ● Patient education is important for success in drug therapy Patient satisfaction with drug therapy promotes adherence Dissatisfaction can be caused by side effects, inconvenient dosing schedules, administration difficulties, and high cost If dissatisfaction is revealed, the regimen should be altered to improve acceptability Criteria for evaluating drug therapy ● Criteria for evaluation vary depending on the drug and its purpose ● Examples include decrease in pain for analgesics, normal laboratory test results for thyroid hormone therapy, and achievement of a target blood pressure goal for antihypertensives Implementation of the care plan in drug therapy ● Components include drug administration, patient education, interventions to promote therapeutic effects, and interventions to minimize adverse effects Summarizing nursing implications ● ● Nursing implications are integrated into the text to reinforce the relationship between pharmacologic knowledge and nursing practice Summaries of nursing implications are provided at the end of most chapters for easy reference on patient care and education Evaluation of drug therapy ● ● Patient must be evaluated for therapeutic responses and adverse drug reactions Criteria for evaluation may be modified based on the needs of pharmacology instruction Nursing responsibilities related to drugs ● ● ● ● Extend beyond the Rights of Drug Administration Include analyzing and diagnosing treatment appropriateness Identifying potential health problems and patient's capacity for self-care Acting as the patient's last defense against medication errors Practical applications of pharmacology in nursing ● ● Contribute to achieving therapeutic objectives of maximum benefit with minimum harm Individualize treatment based on knowledge of pharmacology Application of nursing process in drug therapy ● ● ● Individualizing treatment to achieve therapeutic objectives Performing preadministration assessment to gather data for evaluation Assessing therapeutic and adverse effects, identifying high-risk patients, and evaluating patient adherence and satisfaction