Chapter 1

Helpfulness: +1
Set Details Share
created 2 years ago by Julie_Wardia
186 views
The Nursing Process and Drug Therapy
updated 2 years ago by Julie_Wardia
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

The nursing process beings first with:

an understanding of underlying concepts associated with the art and science of nursing

2

The nursing process has a flexible, adaptable and adjustable five-step process consisting of:

assessment, nursing diagnoses, planning with outcome identification, with implementation including patient education and evaluation

3

The five-step nursing process ensures the:

delivery of thorough, individualized and quality nursing care to patients, regardless of age, gender, medical diagnosis or setting

4

Critical thinking is a major part of the nursing process and involves:

the use of though processes to gather information and then develop conclusions, make decisions, draw inferences and reflect upon all aspects of patient care.

5

The critical thinking elements address the:

physical, emotional, spiritual, sexual, financial, cultural and cognitive aspects of a patient

6

Subjective Data

include all spoken information shared by the patient, such as complaints, problems or stated needs

7

Objective data

include information available through the senses, such as what is seen, felt, heard and smelled. Chart, lab tests, diagnostic procedures, physical assessment and examination findings.

8

Once the assessment phase has been completed, the nurse analyzes:

objective and subjective data about the patient and the drug and formulates nursing diagnoses; there are 3 parts to assessment

9

Deficient knowledge

statement of the human response of the patient to illness, injury and medications or significant change.

10

Deficient knowledge can be:

an actual response, an increased risk or an opportunity to improve the patient's health status

11

Lack of experience with medication regiment and second-grade reading level as an adult

Identifies factors related to the response, it often includes multiple factors with some degree of connection between them

12

Evidenced by inability to person a return demonstration and inability to state adverse effects to report to the prescriber

lists clues, cues, evidence and/or data that support the nurse's claim that nursing diagnosis is accurate

13

The nursing diagnoses are prioritize in order of:

criticality based on patient's needs or problems

14

The ABC's of care are often used as basis for:

prioritization

15

ABC's of care are:

Airway, breathing, circulation

16

Prioritizing always begins with the:

most important, significant, or critical need of the patient

17

Nursing diagnoses that involve actual responses are always ranked:

above nursing diagnoses that involve risks.

18

The planning phase includes:

the identification of outcomes that are patient oriented and provide time frames

19

The planning outcomes are:

objective, realistic, and measurable patient-centered statements with time frames.

20

In the implementation phase, the nurse intervenes on behalf of the patient to address:

specific patient problems and needs.

21

The implementation phase is done through:

independent nursing actions. collaborative activities such as physical therapy, occupational therapy, and music therapy and implementation of medical orders.

22

Evaluation includes:

monitoring whether patient outcomes, as related to the nursing diagnoses are met

23

Monitoring includes:

observing for therapeutic effects of drug treatment as well as for adverse effects and toxicity.

24

If outcomes are met:

the nursing care plan may or may not be revised to include new nursing diagnoses

25

It outcomes are not met:

revisions are made to the entire nursing care plan with further evaluation

26

Nine rights of medication administration are:

right drug, right dose, right time, right route & form, right patient, right documentation, right reason, right response, right to refuse

27

Right drug begins with:

RN's valid license to practice

28

RN is responsible for:

checking all medication orders and/or prescriptions

29

Checking all medication orders and/or prescriptions is to ensure:

the correct drug is given

30

How can you make sure the correct drug is being given?

By checking the medication against the medication label tree times before giving medication

31

All med orders or prescriptions are required by law to be signed by the:

prescriber involved in the patient's care

32

If a verbal order is given,

the prescriber must sign the order within 24 hours or as per guidelines within a health care setting

33

Verbal orders are done in cases of:

emergencies and time-sensitive patient care situations

34

Avoid relying upon:

the knowledge of peers because this is unsafe nursing practice

35

What should a nurse know?

the drug's generic name

36

If there are any questions, who should you contact?

the prescriber

37

Never make:

assumptions

38

Right dose:

whenever a medication is ordered a dosage is identified from the prescriber's order

39

Always confirm that:

the dosage amount is appropriate for the patient's age and size

40

Use of a current, authoritative ______ ___________ is encouraged

drug reference

41

Check the prescribed dose against the:

available drug stocks and the normal dosage range

42

Recheck all:

mathematical calculations

43

A nurse should pay careful attention to:

decimal points

44

Is 0.2mg allowed?

Yes

45

Is 2.0 mg allowed?

no

46

Each health care setting or institution has a policy regarding:

routine medication administration times

47

The medication administration time policies need to be:

checked and committed to memory

48

Right time should be included in:

your 3 checks

49

Three checks are:

the frequency of the ordered medication, the time to be administered, and when the last dose of medication was given.

50

When giving a medication at the prescribe time, you may be confronted with:

a conflict between the timing suggested by the prescriber and specific pharmacokinetic or pharmacodynamics drug properties.

51

For routine medication orders, the standard of care is to:

give the medications no more than 1/2 hour before of after the actual time specified in prescriber's order

52

Military time is used when:

medication and other orders are written into a patient's chart

53

Other factors that must be considered in determining the right time:

multiple-drug therapy, drug-drug, drug-food, scheduling of diagnostic studies, bioavailability of drug, drug actions, biorythym effects

54

Be careful to write out all words and abbreviations because:

the possibility of miscommunication or misinterpretation poses a risk to the patient

55

You must know the particulars about each medication before administering it to ensure that:

the right drug, dose, route, and dosage form are being used.

56

Never assume:

the route

57

A complete medication order includes:

the route of administration

58

Checking the patient's identity before giving each medication dose is critical to the:

patient's safety

59

Confirm the name on the order and the patient, and be sure to use these identifiers:

ask the patient to state his or her names, then check the patient's identification band to confirm the patient's name, identification number, age and allergies

with pediatric patients, the parents and or legal guardians are often the ones who identify the patient for the purpose of administration of prescribed medications

60

The Joint Commission recommends that the patient be identified:

reliably and also that service or treatment be matched to that individual

61

Documentation of information related to medication administration is crucial to patient safety and:

recording patient observations and nursing actions has always been an important ethical responsibility

62

Documentation is now a major:

medical-legal consideration as well

63

Document administration:

only after the medication has been given

64

Document any drug action for:

changes in sysmptoms the patient is experiencing, adverse effects, toxicity and any other drug-related physical and or psychological symptoms

65

Documentation must also reflect any improvement in the patient's condition, symptoms or disease process as well as no change or a lack of improvement and you must:

document these observations and report them to the prescriber promptly

66

Document any teaching along with:

an assessment of the degree of understanding exhibited by the patient

67

What should you document?

If any drug is not administered and why and any actions taken.

Actual time of drug administration

Data regarding clinical observations and treatment of the patient if a med error has occurred

68

If med error has occurred complete:

an incident report

69

Do not record completion of an I.R. in:

med chart

70

Right reason is:

appropriateness in use of the medication to the patient

71

Right response is:

the drug and its desired response

72

Continually assess and evaluate the achievement of the desired response as well as:

any undesired response

73

Right to refuse:

always respect the patient's right

74

When a patient has refused a medication, you should:

determine reason, take appropriate action, including notifying prescriber.

75

Medication errors is a major problem for:

all of health care regardless of the setting

76

The national coordinating council for medication error reporting and prevention defines a medication error as:

any preventable event that may cause or lead to inappropriate medication use or patient harm while the me is in the control of the health care professional, patient or consumer