The Nursing Process: Assessment (Nursing)

00:01 So let's talk about the nursing process in clinical decision making.

00:05 See, that's the difference in pharmacology.

00:07 We don't want you to just memorize drugs, this is clinical decision making. You're preparing yourself, not to be someone who just follows things remotely, but someone who actually gets in there and assesses the safety for each patient.

00:21 So it spells ADPIE.

00:23 I'll show you, the first letter, "A" stands for assessment.

00:26 Next, diagnosing.

00:28 "P" stands for planning.

00:30 "I" stands for implementation, and "E" for evaluation.

00:34 Now, you're going to see the nursing process all throughout your nursing program.

00:39 So this is something you're probably already familiar with, but we're going to talk about how we use these steps in clinical decision-making that involve medications.

00:49 So, our first example is that if we're treating someone's hypertension, their high blood pressure, and we're going to give them medication, we're going to check their blood pressure before we give them medication, and after the medication to make sure that it was effective.

01:02 Another example is if I have a patient who is diabetic and we're giving them insulin to manage their blood sugar.

01:07 We're going to check their blood sugar regularly in the hospital, particularly, because when a diabetic is ill, their blood sugar can be very erratic.

01:15 So before I would give insulin, I would check their blood sugar.

01:19 Sometimes, you look at lab values.

01:21 If I have a patient who is on some type of medication to treat clots, you may have heard them called blood thinners, we'll do things like look at their Prothombin time, their PT or their INR if someone's on something like warfarin, which is a type of blood thinner.

01:35 Now, we'll give that the more scientific name when we actually talk about those medications.

01:40 But for now, it's good enough to know that if someone's on a medication like a blood thinner and anticoagulant and antiplatelet, then we'll draw lab values to make sure they're within a safe range.

01:50 Now, there's some drugs that have serum levels that are drawn.

01:53 Digoxin is an example of one of those medications.

01:56 That's a cardiac glycoside that we use to treat patients with heart disease.

02:00 Meaning a very narrow window where the medication is safe, where they get just enough medication that it will do what we want it to do, but not too much medication that the patient will suffer with toxicity.

02:12 Another one is like gentamicin.

02:13 We do peak and trough levels on those medications.

02:17 Now, don't worry about trying to memorize all those things.

02:19 Those are just a way to give you examples to see that when we do assessment, sometimes there's very specific things we do for each medication, and sometimes there's not. So it'll be vital signs, lab values, or actually looking at some serum drug levels.

02:35 So here's something I always think through, both when I'm taking test questions, and when I'm giving medications to actual patients: "For this particular patient in this particular setting, is it reasonably safe for this patient to receive this medication?" So, you're just thinking through all those types of things based on the type of medication that you're giving for this patient in this particular setting, is it reasonably safe for them to receive this medication? Because it's our role to understand the risks and the adverse effects of any medication that we give.

03:07 So you want to know what the risks are compared to the patient's current status.

03:11 Now, let me explain what I mean.

03:13 If I give a diuretic to a patient that you may have heard that called a "water pill," that's sometimes what their elderly clients call that, but a diuretic causes you to lose excess volume from your body.

03:24 So when you lose excess volume, your blood pressure will drop.

03:28 So if I'm going to give a diuretic to a patient who already has low blood pressure or hypotension, that's going to be a big risk. And we're going to want to evaluate that very closely and monitor them very closely.

03:39 Also, when a patient has low blood pressure, they're at risk for falls.

03:45 Another example is someone, if they have low serum potassium, that means if we do lab work from them and the potassium was lower than normal, and they're taking digoxin, for this particular medication, a low potassium makes them at increased risk to become toxic to their digoxin.

04:03 The biggest risk with insulin is too low blood sugar.

04:06 We always worry about high blood sugar with diabetics, but when we give insulin, actually the biggest risk to the patient will be that their blood sugar will drop too low.

04:15 And last, if someone has kidney dysfunction. So, if someone can be in… starting to have kidney problems, either because of a trauma or another medication that they've got, we don't want to give a drug that's nephrotoxic, meaning it's toxic to the kidneys.

04:29 So, by you understanding the risk of each particular medication and knowing your patient, you can help keep them safe.