The Nursing Process: Diagnosis and Planning (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides 01-02 The Responsibility of Nurses and Medication.pdf
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      Reference List Pharmacology Nursing.pdf
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    00:01 Okay.

    00:02 So we've talked about assessment.

    00:04 Now we're going to talk about the diagnosis and planning part of the nursing process when it comes to making clinical decisions about medications.

    00:11 So this happens after you've got the assessment data and you've got that all collected, then you look at their patient's condition and their medical needs.

    00:18 Remember, we talked about possible nephrotoxicity and other things that we've assessed.

    00:23 So remember, the goal of giving any medication is that we want the patient to get the maximum benefit with a minimum of the adverse effects, because, as you remember from our other video, there are no ideal medications.

    00:36 And we have to weigh out the benefits with the potential risks for any of the patients that we give medications to.

    00:43 So, what can we do to make sure we keep our patients safe, be that they get the most benefit out of their drugs? Well, you have to understand the intended effect of the medication for the patient in order to make sure that you're doing the right assessments.

    00:57 Some drugs can be given for multiple reasons.

    01:00 Take beta blockers, for instance.

    01:01 We can give beta blockers to manage blood pressure, anxiety, migraines, and we give them in all different dosages and types of routes.

    01:10 So you need to understand why your patient is getting that particular medication, and what we're trying to treat with it, so you know the appropriate assessments to take.

    01:19 Now, you want to make sure that your knowledge is up to date.

    01:22 Now, you can't know everything about every medication, and that's why most hospitals have great systems for you to look up medications and you'll work with a pharmacist who's on the team to help make sure that you have a good idea of what adverse effects might happen for that patient.

    01:38 And also, don't forget to listen to your patients.

    01:41 If they tell you they're having a symptom with a certain medication, believe them and follow up on it.

    01:47 And last, you want to take proactive steps.

    01:51 So if you know a drug has a certain adverse effect, you want to pre-medicate or take whatever steps you can to minimize that.

    01:57 Now, we've talked about Red man syndrome before with vancomycin, but we would premedicate them with probably some acetaminophen to deal with that flushing and that possible pain, and we would also give the medication very slowly.

    02:10 Because with vancomycin, we know that certain people have this really strange adverse effect.

    02:16 Now, it's not going to kill them, but it makes the patient really uncomfortable.

    02:20 So since we know that vancomycin can cause that type of effect, we premedicate with some acetaminophen, and we give the medication slowly to make sure we minimize the risk of the patient experiencing that.

    02:33 If we give corticosteroids to a patient, that can cause adrenal gland suppression.

    02:37 Now, your adrenal glands live on top of your kidneys, and they do lots of important things in your body.

    02:42 But when we give a patient corticosteroids, those glands don't really have to do what they're intended to do, so they get kind of lazy or suppressed.

    02:50 So it's very important when you give a patient corticosteroids that we know, kind of, how that adrenal gland is functioning, and that you don't abruptly stop steroids.

    02:58 That's why you wean them off.

    03:00 The higher the dosage, the longer a patient is on corticosteroids, the more likely they are to have adrenal gland suppression.

    03:06 So let's go back and walk through this slide just one more time.

    03:10 How do I help a patient get the most benefit out of a drug and minimize their adverse effects? I have to understand the intended effect of the medication, know why they're getting that medication.

    03:21 I need to know that my knowledge is up to date on adverse effects and risks for this patient.

    03:27 And I want to be proactive in taking the steps for known reactions to help minimize that for your patient.

    03:34 Now, drug interactions is something that you'll work very closely with your pharmacist on.

    03:39 They catch a lot of those before they ever make it to you to give to the patient, but we're not off the hook.

    03:45 Remember, nurses are a really important part of that team.

    03:49 So you need to get a complete list of your patient's medications and supplements.

    03:54 Hey, that is easier than it sounds because many patients don't have a complete list.

    03:59 They don't present to you with a typewritten list of all the medications that they're on.

    04:04 Also, sometimes patients don't know to tell you about their supplements, so you need to be very careful in the word choices you use when you ask them.

    04:12 So ask them what medications have been prescribed by their physician.

    04:16 What medications do they get at their local drugstore, like Walgreens or CVS, then also ask them are there any supplements or vitamins or things that they get from maybe a health food store.

    04:27 It's not that patients want to hide that from you.

    04:30 Sometimes they just think that medications are only things prescribed by a health care provider.

    04:35 So make sure you get a thorough list of medications, and that we can look for potential drug interactions.

    04:42 One example is St. John's Wort.

    04:44 That can be purchased at any health food store, but it does not play well with hardly any other drugs.

    04:50 So we'll want the patients to remember those types of things by us asking the appropriate questions to assess their complete list of drugs.

    05:00 So, let's take a look at some examples.

    05:03 We're gonna look at the following medications and supplements and think about the potential drug interactions.

    05:09 Okay, so pause this slide for just a moment, and I want you to see if you can come up with some possible drug interactions.

    05:16 It's okay if you don't know them.

    05:18 Just guess the ones that you think you might.

    05:25 Okay.

    05:26 Let's walk through those.

    05:28 Now, what happens if someone is taking contraception or birth control, and they take an antibiotic? Surprise! That can be loss of protection and possibly, a baby, which is not what you're looking for if you're taking contraception.

    05:42 What if you take an ACE inhibitor, which is a blood pressure medication, and a potassium-sparing diuretic? Well, that can end up in hyperkalemia or potassium that is way too high.

    05:55 ACE inhibitors have a side effect of elevating your potassium.

    05:59 Potassium-sparing diuretics also elevate your potassium.

    06:02 So when a patient is taking two medications that have the same side effect, they're really at risk to have a really nasty side effect, so that's why hyperkalemia can be such a problem with those two meds.

    06:15 Now, what if you take a central-acting antihistamine, like Benadryl or Diphenhydramine, plus another sedative; could be alcohol.

    06:24 What would happen? Patient's at a risk for over sedation.

    06:29 What about MAOIs? That's a psych med and aged foods that have tyramine, like aged special cheeses or aged salamis or aged wines? Yeah, you can end up with a hypertensive crisis.

    06:43 So patients on MAOIs have to have very strict dietary education about what foods they cannot eat without risk of going into a blood pressure hypertensive crisis.

    06:54 Now, IV medications in certain fluids also might cause a precipitate.

    06:58 So if you mix certain IV medications in fluids in the same line, you'll end up with precipitate, which is not a good idea in your bloodstream.

    07:07 So, these are examples of potential drug interactions that every nurse should know before they give the medication.

    07:14 Remember, you're not alone in this.

    07:16 You can always contact your pharmacist and ask them about any particular questions that you have, but there's just basics that you should know as you go through the process of giving patients medications.

    About the Lecture

    The lecture The Nursing Process: Diagnosis and Planning (Nursing) by Rhonda Lawes, PhD, RN is from the course Pharmacology and Implications for Nursing.

    Included Quiz Questions

    1. Flushing
    2. Nausea
    3. Ototoxicity
    4. Vision loss
    1. Current medications prescribed by the health care provider
    2. Vitamins and minerals taken without prescription
    3. Over-the-counter medications or herbal supplements taken
    4. Frequency of fast food eating
    5. Nutritional and medication allergies
    1. Do not mix diphenhydramine with other central nervous system depressants like alcohol
    2. Don't take diphenhydramine in the morning
    3. Don't take diphenhydramine with drugs that cause central nervous system stimulation, like caffeine
    4. Do not take diphenhydramine with ACE inhibitors
    1. A pharmacist
    2. The client's chart
    3. An online search engine
    4. A drug information handbook

    Author of lecture The Nursing Process: Diagnosis and Planning (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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