The Nursing Process: Implementation and Evaluation (Nursing)

00:01 Okay, so we've talked that what a nurse does in assessing, diagnosing, and planning the medication plan.

00:07 Now it's time to implement it.

00:09 There's a decision that the nurse has to make, and that's whether to give the medication exactly as it's ordered, or you might determine that it's not safe for the patient to get the medication at this point, and so you hold the medication and contact the health care provider.

00:22 So, part of implementation is your decision if the medication should be administered exactly as it's ordered, or holding the medication because it's unsafe for the patient to receive it, and our responsibility is to notify the healthcare provider and discuss what the next best step is to keep that patient safe.

00:40 Finally, in the nursing process and clinical decision making, there's the evaluation.

00:45 Now, I'm part of the team that is responsible for evaluating the effectiveness of the medication.

00:50 You'll work with the health care provider, the pharmacist, and therapist to make sure that this medication is doing what we want it to do.

00:58 Now that's all of the steps of the nursing process and how we use them in clinical decision-making.

01:03 So, as you're putting in the hard work of studying drugs in pharmacology, remember, this is really what you're preparing yourself to do: to know how to safely assess, diagnose, plan, implement or not, and evaluate that medication treatment plan.

01:19 So let's talk about some examples of common evaluations that you do.

01:24 If I have a Level Of Pain patient, I have someone who comes in with chest pain or abdominal pain or any type of pain, I'm going to assess their pain, usually using a scale of 1 to 10.

01:34 So if you have a patient who admits with pain, you ask them, "Hey, on a scale of 1 to 10, with 1 being pretty light pain, and 10 being the most excruciating pain you've ever experienced, what number is this level of pain?" Then after I give the medication, depending on which route I give it, oral or IV, I come back at the appropriate time and ask the patient to give me another number.

01:56 Now, sometimes, patients can get frustrated with this because they think, "I just want you to take my pain away," but it's really important to try to walk them through how to give you a number or a level of pain, so you can evaluate if you're effectively treating their pain.

02:10 Now, cultural insensitivity.

02:11 This will be really fun when we look at the antibiotics.

02:14 I'll show you how to look at the lab work and make sure that your patient is on the right antibiotic, or the right drug for the right bug.

02:22 We look at a CBC.

02:23 Now this is when it's really fun to look at lab work and make sure you can tell if there's an improvement in infection.

02:28 If their white cell count is elevated, we know that's a sign of infection.

02:33 So we'll want that white cell count to be coming down back to normal if we know that the medication is effective.

02:38 Sometimes we look at urine output with diuretic therapy.

02:41 So we look at a total intake and output to see if we have a patient who we think is in fluid volume overload that we want to monitor that they're having a result from that diuretic therapy.

02:51 Now, we talked about pain in the first example, but chest pain is a particular type of emergency.

02:56 When a patient is having chest pain, we're risking heart muscle, so it's really important that we get a number from them and we give nitroglycerin to help relieve that pain and we get a number after we give the medication.