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Chapter 1
Pharmacology and the Nursing Process
in LPN Practice
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Chapter 1
Lesson 1.1
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Learning Objectives
• List the five steps of the nursing process
• Identify subjective and objective data
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Five Steps of the Nursing
Process
1.
2.
3.
4.
5.
Assessment
Diagnosis
Planning
Implementation
Evaluation
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The Nursing Process
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Responsibilities
• Dictated by licensure and experience
RN: licensure and authority to carry out all
steps of the nursing process
LPN/LVN: working under the supervision of
the RN; assess, implement, and evaluate
with guidance
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Assessment
• Gathering information to develop a
database, or record, from which all
nursing process plans develop
• Requires skill and expertise of the nurse
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Assessment (cont.)
• Two types of data:
Subjective data: obtained through
questioning; information that cannot be
measured
Objective data: obtained through observation;
information that is observed or could be
verified by another
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Sources of Information
•
•
•
•
•
•
Patient
Family
Medical Records
History
Health Care Providers
Lab Reports
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Sources of Information (cont.)
• Techniques used to obtain objective
data:
Inspection = close observation
Palpation = feeling
Percussion = detecting differences in
vibrations through the skin
Auscultation = listening with a stethoscope
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Drug History Assessment
• Helpful information to be used in
planning drug therapy:
– Symptoms, signs, or diseases that explain
need for medication
– Current (and sometimes past) use of
medications and drugs
– Problems with drug therapy
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Chapter 1
Lesson 1.2
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Learning Objectives
• Discuss how the nursing process is
used in administering medications
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Diagnosis
A conclusion about what the patient’s
problems are.
• The physician makes a medical diagnosis.
• The nurse makes a nursing diagnosis.
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Diagnosis (cont.)
To make a nursing diagnosis ask:
– What are the major problems for the patient?
– What procedures or medications will the
patient require?
– What special knowledge or equipment is
required to give these medications?
– What special concerns or cultural beliefs does
the patient have?
– What does the patient understand?
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Diagnosis (cont.)
• Once the nursing diagnosis is made, a
plan of care is initiated that includes
patient and nurse involvement.
• Goals are established.
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Planning
• Patient goals
– Help the patient learn about a medication
and how to use it properly.
• Nursing goals
– Help the nurse plan what equipment or
procedures are needed to administer a
medication.
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Four Steps of Planning
1. Determine the reason for each
medication to be given.
2. Learn information regarding the
medication.
3. Plan for special storage, techniques,
or equipment.
4. Develop a patient teaching plan.
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Four Steps of Planning (cont.)
Prior to medication administration,
critical thinking is essential to:
– Verify the accuracy of the medication by
checking the medication record against the
physician’s original order.
– Determine whether the type of medication and
dosage are appropriate for the patient.
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Planning
If the nurse determines:
– the medication order is unclear or appears
incorrect
– the patient’s condition would decline with the
medication
– the physician did not have all the relevant
information needed before writing the order
– there is a change in patient condition
The medication is HELD until the order is
clarified.
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Chapter 1
Lesson 1.3
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Learning Objectives
• List specific nursing activities related to
assessing, diagnosing, planning,
implementing, and evaluating the
patient's response to medications
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Implementation
• Six Rights of Medication Administration
1.
2.
3.
4.
5.
6.
Right drug
Right time
Right dose
Right patient
Right route
Right documentation
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Right Drug
• Drug label is verified three times
1. Before taking the drug from the unit dose
cart or shelf
2. Before preparing the prescribed dose
3. Before replacing the medication on the shelf
or before administering it to the patient
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Right Time
Considerations:
– Action of the medication
– Hospital policies
– Patient routines
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Right Dose
Considerations:
– Age
– Weight
– Health status
– Recent changes in health status
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Right Patient
• It is critical to identify patients using
objective data such as ID number, name,
date of birth.
• Many patients are at risk for
misidentification; for example, those
unable to effectively communicate with the
nurse (pediatric, geriatric, critically ill,
confused, non-English speaking patients).
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Right Route
• Routes alter effects of medications.
• Nurses must not alter the route
prescribed for a medication without a
physician’s order.
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Right Documentation
• If it isn’t documented, it wasn’t given.
• Nurses should only document what they
have given.
• Document accurately after the
medication is administered.
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Evaluation
• Have therapeutic effects from the
medication been seen?
• Have any side effects from the
medication been seen?
• Have any allergic responses from the
medication been seen?
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