Chapter 1
The Nursing Process and Drug Therapy

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

The Nursing Process
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A research-based organizational framework for professional nursing practice
Ensures the delivery of thorough, individualized, and quality nursing care to patients
Requires critical thinking
Ongoing and constantly evolving process

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Five Steps of the Nursing Process
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Assessment
Nursing diagnosis
Planning
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Goals
 Outcome criteria
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Implementation including patient education
Evaluation

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Assessment
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Data collection, review, and analysis
Medication profile
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Any and all drug use
Prescriptions
Over-the-counter medications
Vitamins, herbs, and supplements
Compliance and adherence

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Classroom Response Question
The nurse answers a patient’s call light and finds the patient sitting up in bed and requesting pain medication.
What will the nurse do first?
A. Check the orders and give the patient the requested pain medication.
B. Provide comfort measures to the patient.
C. Assess the patient’s pain and pain level.
D. Evaluate the effectiveness of previous pain medications. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Classroom Response Question
Answer
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Correct answer: C
Rationale: The nurse should always assess a patient before any intervention. Although the nurse will check the orders and possibly give the medication (and possibly even perform the actions in responses B and D), the first priority is assessment. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Nursing Diagnosis
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Nursing diagnoses are used to communicate and share information about the patient and the patient experience
Common nursing diagnoses related to drug therapy include: 
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Deficient knowledge
Risk for injury
Noncompliance

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Nursing Diagnosis
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Three-step process:
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Human response to illness, injury, or significant change
 Factors related to the response (“related to”)
 Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”)

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Planning
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Identification of goals and outcome criteria
Goals
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Objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria

Outcome criteria
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Concrete descriptions of patient goals

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Classroom Response Question
The patient’s medication administration record lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do?
A. Give the medications PO with a small sip of water.
B. Give the medications via the IV route because the patient is NPO.
C. Hold the medications until after the test is completed.
D. Call the health care provider to clarify the instructions.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Classroom Response Question
Answer
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Correct answer: D
Rationale: The dosage for the IV route would not be the same as for the PO route. Holding the medications may cause drug levels to drop and result in seizure activity, and giving the medications PO without consent may alter the test results. The nurse must never assume the route of medication administration and should consult the physician for clarification of the orders.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Implementation
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Initiation and completion of specific nursing actions as defined by the nursing diagnoses, goals, and outcome criteria Independent, collaborative, dependent