A HOLISTIC NURSING APPROACH IS

CRUCIAL TO THE SUCCESS OF DRUG THERAPY INITIATION, MAINTENANCE, AND EVALUATION

THERE ARE FOUR PHASES OF THE NURSING PROCESS THEY ARE:

ASSESSMENT (INCLUDING NURSING DIAGNOSIS), PLANNING, IMPLEMENTATION, AND EVALUATION.

ASSESSMENT PHASE

FIRST PHASE OF THE NURSING PROCESS, IS PARTICULARLY IMPORTANT BECAUSE THE DATA PROVIDED BY THE ASSESSMENT FORM THE BASIS ON WHICH CARE IS PLANNED, IMPLEMENTED, AND EVALUATED. DATA COLLECTION INVOLVES BOTH SUBJECTIVE AND OBJECTIVE INFORMATION.

SUBJECTIVE DATA

*PATIENT IS SUBJECT* SUBJECTIVE IS ONLY OBTAINED FROM PATIENT, BECAUSE ONLY THE PATIENT CAN TELL YOU IF THEY HAVE A HEADACHE, PAIN, OR WHERE AND HOW HE LIVES.

EXAMPLES OF DATA COLLECTED: CURRENT HEALTH HISTORY, SYMPTOMS, MEDICATIONS CURRENTLY ON, PAST HEALTH HISTORY, CLIENTS ENVIRONMENT (LANGUAGE, COMMUNICATION NEEDED, READ AND FOLLOW INSTRUCTIONS, KNOWLEDGE OF DRUG STORAGE, HOUSEHOLD MEMBERS, LEARNING STYLE...ETC....ETC)

OBJECTIVE DATA

GATHER FROM OBJECT (PATIENT) HERE YOU CAN ONLY GATHER DATA FROM WHAT YOU ARE ABLE TO SEE.
PHYSICAL ASSESSMENT, LABORATORY TESTS, DIAGNOSTIC STUDIES.

EXAMPLE: SWOLLEN FEET, HIGH BLOOD PRESSURE, LIMITATIONS.

DATA COLLECTION

SHOULD FOCUS ON SYMPTOMS AND THOSE ORGANS MOST LIKELY TO BE AFFECTED BY DRUG THERAPY. ASSESS MAJOR BODY SYSTEMS FOR ANY SIGNS OF REACTION OR INTERACTION OF DRUGS OR INEFFECTIVENESS OF THERAPY.

BASED ON ASSESSMENT DATA, THE NURSE MUST

IDENTIFY HIGH RISK CLIENTS (THOSE MOST LIKELY TO HAVE A ADVERSE REACTION)

THE CLIENTS ATTITUDE AND VALUES ABOUT TAKING MEDICATION ARE VERY IMPORTANT IN

PLANNING INTERVENTIONS TO SUPPORT THE CLIENTS DECISIONS TO ADOPT HEALTHY BEHAVIORS RELATED TO TAKING MEDICATIONS. CLIENTS SUPPORT SYSTEM IS EMPHASIZED, WHICH PROMOTES THE TAKING OF MEDICATION AS PRESCRIBED AND/OR NOTIFYING THE HEALTH CARE PROVIDER IF A PROBLEM ARISES.

ENHANCING CLIENT ADHERENCE WITH THE DRUG THERAPY REGIMEN IS AN ESSENTIAL COMPONENT OF HEALTH TEACHING. THE CLIENT AND FAMILY RESPONSE TO THE FOLLOWING THREE QUESTIONS PROVIDES THE NURSE WITH CRITICAL INFORMATION UNIQUE TO EACH CLIENTS TEACHING SITUATION:

1. WHAT THINGS HELP YOU TAKE YOUR MEDICINE AS PRESCRIBED?
2. WHAT THINGS PREVENT YOU FROM TAKING YOUR MEDICINE AS PRESCRIBED?
3. WHAT WOULD YOU DO IF YOU FORGOT TO TAKE A DOSE OF MEDICATION?

FACTORS OF NON-ADHERENCE INCLUDE:

FORGETFULNESS, KNOWLEDGE DEFICIT, SIDE EFFECTS, LOW SELF-ESTEEM, DEPRESSION, LACK OF TRUST IN THE HEALTH CARE SYSTEM, FAMILY PROBLEMS, LANGUAGE BARRIERS, HIGH COST OF MEDICATIONS, ANXIETY, VALUE SYSTEMS (RELIGIOUS AND OTHER), AND LACK OF MOTIVATION.

THE NURSES ROLE IS CRITICAL TO DRUG THERAPY. THE NURSE IS MOST OFTEN THE ONE PERSON WHO?

FOLLOWS THE CLIENT MOST CLOSELY AND THE ONE WHO IS FREQUENTLY FIRST TO ASSESS THE CLIENTS RESPONSE TO DRUGS. THE NURSE APPLIES KNOWLEDGE OF PHARMACOLOGY TO ANTICIPATE DRUG RESPONSES IN THE INDIVIDUAL CLIENT.

NURSING DIAGNOSIS IS MADE BASED ON?

THE ANALYSIS OF THE ASSESSMENT DATA. MORE THEN ONE APPLICABLE NURSING DIAGNOSIS MAY BE GENERATED AND A NURSING DIAGNOSIS MAY BE ACTUAL OR POTENTIAL.

NURSING DIAGNOSIS

THE REGISTERED NURSE FORMULATES NURSING DIAGNOSIS AND USES THEM, WITH THE ASSISTANCE OF OTHERS, TO GUIDE THE DEVELOPMENT OF A CARE PLAN.

NURSING DIAGNOSIS (TEST)

1. DEFICIENT KNOWLEDGE ABOUT DRUG ACTION, ADMINISTRATION, AND SIDE EFFECTS RELATED TO CULTURAL/LANGUAGE BARRIER
2. NONCOMPLIANCE RELATED TO FORGETFULNESS
3. INEFFECTIVE THERAPEUTIC REGIMEN MANAGEMENT

NURSING DIAGNOSIS VS. MEDICAL DIAGNOSIS

A NURSING DIAGNOSIS IS NOT A MEDICAL DIAGNOSIS. THE NURSE NEVER GIVES A MEDICAL DIAGNOSIS (CAN ONLY BE GIVEN BY SOMEONE LICENSED TO DO SO).
**NURSES NEVER DO MEDICAL DIAGNOSIS**
E.G. OF N.D.- AS RISK FOR A FALL, HOW TO PREVENT OR HELP, PATIENTS KNOWLEDGE ON MEDICATION, HOW TO HELP THEM UNDERSTAND BETTER....ETC...ETC..

3 PARTS OF A NURSING DIAGNOSIS

GOAL: WHATS GOING TO FIX DIAGNOSIS
ACTIONS: THINGS YOU DID TO FIX THE NURSING DIAGNOSIS
EVALUATION: DID YOU REACH THE GOAL

QUALITIES OF EFFECTIVE GOALS

SMART:
- CLIENT-CENTERED, CLEARLY STATES THE EXPECTED CHANGE
- ACCEPTABLE TO BOTH CLIENT AND NURSE
-REALISTIC AND MEASURABLE
-SHARED WITH OTHER HEALTH CARE PROVIDERS
-REALISTIC DEADLINES
- IDENTIFIES COMPONENTS FOR EVALUATION

GOALS HAVE TO BE __________ AND ___________.

MEASURABLE; REALISTIC

E.G. CAN A LEGALLY BLIND PATIENT DRAW UP HIS OWN INSULIN? NSGDX: TEACH DAUGHTER, THE PATIENT WILL TAKE MEDS WITH DAUGHTER

SMART (ACCEPTABLE COMPONENTS)

SPECIFIC
MEASURABLE
ATTAINABLE
REALISTIC
TIMED

THE PLANNING PHASE OF THE NURSING PROCESS IS CHARACTERIZED BY?

GOAL SETTING OR EXPECTED OUTCOMES. PLANNING ALSO INCLUDES DEVELOPMENT OF NURSING INTERVENTIONS THAT WILL BE USED TO ASSIST THE CLIENT TO MEET THE OUTCOME.

E.G. THE CLIENT WILL INDEPENDENTLY ADMINISTER PRESCRIBED DOSE OF ALBUTEROL BY THE END OF THE FIRST SESSION OF INSTRUCTION.

IMPLEMENTATION OCCURS ONCE THE?

NURSING INTERVENTIONS ARE ACTUALLY OUT INTO ACTION.

IMPLEMENTATION (INTERVENTIONS)

(ACTIONS)- NURSING ACTIONS NECESSARY TO ACCOMPLISH THE GOALS OR EXPECTED OUTCOMES.

-CLIENT TEACHING-*EDUCATION AND TEACHING ARE KEY IN THIS PHASE*

GENERAL, SELF-ADMINISTRATION, DIET, SIDE EFFECTS, AND CULTURAL AND GENETIC CONSIDERATIONS

CLIENT TEACHING

MORE EFFECTIVE IN AN ENVIRONMENT FREE OF DISTRACTIONS, AND THE INFORMATION SHOULD BE TAILORED TO THE CLIENTS INTEREST AND LEVER OF UNDERSTANDING.

ASSESSMENT DATA SUGGEST THE COMPLEXITY, NUMBER AND LENGTH OF TEACHING SESSIONS THAT ME BE REQUIRED.

BE SENSITIVE TO THE CLIENTS MOTIVATION TO LEARN, ATTENTION SPAN, AND LEVEL OF FRUSTRATION. READINESS SHOULD BE ASSESSED FIRST, BEFORE INFORMATION IS PRESENTED TO THE CLIENT. USE A POSITIVE APPROACH, BE AN ACTIVE LISTENER AND OBSERVER. INCLUSION OF A FAMILY MEMBER FRIEND IN THE TEACHING PLAN IS AN EXCELLENT IDEA. PROVIDE SIMPLE WRITTEN MATERIAL APPROPRIATE FOR INDIVIDUAL CLIENT NEEDS.

ASSESSMENT DATA GUIDE THE NURSE TO THE APPROPRIATE PERSON TO BE INCLUDED. THIS OTHER PERSON MAY:

1. ACT AS A PSYCHOLOGICAL SUPPORT
2. ACTUALLY ADMINISTER ALL OR PART OF THE DRUG THERAPY
3. OBSERVE THE EFFECTIVENESS AND SIDE EFFECT OF DRUG THERAPY.
4. IMPLEMENT OTHER CHANGES SUCH AS GOOD SHOPPING INSTITUTING NEW METHODS OF FOOD PREPARATION.

HELPFUL AND HEALTHFUL POINTS TO REMEMBER

-INSTRUCT CLIENT TO TAKE DRUG AS PRESCRIBED. IF YOU HAVE QUESTIONS CALL. IF THEY STOP DRUGS BEFORE THE COURSE IS COMPLETED MAY RESULT IN RELAPSE OR FUTURE INEFFECTIVENESS OF THE DRUG.
-KEEP MEDICATION IN ORIGINAL LABELED CONTAINER AND STORE AN INSTRUCTED.
-KEEP ALL MEDICATIONS OUT OF REACH OF CHILDREN.
-BEFORE USING ANY OTC OR HERBAL DRUGS CHECK WITH OUR HEALTHCARE PROVIDER. (AND IF PREGNANT)
-BRING ALL MEDICATIONS WITH YOU WHEN YOU VISIT THE HEALTHCARE PROVIDER.
-KNOW WHY YOU ARE TAKING EACH MEDICATION
-ALCOHOL MAY ALTER THE ACTION AND ABSORPTION OF THE MEDICATION. CAN CONTRAINDICATE WITH CERTAIN MEDICATIONS.
-SMOKING CONSTRICTS BLOOD VESSELS SO ITS SLOWS DOWN DISTRIBUTION.
-CONSULT YOUR HEALTH CARE PROVIDER OR PHARMACIST FOR SPECIFIC INFORMATION

ADDITIONAL TEACHING TIPS INCLUDE:

-ESTABLISH A TRUSTING RELATIONSHIP
-INCORPORATE INTERVENTIONS THAT INVOLVE STIMULATION OF SEVERAL SENSES.
-ACTIVELY INVOLVE THE CLIENT.
-PROVIDE WRITTEN INSTRUCTIONS IN ADDITION TO OTHER TEACHING AIDS.
-USE COLORFUL CHARTS, GRAPHS, AND A VARIETY OF MEDIA.
- ENCOURAGE QUESTIONS
- USE MATERIALS AND LANGUAGE APPROPRIATE FOR CLIENTS LEVEL OF UNDERSTANDING.
-REVIEW COMMUNITY RESOURCES, SUPPORT MULTIAGENCY RESOURCES.
-IDENTIFY CLIENTS AT RISK FOR NON-ADHERENCE. -EVALUATE THE CLIENTS UNDERSTANDING OF THE MEDICATION REGIMEN ON A REGULAR BASIS.
-EMPOWER THE CLIENT TO TAKE RESPONSIBILITY FOR MANAGING MEDICATION.

TOP 10 TIPS FOR SUCCESSFUL TEACHING SESSIONS

1. BE FOCUSED
2. ASSESS THE CLIENT
3. LISTEN TO THE CLIENT
4. KEEP IT SIMPLE
5. KNOW THE CLIENTS MOTIVATION
6. CONSIDER TIME CONSTRAINTS
7. PICK THE APPROPRIATE STRATEGY
8. KNOW YOUR RESOURCES
9. DOCUMENT YOUR TEACHING
10. TRUST YOURSELF

CHECKLIST FOR HEALTH TEACHING IN DRUG THERAPY

-COMPREHENSIVE DRUG AND HEALTH HISTORY
-REASON FOR MEDICATION THERAPY
-EXPECTED RESULTS
-SIDE EFFECTS AND ADVERSE REACTIONS
-WHEN TO NOTIFY HEALTH CARE PROVIDER OR PHARMACIST
-INTERACTIONS: DRUG-DRUG, DRUG-FOOD, DRUG-LABORATORY, DRUG-ENVIRONMENT INTERACTIONS.
-REQUIRED CHANGES INA ACTIVITIES OF DAILY LIVING (ADLs) E.G. OPERATING A DRIVING VEHICLE
-DEMONSTRATION OF LEARNING METHODS: LISTENING, DISCUSSION, AND RETURN DEMONSTRATION OF PSYCHOMOTOR SKILLS.
-MEDICATION SCHEDULE: ASSOCIATION WITH ADLs, RELATED DRUG LEVEL OF ACTION.
-RECORDING SYSTEM
-DISCUSSION AND MONITORING
-DEVELOPMENT AND SUPPORT OF BACKUP SYSTEM
- COMMUNICTY RESOURCES (NEED TO IDENTIFY ANY PROBLEMS WITH PATIENT GETTING/BUYING MEDICATIONS.

THE EVALUATION PHASE OF THE NURSING PROCESS:

THE EFFECTIVENESS OF HEALTH TEACHING ABOUT DRUG THERAPY AND ATTAINMENT OF GOALS ARE ADDRESSED. THE SPECIFIC OUTCOMES NEED TO BE ARTICULATED WITH THE CLIENT AND SIGNIFICANT OTHERS TO DETERMINE OF THE HAVE BEEN MET.
-IF GOAL/S NOT MET, REASSESS AND CONTINUE
*DID YOU FIT IS/OR NOT, WHY NOT, WHERE YOU CLOSE TO REACHING GOAL, HOW CAN YOU REASSESS TO MAKE IT REACHABLE.

IF GOAL IS NOT MET, THE NURSE (IN COLLABORATION WITH THE CLIENT WHEN POSSIBLE) NEEDS TO

DETERMINE THE REASONS FOR THIS AND REVISE THE PLAN ACCORDINGLY. THIS INCLUDES ADDITIONAL ASSESSMENT DATA AND THE SETTING OF NEW GOALS. IF THE GOAL IS MET, THE PLAN OF CARE OF COMPLETED.

TO COMPLETE THE CARE FOR ANY CURRENT CLIENT, FOLLOW THESE RECOMMENDATIONS:

-REVIEW WITH THE CLIENT AND FAMILY THE NEED FOR FOLLOW-UP CARE, IF REQUIRED.
-ENCOURAGE CHOICES IN ADLs
-REFER THE CLIENT TO COMMUNITY RESOURCES AS NECESSARY.