Agents produced in animal cells, microorganisms, or in the bodyitself

(ie: Hormones, vaccines)

Nursing Process

1.  Assess

History

Physical

Nursing Process

2.Diagnose

1. Primary medical problem

2. Secondary medical problems

3.Social, psychological, educational,environmental, safety,nutritional problems

Nursing Process

3. Plan

1. Therapeutic goal
2. Medication knowledge
3. Special Needs Equipment
4. Teaching Needs

Nursing Process

4. Implement

1. Right drug
2. Right time
3. Right dose
4. Right patient
5. Right route
6. Right documentation

Nursing Process

5. Evaluate

1. Therapeutic effects
2. Adverse effects
3. Allergy

Dictated by licensure and experience

RN: Licensure and authority to carry out all steps of the nursing process

LVN: Working under the supervision of the RN, assess, implement and evaluate with guidance

• Gathering information to develop a database, or record, from which all nursing process plans develop
• Requires skill and expertise of the nurse
• Two types of data
  • Subjective
  • Objective

• Subjective data: Information given by the patient or family. It includes the concerns or symptoms felt by the patient
• Objective data: Obtained through physical exam; information that is observed or could be verified by another. Collected from your physical assessment findings

• Patient
• Family
• Medical Records
• History
• Health Care Providers
• Lab Reports

• Inspection
• Palpation
• Percussion
• Auscultation

Drug History Assessment

Helpful information to be used in planning drug therapy

• Symptoms, signs, or diseases that explain need for medications
• Current (and sometimes past) use of medications and drugs
• Problems with drug therapy

• Conclusions about what the patients problems are
• Once the data is collected the "team" makes the diagnoses
  • Physician makes the medical DX
  • Nurse makes a nursing DX

• What are the major problems for the pt
• What brought them to the hospital
• How sick is the pt
• What procedures or meds will be needed
• What special concerns or cultural beliefs does the pt have
• What does the pt understand

Patient Goals: Help the pt 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 certain medication

1. Reason medication given (what is it supposed to do)
2. Learn info re: drug (desired effect, side effects, dosages,route & frequency,drug interactions, reasons not to give)
3. Special storage, techniques, or equipment
4. Develop pt teaching plan (what pt needs to know about side effects, admin of med, what pt needs to report to nurse or md and pt response)

• Verify accuracy of med by checking MAR against physician's original order
• Determine whether type of medication and dosage are appropriate for pt 

• Medication order is unclear or appears incorrect
• Pt's condition would decline with the medication
• Physician did not have all the relevant info needed before writing the order
• There is a change in pt condition

1. Right drug
2. Right dose
3. Right patient
4. Right route
5. Right time
6. Right documentation

Right Drug

Drug label verified three times

1. Before taking drug from unit dose cart or shelf
2. Before preparing prescribed dose
3. Before replacing drug on shelf or administering to patient

• Action of medication
• Hospital policy
• Patient routines

• Age
• Weight
• Health Status
• Recent changes in health status

• Verify pt using two identifiers (name, date of birth, ID #)
• Many pts at risk for misidentification (pediatric, geriatric, confused, non-English speaking

• Route alters affects of medications
• Nurses must not alter the route prescribed without physician's order

• If it isn't documented, it wasn't given
• Nurses should only document that they have given
• Document accurately after medication is administered

• Have therapeutic effects been seen?
• Have any side effects been seen?
• Have any allergic responses been seen?

Preparing a teaching plan

Nursing considerations involved with presenting education

• Planning teaching over time
• Planning to what the pt needs and what they can handle
• Informed consent

• Patient assessment
  • Need to learn
  • Willingness to learn
  • Mutually determined learning objectives
• Types of teaching methods
  • verbal, written, audiovisual, combo
• Pt return demonstration and/or verbalization
  • Give feedback and praise

• Role of pt stress and anxiety
• Planning and timing of sessions
• Learning capacity
• Variety of teaching methods
• Verbal education
  • group settings
• Written information
  • pt teaching resources
• Audiovisual resources
  • internet & navigating the web

• Nurse time constraints
• Cultural considerations and beliefs
  • Nurse and/or patient
• Common language between nurse and patient
• Written education
  • Literacy
  • Health literacy
• Pt problems resulting from inability to read or write
• Poor health outcomes
• Health disparity: increased risk for disease