Chapter 1

Front 1

What factors will increase the future demand for nurses?

Back 1

1) Many more people are retiring
2) older people are living longer
3) chronic diseases are affecting more people
4) incidence of problems like obesity and dementia are increasing
5) more registered nurses are retiring and leaving the workforce and fewer RNs are being trained to replace them.

Front 2

The well known process that helps guide the nurse's work in logical steps is known as what?

Back 2

The Nursing Process

Front 3

The Nursing Process consists of what five major steps?

Back 3

1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluat

Front 4

Who has both the knowledge and the authority they need to carry out all the steps of the nursing process?

Back 4

Registered nurses

Front 5

What steps of the nursing process will the LPN need to work with the RN?

Back 5

Diagnosis and Planning

Hint 5

If starts with a vowel, LPN can do independently. If not, RN will be involved.

Front 6

It is usually the LPN who takes VS, checks responses to medications and treatments and monitors symptoms the patient is having, RNs and LPNs work together to carry out what steps?

Back 6

To carry out medication or treatment orders written by health care providers.

Front 7

This step involves looking and listening carefully. It is a process that helps you get information about the patient, patient's problem, and anything that may influence the choice of drug to be given to the patient.

Back 7

Assessment Step

Front 8

What information is involved in the 'Assessment' step

Back 8

Assessment means getting information by talking to the patient, looking at old records, or reviewing materials that the patient may bring. When the patient is admitted to the hospital, ask carefully about any current health problems, as well as any history of illnesses, surgery, and medications taken both now and in the past. This information is important for all team members to know and helps everyone plan the patient's care. Information in the patient's history often directs the nurse and the physician to look for certain physical signs of illness that may be present.

Front 9

What is a database used for in the assessment step?

Back 9

It is a record from which all nursing-process plans will grow.

Front 10

What questions are involved in the 'Assessment'?

Back 10

ask carefully about any current health problems, as well as any history of illnesses, surgery, and medications taken both now and in the past. This information is important for all team members to know and helps everyone plan the patient's care. Information in the patient's history often directs the nurse and the physician to look for certain physical signs of illness that may be present.

Front 11

What 2 categories does information you obtain from the assessment fall into?

Back 11

Subjective and Objective data

Front 12

Define Subjective data

Back 12

information given by the patient or family, includes the concerns or symptoms felt by the patient. Examples of subjective data include:

•The chief problem of the patient (in the patient's own words)
•The detailed history of the present illness
•The medical history of the patient
•The family medical history
•Social information: the patient's job, education level, and cultural background
•A review of problems found in different body systems

Front 13

Define Objective data

Back 13

obtained from physical examination. old laboratory results, electrocardiogram (ECG) printouts, or x-rays, and from info during the physical exam. Pts may bring medicines with them. Objective data are gathered through assessment of VS, physical findings you can see during inspection, results of recent lab tests and diagnostic procedures.

Front 14

What techniques are used during assessment?

Back 14

Inspection
palpation
percussion
auscultation

Front 15

Why is it important to get subjective and objective assessment data when pt is first seen or on admission to hospital?

Back 15

This provides initial or baseline information used to determine how ill the patient may be.

Front 16

How big a role you (LPN) plays in assessing pt is defined by whom?

Back 16

By your state nursing practice act which lists what LPNs may and may not do.

Front 17

Who are your 'primary source', 'secondary source', and 'tertiary sources' for assessment data?

Back 17

primary = patient
secondary = patient's relative or old medical records
tertiary = nursing books, internet

Front 18

During assessment it is important to take special note of what?

Back 18

drug history of patient

Hint 18

This is very helpful in planning drug therapy

Front 19

What areas does the nurse assess when asking about the patient's drug history?

Back 19

1. Symptoms, signs, or diseases that explain the patient's need for medication (high B/P)
2. Current (and sometimes past) use of all meds:
All prescription meds
• OTC meds
• Alcohol/street drugs
• CAM
3. Any problems with drug therapy:
•Allergies
•Diseases that may prohibit or limit use.
Also assess changes in pt condition/status influencing drug therapy during hospitalization.

Front 20

After assessing the patient you will make your own decisions about some questions which are what?

Back 20

•What are the major problems of this patient?
•How sick is this patient?
•What procedures or medications will this patient require?
•What special knowledge or equipment is required in giving these medications?
•What special concerns or cultural beliefs does the patient have?
•How much does this patient understand about the treatment and medicine prescribed? Answers to these questions will help you set goals of nursing care, affect how closely you work with the pt and tell you what type of pt education is needed.

Front 21

What is the purpose of patient goals on a care plan?

Back 21

To help the patient learn about a medication and how to use it properly.

Front 22

What is the purpose of nursing goals on a care plan?

Back 22

They help the nurse plan what equipment or procedures are needed to give the medication.

Front 23

Will the importance of problems change once established as part of the care plan?

Back 23

yes, importance may shift as the patient's condition changes.

Front 24

Planning to give a med involves what 4 steps? RIST

Back 24

1. reason or goal for each med.
2. Learn specific information about the medication:
•The desired action of the drug
•Side effects that may develop
•The usual dosage, route, and frequency
•contraindications
•Drug interactions
3. Plan for special storage or procedures, techniques, or equipment needs.
4. Develop a teaching plan for the patient, including:
•What the pt needs to know about the med
•What pt needs to know about the admin of me
•What the pt needs to report to the nurse or physician about med

Front 25

What is the most important step of the planning process?

Back 25

Is to collect and use info about pt and meds.

Front 26

Who is able to order medications?

Back 26

doctors , Nurse practitioners, nurse midwives, nurse anesthetists, and physician assistants, staff hospitalist. A teaching hospital may have resident's that can write scripts.

Front 27

Once med is ordered, what is the nurse responsible for?

Back 27

The nurse must verify that the order is correct by checking medication chart, medication card, medication admin record, or computer med record with original order. This must be done each time the med is given.

Front 28

True or False: The nurse is not responsible for an incorrectly written order?

Back 28

False, the nurse must apply knowledge of the specific drug order to determine whether the drug and dosage ordered seem correct. No part of the order or reason giving the order s/b unclear.

Front 29

What does the nurse do if the order is unclear?

Back 29

Use good judgment in carrying out the med order. If you decide that (1) any part of the order is incorrect or unclear, (2) the pt's condition would be made worse by the med, (3) the physician may not have had all the info needed about the patient when drug therapy was planned, or (4) there has been a change in the pt's condition and a question has arisen about whether the medication should be given, the medication should be withheld until the question can be answered and the physician called.

Front 30

What does the nurse do about an unclear order and the physician cannot be contacted?

Back 30

Do not change the order under question, notify the charge nurse and the nursing supervisor as soon as possible.

Front 31

The planning step of the nursing process is also the time to do the what?

Back 31

1. Get any special equipment you need to give the medication (such as intravenous [IV] infusion bottles, IV poles, or nebulizers).
2. Review any special procedures you will need to give the medicine (such as the Z-track injection technique or the IV-push policy).
3. Decide what you will need to tell the patient.
All info can be written on nursing care plan or in Kardex, or entered into computer so other team members can see the plan.

Front 32

This step of the nursing process involves giving the medicine accurately to the patient.

Back 32

Implementation

Front 33

During the implementation step the nurses job is what?

Back 33

1) understand why medication is ordered, 2) know drug's actions, 3) know how to safely administer it.

Front 34

Implementation step may also require what before the medication can be given?

Back 34

You may have to check pt's pulse before giving digitalis (for example) to ensure it may be safe to give and not make pt's condition worse. If any adverse reactions, be sure to record in pt record.

Front 35

What are the six "rights" of medication administration?

Back 35

1 The right drug
2 The right time
3 The right dose
4 The right patient
5 The right route
6 The right documentation

Hint 35

PDDRTD

Front 36

During the right drug step what must be done?

Back 36

Check spelling of the name and the dose of each med before any drug is given. Be aware of generic and trade names.

Front 37

Before administering a drug you must read the label at least three times. When are these?

Back 37

1. Before taking the drug from the unit-dose cart or shelf
2. Before preparing or measuring the prescribed dose of medication
3. Before putting the medication back on the shelf or just before opening the medication when giving to pt

Front 38

To be effective, when should drugs be given?

Back 38

On schedule day and night to keep the level of medication constant in the body.

Front 39

What type of patient activities may you need to plan around when giving meds?

Back 39

1) Pts undergoing eval of thyroid function need to have blood tests for those functions done before having gallbladder x-ray studies, b/c use of chemicals that may confuse thyroid function study results or make them inaccurate. 2)Pts with infection need to have culture specimens done before starting antibiotic therapy. Most meds are usually given they absorb best and have least risk for side effects.

Front 40

What should the nurse check if the patient is taking several meds at one time?

Back 40

Check to make sure the drugs do not interfere with each other.

Front 41

What is important to check when it comes to PRN meds?

Back 41

The nurse should verify that someone else hasn't already given the PRN med or that it is the appropriate time to give the med.

Front 42

What are the major things to remember when giving meds?

Back 42

• Understand/follow rules of facility regarding the times to give scheduled drugs.
• Follow drug treatment guides to achieve the best drug absorption and to limit chances for drug interactions with other drugs. Give medications as ordered to help keep blood levels constant.
• Plan drug therapy keeping in mind other diagnostic and laboratory testing plans.
• Be especially careful in giving prn or stat medications to avoid the risk of overdosing the patient (giving too much medicine).

Front 43

The amount of med to be given is usually ordered for the "average" person. Who may be at harm and require changes to this order?

Back 43

A patient who is old, who has severe weight loss as a result of illness, or who is small or very obese may require changes in the usual dosages.

Front 44

What else is required when giving the correct dose of med?

Back 44

Giving the correct dosage of med also requires that you use the proper equipment.

Front 45

How do you ensure you are giving the medication to the right patient?

Back 45

Verify patient name & birth date while examining wristband.

Front 46

What group of patients are most at risk for errors in giving the meds?

Back 46

the pediatric patient, the geriatric patient, the non–English-speaking patient, and the very confused or critically ill patient. The common factor among these four groups is that it might be hard for them to tell the nurse who they are.

Front 47

What do you do in the hospital when giving the med and the patient is missing their wristband?

Back 47

Never give a pat who is not wearing an identification bracelet.

Front 48

What does the nurse do if an order states the incorrect method of giving a medication?

Back 48

The nurse must never change routes of how a med is given without getting a new order. The dose is always different for different routes.

Front 49

What is the preferred route of giving a medication?

Back 49

Oral route is the preferred route if the pt is oriented. But is a faster delivery or higher blood level of a drug is needed IV or IM may be required.

Front 50

Why is an IM injection not always preferred over IV?

Back 50

IM injections can be very painful

Front 51

When should you chart that a medication was given?

Back 51

Immediately following administration as possible.

Front 52

Agency rules for IM meds may include what requirements for documentation?

Back 52

Where on the body you gave the injection and any complaints made by the patient at the time of injection.

Front 53

What should always be included in documentation of a drug given?

Back 53

The drug given, the dose, and time it was actually given (not when it was suppose to be given). Also pts response to the med. Along with if the pt does not receive the med notify the in-charge nurse or the person who wrote the order.

Front 54

It is okay to give a medication prepared by another nurse? True or False?

Back 54

False, you should never give medication prepared by another nurse.

Front 55

What do you do if a dr. wants to give a medication?

Back 55

You should prepare the medication. And then follow the physician to give the medication to see it's given as ordered and write in notes that physician gave medication.

Front 56

The process of looking at what happens when the care plan is put into action.

Back 56

Evaluation

Front 57

Evaluation of what happens after a pt is given a drug helps the healthcare team determine what?

Back 57

whether to proceed with the plan because it is working or if a change is needed. It also is important to watch the patient and look for any adverse reactions, side effects, or allergic responses.

Front 58

What does the nurse check for in response to drug therapy?

Back 58

The nurse checks for two types of responses to drug therapy: therapeutic effects and adverse effects.

Front 59

When the drug does what it was supposed to do

Back 59

Therapeutic effects are seen

Front 60

When patients do not respond to their medications in the way they should or develop new signs or symptoms.

Back 60

They are having adverse or side effects to a medication.

Front 61

Sometimes a side effects such as N&V may be stopped how?

Back 61

By decreasing the dosage or by giving the med with food. The physican will decide if the pt should keep taking the drug or if it should be stopped.

Front 62

What are the critical decision points in administering drugs?

Back 62

• Assess pt and understand why pt getting med.
• Prepare med to be given
• calculate dosages.
• Administer the med
• Document the medications given.
• Watch the pt's reaction and evaluate the response.
• Educate the patient about medications.

Hint 62

APCADW