The Nursing Process and Pharmacotherapy

Pharmacology and Nursing

 

1. United States Pharmacopoeia (USP) – a directory of drugs approved by the Food and Drug  Administration (FDA), the physical and chemical composition of each drug are listed here. Any of the drug included in this book met rigorous standards of quality, strength, purity. Also, the drugs that are listed here have permission to use the letter USP after the drug name (Wilkinson & Van Leuven, 2007, p.475).

2. Nursing drug handbooks – It is a quick resource of drug information like dosage and side effects and nursing interventions associated with a drug (Wilkinson, & Van Leuven, 2007, p.475).
3. Physicians Desk Reference (PDR) -the pharmaceutical companies financed this book and listed several thousand drugs with complete drug information and a standard resource for physician and pharmacist. The information on this book is the same found in drug package inserts. PDR does not include nursing interventions but contains information on dosing routes of administration and side effects (Wilkinson & Van Leuven, 2007, p.475).

We believe that these are the best resources in finding up-to-date drug therapy information. As an aspiring psychiatric nursing student, it is important for us to gain more knowledge about the current information of all medications because we have to make sure that we are giving the right medications to the right patients. In addition, Pharmacology textbook, Pharmacist and medication package inserts are also ways in finding drug therapy information.

Choose any drug you can think of and develop a list of nursing (not pharmacological) priorities for the drug you have selected. With that same drug set 2-3 realistic goals and outcomes if a client was going to be receiving that drug.

Nursing Process Focus Clients Receiving Warfarin

Assessment	Potential Nursing Diagnoses/Identified Patterns
Before administration: Gather a complete history of health containing current surgeries or trauma, allergies, history of drugs and viable drug interactions. Check vital signs; assess the baseline values of the client. Check for signs of bleeding and hemorrhage (bleeding gums, nosebleed, unusual bruising, tarry, black stool, fall in hematocrit, hematuria, fall in hematocrit or BP; guaiac-positive stools, urine, or nasogastric aspirate). Laboratory test considerations: PT, INR and other coagulation factors are often monitored during treatment. Geri: Patients over the age of 60 have a higher PT / INR response than expected. Monitor lower therapeutic ranges for side effects. Check for hepatic function and CBC before and annually throughout therapy Examine stool and urine for occult blood before and regularly during treatment.	Sufficient knowledge regarding drug therapy and adverse effects Safety from injury (bleeding, bruising) related to the adverse impacts of anticoagulant therapy Protection from physical damage such as falls Ineffective tissue perfusion Risk for injury Protection from infection
Planning: Client Goals and Expected Outcomes
The client will: Experience decrease in blood coagulability as evidenced by laboratory values and signs of adequate blood circulation Encounter a safe environment with no evidence of physical injury Indicate an understanding of the drug’s action by accurately describing drug side effects and precautions
Implementation
Interventions (Rationales)	Client Education/Discharge Planning
High Alert: Do not get mix up with Coumadin (Warfarin) to Avandia (rosiglitazone) or Cardura (doxazosin). Due to an extensive number of drugs that can alter the effects of warfarin significantly, careful monitoring is recommended when new agents or other agents are started or discontinued. Keep an eye for adverse clotting reactions. (Warfarin may cause microemboli of cholesterol resulting in gangrene, localized vasculitis or “purple syndrome of the toes. ” Notice signs of skin necrosis such as blue or purple mottling of the feet blanching with pressure or fading when the legs are raised. (Anticoagulant therapy for clients continues to be at risk of developing embolism, leading to CVA.) Caution should be applied to clients with GI, renal and liver disease, alcoholism, diabetes, hypertension, hyperlipidemia, and elderly and premenopausal women. (Clients with CAD risk factors are at higher risk of acquiring microemboli of cholesterol. Note for signs of bleeding: flu-like symptoms, extreme bruising, pallor, epistaxis, hemoptysis, hematemesis, menorrhagia, hematuria, melena, frank rectal bleeding, or excessive bleeding from wounds or in the mouth. (Bleeding is a sign of overdose of anticoagulant.) Monitor vital signs. (Increasing heart rate with low blood pressure or subnormal temperature can indicate bleeding.) Check laboratory values (aPTT- activated partial thromboplastin time, PTT- prothrombin time) for therapeutic values. (Since heparin metabolized by the liver and can cause significant SGOT{S-AST} and SGPT{S-ALT} elevations, these enzyme values should also be assessed. Monitor CBC (complete blood count), in premenopausal women in particular	Instruct client to report sudden dyspnea, chest pain, temperature or colour change in the hands, arms, legs and feet immediately (Gangrene may occur between day 3 and 8 of warfarin therapy. Purple toes syndrome usually occurs within weeks 3 to 10 or later.) Instruct client to feel the pulses of the pedal daily, to monitor circulation. Instruct client to wear loose-fitting socks to prevent feet injury; refrain going barefoot Inform elderly clients, menstruating women and those with peptic ulcer, alcoholism or kidney or liver disease that they have an immense risk of bleeding. Instruct client that despite anticoagulant therapy, diabetics and clients with high blood pressure or cholesterol are at risk of developing tiny clots. Check foods with high vitamin K. Patients should have consistently limited intakes of these foods, as vitamin K is the warfarin antidote, and alternating intakes of these foods will cause PT levels to fluctuate. Tell your patient during therapy to avoid cranberry juice or products. Notify client to report flu-like symptoms immediately (dysfunction, chills, weakness, pale skin); blood from a cough, nose, mouth or rectum; menstrual “flooding “; vomiting “coffee grounds; tarry stools; excessive bruising; wound bleeding that cannot stop within 10 minutes; all physical injury Inform the client to refrain from all contact sports and fun park rides that cause intense or violent jostling. Notify the client to use an electric shaver and a soft toothbrush. Advise the client to maintain a pad count to estimate blood loss during menstrual periods. Instruct client to report palpitations, fatigue or feeling faint immediately, which may signal low blood pressure associated with bleeding. Instruct client to always inform the laboratory staff of heparin therapy when giving a sample. Instruct client to carry a wallet card or wear heparin therapy medical ID.

References

• Adams, M. P., Urban, C. Q., El-Hussein, M., Osuji, J., King, S. (2018). Pharmacology for  Nurses: A Pathophysiological Approach. Don Mills, ON Pearson.
• Vallerand, A. H., Sanoski, C. & Deglin, J. H. (2017). Davis’s Drug Guide for Nurses (15^th Ed.).
• Philadelphia: F.A. Davis Company https://guides.library.harvard.edu/drug_resources
• Wilkinson, J., & Van Leuven, K. (2007). Fundamentals of Nursing: Theory, Concepts &
• Applications, Volume 1, p.475, F. A. Davis

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