Chapter One: Pharmacology in the Nursing Process in LPN Practice

Introduction

• LPNs (Licensed Practical Nurses) play a crucial role in providing nursing care.
• Responsibilities of LPNs/LVNs (Licensed Vocational Nurses) are increasing due to a shortage of RNs (Registered Nurses).
• Delegation: RNs delegate tasks to LPNs, but the person who delegates remains accountable.

Nursing Process

• Five steps: Assessment, Diagnosis, Planning, Implementation, and Evaluation.
• Framework: Provides a scientific, standardized process to ensure quality patient care.
• Accountability: Helps ensure nurses are accountable for their practice.

ADPIE vs. AAPIE

• ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation.
• AAPIE: Assessment, Analysis, Planning, Implementation, Evaluation.

Role of LPNs in the Nursing Process

• LPNs contribute information but do not perform initial assessments, diagnosis, or initial planning independently.
• Practice settings: nursing homes, assisted living agencies, outpatient clinics, home health agencies, hospices, rehabs.

Assessment

• Objective and Subjective Data:
  • Subjective: What the patient says (e.g., pain level, palpitations).
  • Objective: Observable and measurable (e.g., vital signs, physical exam).
• Initial Assessment: Must be performed by an RN.
• Data Sources: Patient, family members, medical records, other healthcare providers, lab results.

Physical Examination

• Methods: Inspection, palpation, percussion, auscultation.
• Important for gathering thorough patient information.

Diagnosis

• Differentiation between medical and nursing diagnosis.
• LPNs contribute to nursing diagnoses by providing data.
• Common Nursing Diagnoses: Acute pain, impaired physical mobility, deficient knowledge related to drug therapy.

Planning

• Goals: Developed in collaboration with the patient and RN.
  • Must be patient-centered.
• Nursing Orders: Specific actions to help the patient meet goals.
• Consider factors like drug actions, contraindications, drug interactions, special storage requirements, and developing teaching plans.

Implementation

• Carry out the care plan, including drug administration.
• Monitor changes in the patient's condition.
• Nine Rights of Drug Administration: Right patient, right drug, right dose, right route, right time, right reason, right documentation, right response, right to refuse.

Handling Drug Orders

• Verify accuracy against Medication Administration Record (MAR) or Electronic MAR (Emar).
• Verify if type and dosage are appropriate.

Drug Administration

• Right Patient: Use two unique identifiers (name and date of birth).
• Right Drug: Verify drug label three times.
• Right Dose, Right Route, Right Time: Know hospital policies and the specifics of drug administration.

Documentation

• Complete documentation accurately after drug administration.
• Document PRN medications in both MAR and nurse's notes, along with the patient's response.
• Right to Refuse: Educate the patient and document refusal and the reason.

Evaluation

• Evaluate the patient's response to care and medication.
• Distinguish between assessment (before intervention) and evaluation (after intervention).
• Consider patient education, potential side effects, and compliance.

Classroom Response Questions

1. When a patient requests pain medication, assess their pain level first.
2. For a patient NPO for a barium study with due anti-epileptic medications, call the healthcare provider to clarify instructions.
3. If a patient claims a medication was not administered, check the MAR first.