Chapter 1: Pharmacology in the Nursing Process for LPN/LVN Practice

Introduction

• LPNs/LVNs are vital in providing nursing care.
• LPN responsibilities are set to grow as more RNs leave the workforce.
• Delegation: Tasks assigned to another person, but the delegator remains accountable.

Nursing Process Overview

• 5 Steps: Assessment, Diagnosis, Planning, Implementation, Evaluation.
• RNs have the authority for all steps; LPNs work under RN supervision mainly for assessment, implementation, and evaluation.
• LPNs contribute information but do not make initial diagnoses or plans.
• Practice settings: Nursing homes, assisted living, clinics, home health, hospices, rehabs.
• Role in Drug Administration: Significant in many facilities.

Steps of the Nursing Process

1. Assessment

• Purpose: Gathering information.
• Methods: Talking to patients, observing, reviewing records.
• Types of Data:
  • Subjective: Patient-reported, e.g., pain level.
  • Objective: Observable and measurable, e.g., vital signs.
• Roles: Initial assessment by RN; LPN can follow-up.
• Sources of Data: Patient, family, medical records.
• Physical Exam Techniques: Inspection, palpation, percussion, auscultation.

2. Diagnosis

• Medical vs. Nursing Diagnoses: MDs make medical diagnoses; RNs make nursing diagnoses.
• Role of LPN: Contributes to the nursing diagnosis but does not make the final determination.
• Examples: Acute pain, impaired mobility, deficient knowledge related to drug therapy.

3. Planning

• Goals/Outcomes: Patient-centered, short-term, and long-term.
• Nursing Orders: Specific actions to meet goals, including medication administration.
• Factors to Consider: Drug purpose, interactions, contraindications, need for special equipment, teaching plans.
• Critical Thinking: Verify orders, plan for safe and effective care.

4. Implementation

• Carrying out the Care Plan: Giving medications accurately.
• 9 Rights of Drug Administration:
  • Right patient: Use two unique identifiers.
  • Right drug: Verify label three times.
  • Right dose: Consider patient-specific factors.
  • Right route: Never assume, verify the prescribed method.
  • Right time: Generally within 1 hour before/after scheduled time. Exceptions: insulin, specific timing drugs.
  • Right reason: Understand why the medication is given.
  • Right documentation: Record only what you give.
  • Right response: Monitor for expected outcomes and side effects.
  • Right to refuse: Patients have the autonomy to refuse medication; document and notify the prescriber.

5. Evaluation

• Assessing Outcomes: Did the medication achieve the desired effect?
• Documentation: Record both expected and adverse reactions.
• Misconceptions: Differentiate between side effects and adverse effects.
• Patient Education: Explain time frames for drug effects, importance of compliance, and side effects.

Accountability & Responsibilities

• Nurse Accountability: Following the nursing process ensures quality care and accountability.
• Initial Teaching: Done by RNs, reinforced by LPNs.
• Order Clarification: If uncertain about an order, hold the medication and clarify with the prescriber.

Classroom Response Questions

1. Pain Medication Request: Assess the patient’s pain level first to follow the nursing process.
2. NPO Patient with Scheduled Meds: Call the healthcare provider to clarify instructions to ensure therapeutic levels.
3. Untaken 9 PM Medication: Check the medication administration record first to confirm if it was given.

Hope this was helpful!