Angelite Nurses

Basic Critical Thinking Guidelines for Safe Drug Administration

Before administration:

• gather general baseline data
• VS, lab results, allergies, co-morbidities, Ht, Wt; liver, pulmonary, renal, neuro, nutrition, hydration status
• identify client factors
• affects on drug action from age, cultural factors, history
• determine purpose of therapy
• indication for drug; desired therapeutic outcome
• reconcile medication profile
• with client, family, nursing staff, provider
• verify prescription and client
• dose, time, calculations, dosing range, dispensing method

After administration:

• monitor client response
• therapeutic effect, adverse effects, toxicity
• document findings and act
• data requiring action or follow-up nursing care
• document nursing care
• describe: care before and after, drug administration
• evaluate care and process
• describe: med errors, problems so others, agency benefit

Client teaching

• instruct client and family about drug
• what to report; how to administer; food, substances, activities to avoid; need for follow-up care and testing

Basic Nursing Care to Prevent or Minimize Common Adverse Effects of Drug Therapy

• Adverse effect: nursing care, monitoring, teaching
• nausea, vomiting, anorexia
• collaborate for antiemetic, eliminate triggers, maintain NPO status
• monitor F/E balance, bowel sounds and pattern, food intake
• teaching: small, frequent meals, breathing techniques; avoid triggers
• constipation
• provide fluid, fiber, stool softener, encourage ambulation
• monitor bowel sounds, pattern; review diet for fluid, fiber
• teaching: increase fluid, fiber; ambulate; establish bowel habits
• diarrhea
• provide hygiene, skin care, close supervision to prevent injury
• monitor bowel pattern, F/E balance, weakness, skin, cultures
• teaching: increase fluid intake, wash hands, avoid irritating foods
• rash, allergy
• screen for allergies, previous reactions, provide skin care
• monitor airway, breathing, BP, skin, pruritus, cultures
• teaching: report dypsnea, pruritus, hives, worsening condition
• hypotension, dizziness
• maintain supine position, encourage fluids, review med profile
• monitor VS, Sa0₂, EKG, level of consciousness, U/O
• teaching: remain in bed; ask for help to stand; avoid alcohol, sedation

Basic Nursing Care to Prevent or Minimize Adverse Effects of a Drug Class or Type

• Drug class or type with related adverse effects: nursing care, monitoring, and teaching
• antihypertensives: orthostatic hypotension, F/E imbalance
• assist with activity; eliminate drug interactions, vasodilators, CNS depressants
• monitor BP, pulse, breath sounds, serum electrolyte levels, edema, dizziness
• teaching: get help to stand, report dizziness; avoid alcohol, sedatives, OTC agents, caffeine
• anticholinergic agents: dry mouth, constipation, blurred vision
• provide sips of water, oral care; assist with activity; remove environmental hazards
• monitor bowel pattern, vision, oral mucous membranes
• teaching: frequent oral care, avoid dangerous activity, ask for help to stand
• anticoagulants and antiplatelet agents: bleeding
• minimize invasive procedures, shaving; provide gentle oral care; assist with activity
• monitor bleeding, coagulation tests, CBC, bruising; remove adverse drug and food affects
• teaching: avoid dangerous activity, wear Medic alert tag, avoid NSAIDs, alcohol
• anticonvulsants: CNS depression, myelosuppression: infection and bleeding
• assist with activity; protect airway, breathing; minimize invasive procedures
• monitor seizure activity, CBC with diff, temperature, regional redness, swelling, or drainage
• teaching: wear Medic-alert tag, avoid dangerous activity, wash hands, avoid crowds, need for follow-up care and testing
• antidysrhythmics: new or more dangerous dysrhythmias, changes in BP
• maintain F/E balance, SaO2 >95%, sinus rhythm; assist with position changes
• monitor PFT, EKG, BP, pulse, SaO₂, serum electrolytes, LOC
• teaching: ask for help to stand, report irregular pulse, technique for counting pulse
• antiinfective agents: renal and hepatic dysfunction
• obtain cultures before administration, verify administration guidelines, screen for renal and hepatic dysfunction, allergy, nephrotoxic or hepatotoxic drugs
• monitor RFT, LFT, jaundice, dark stool or urine, nausea and vomiting
• report nausea, vomiting, dark stool or urine, jaundice; need for follow-up care and testing
• loop, thiazide diuretics: circulatory collapse, myelosuppression, F/E imbalance, ototoxicity
• verify infusion guidelines, B/P, serum electrolytes, and U/O before giving
• monitor serum Na+ and K+, breath sounds, edema, BP, U/O
• teaching: report palpitations, weakness, irregular pulse, decreased U/O, temperature
• female hormones: thromboembolic disorders, increased risk of breast and endometrial cancer, hyperglycemia, hypercalcemia, depression, seizures
• monitor peripheral perfusion, edema; leg pain, tenderness; serum Ca++, glucose
• teaching: report lumps and abnormal bleeding, muscle twitching