Editing Pharmacology (section)

== The Nursing Process Applied to Medication Administration ==

'''Assessment.''' Before giving any drug, know the indication, the usual dose range, the route, and the expected action. Assess the parameters that the drug acts on and the parameters that make it unsafe: apical pulse before digoxin and beta blockers, blood pressure before antihypertensives and nitrates, respiratory rate and sedation level before opioids, blood glucose before insulin, potassium before digoxin or a potassium-sparing diuretic, and renal and hepatic function for drugs cleared by those organs. Obtain a complete allergy history including the '''nature''' of the reaction, and a full medication reconciliation that includes over-the-counter drugs, herbals, and supplements.

'''Analysis and planning.''' Identify the therapeutic goal and the measurable outcome. "Pain rated 3 or less within 60 minutes" is a usable outcome; "patient comfortable" is not.

'''Implementation.''' Verify the order, perform the safety checks below, use two patient identifiers, and never administer a medication another nurse prepared or one you did not personally verify.

'''Evaluation.''' Reassess for both therapeutic effect and adverse effect within the drug's expected time to onset. Document the effect, not just the administration. Pain reassessment is generally within 15 to 30 minutes for intravenous analgesia and within 45 to 60 minutes for oral analgesia.

'''Scope note.''' In most jurisdictions the practical or vocational nurse may administer oral, topical, subcutaneous, intramuscular, and other basic route medications, monitors for effects, reinforces teaching that the registered nurse initiated, and reports findings. The practical nurse generally does '''not''' perform initial patient assessment, does not push intravenous medications, does not titrate vasoactive or other continuous infusions, does not administer blood products, and does not initiate patient teaching plans. The registered nurse retains responsibility for assessment, clinical judgment, titration, and evaluation. Always verify the specific state nurse practice act and facility policy.