7/29/2019 The Nursing Process and Client Teaching

1/15

The Nursing Process and Client Teaching:

Assessment

-begins with the patients history (allergies,use of alternative medicine, socioeconomicstatus, life style, family history and pastmedical history)

- physical examination(mental state, sensoryimpairment, including other systems.. etc)

- patients knowledge and understandingabout the drug therapy he is about toreceive

Nursing Diagnosis

- samples are found in the book page 17-18

( NANDA 2005-2006)- based on the clients foreseeable actual

problems according to the priority.- Should be individualized and minimize

psychological aspects because you are nota psychologist. If you choose a nursingdiagnosis based on these it should be the

last priority.- As a nurse a detailed scientific explanation

and pathologic changes in the body shouldbe focused to.

7/29/2019 The Nursing Process and Client Teaching

2/15

Planning and Implementation

- should be measurable, objective, concise,

realistic for the patient, attainable for thenurses with a time frame.

- Allow the patient to express the behavior orchange

- Make schedules or plot for the patientmedications.

- Practice the things you have learned in skillslab.

Evaluation

- this is to determine whether the outcome iseffective or not at all.

-This should be the basis if the treatmentshould continue or be stop.

- Then go back to the assessment process forbetter outcome.

Client Teaching

-health teachings regarding to administrationof the drug ( dose, route, time, etc),functions/actions of the drugs and its sideeffects/ adverse effects on the body.

7/29/2019 The Nursing Process and Client Teaching

3/15

- It should also involve the costeffectiveness/benefits by choosing thegeneric names and rational drug use.

-Price of the drug should be also emphasizedbased on the socio economic status patient

- Importance of the compliance to thetreatment

Medications and Calculations:

-you should be able to know the skills inbasic arithmetic, and or basic algebra.

- In practice calculator is a must for fast andaccurate calculations but as a student learnto compute without it for a while.

a. Know the Principles of Drug Administration(10 Rs)b. Know how to interpret the order of the

Prescriber/MDs/DMDs.c. Know the Basic Common Abbreviations on

Medication Orders.

-usually on the chart abbreviations isdiscouraged and complete name/wordshould be placed.

7/29/2019 The Nursing Process and Client Teaching

4/15

- But there are universally acceptedabbreviations on medication orders andplease get familiar with it.

Systems of Measurement with Conversion

Be familiar with the values and units

Metric System: both liquid and solids

- liters, meters, grams

Apothecary System:- use of Roman Numerals

-grains V ( 5 grains)

- smallest is the minims = 1 gtt of water- 1 ml = 15-16 minims

Household System:- teaspoon, tablespoon, cups

Units:

- Insulin (U-100 insulin means that 1 ml ofinsulin solution contains 100 units of insulin)

- Heparin

7/29/2019 The Nursing Process and Client Teaching

5/15

- Other antibiotics like Penicillin G or Nystatin- Written as Units not (U)

International Units:

- measures biologicals such as vitamins,enzymed, and hormones.

- Written as (IU)

Milliequivalents: (mEq)

- Electrolytes (Potassium Chloride 20 mEqsolution)

Methods of Calculation

a. Basic Formula

D = Desired Dose or OrderH or S = On-hand dose or Stock Dose

V = Vehicle (tabs, capsules, syrup etc.)A = Amount needed for the client

D/H x V = A

7/29/2019 The Nursing Process and Client Teaching

6/15

Example:

Order: Penicillin 0.5g PO BID

Stock : Penicillin 250mg capsules

Answer: convert grams to milligrams

D/H x V = A

= 500mg/ 250 mg x 1 capsule

= 2 capsules BID

b. Ratio and Proportion

D = Desired Dose or OrderH or S = On-hand dose or Stock DoseV = Vehicle (tabs, capsules, syrup etc.)

X = Amount needed for the client:: = as or equal to

means = V x Dextremes = H x X

example:

Order: Penicillin 100mg PO QIDStock: Penicillin 250mg/5ml suspension.

H:V : : D:X

7/29/2019 The Nursing Process and Client Teaching

7/15

Answer:

250 mg : 5ml : : 100mg : x(ml)

250mg x ?(ml) =500mg

X = 2 ml

c. Fractional Equation

- H/V =D/X (same principle in ratio andproportion)

d. Dimensional Analysis (factor labeling or

label factor method)

V = V (vehicle) x C(H) x D (desired)

H (on hand) x C(D) x 1 ( drug order)

7/29/2019 The Nursing Process and Client Teaching

8/15

C = conversion factor

Samples:

1 g = 1000 mg1000mg = 15 gr1g = 15 gr1 gr = 60 mg

D = Dosage desired

V = drug label factor

e. Body Weight

- convert pounds(lbs) to kilograms (kg):

lbs (divide) 2.2 = Kg

- determine the drug dose per BW :

Drug dose (mg/kg/day) x Kg(BW) =Clients mg/day

7/29/2019 The Nursing Process and Client Teaching

9/15

f. Body Surface Area with NomogramScale

Most accurate way to calculate the infantschildrens drug dose.

- uses the height and weight intersect tocome up with square meters.

Drug dose x BSA in m2 = X mg

BSA = wt in kg x height in cm

3600

BSA = wt in lbs x height in inches

3131

( with square root)if metric system

only

( with squareroot)if householdsystem only

7/29/2019 The Nursing Process and Client Teaching

10/15

Calculation for Oral Dosages:

One step calculations

Order: 50 mg of Meclizine P.O STATStock: 25mg Meclizine tabs

S = D tabs (1 tab = 25mg)

50 mg = ? tabs50 mg x 1 tab/25mg = 2 tabs

Dosage by BW = same as above

Calculating by BSA = same as above

Calculations of Injectables Fluids

1 cc = 1ml

syringesprepackaged cartridgetuberculin syringesInsulin syringes

7/29/2019 The Nursing Process and Client Teaching

11/15

Calculations of Intravenous Fluids

Common Intravenous Fluids:

0.45% NaCl injection USP or NS, 0.45% NS0.9% NaCl USP or 0.9 NS5% Dextrose in 0.22% NaCl inj. USP or 5 D/0.22NS5% dextrose inj. USP or 5% D/W D/5/W

Lactated Ringers Inj. USP or LR, RL, RLSLactated Ringers and 5% dextrose Inj or 5%D/LRD5/LRS

Flow rate: measures gtts/min , ml/min, mm/minYou can check this at the DRIP CHAMBER

Roll valve CLAMP or CLIP = adjust the FLOWRATE

Drop factor: Its based on manufacturerspreference on the type of tubing size used.

10gtts = 1ml15gtts = 1ml20gtts = 1ml60ugtts (microdrops) = 1ml

7/29/2019 The Nursing Process and Client Teaching

12/15

Infusion pumps = if electronic capable

Volume Controlled set or drip chamber

Order: 50 ml D6WIV in 4 hoursDF: 60ugtts/min

50ml/ 240min x 60 = 300/24= 12.5 ugtts/min

Drop factor x ml/min = drops/min

Total infusion time = Total drops to be(hours/min) Infused

Flow Rate(drops/min) x 60

mcg /kg/hr to ml/hr

Kg x { mcg / kg(hr) } x { ml/mg }x {mg/mcg } = ml/hr

7/29/2019 The Nursing Process and Client Teaching

13/15

Sample: Order: 0.3mg/kg/hrSolution: 250mg ml D5W W/400 mg

Dopamine

BW: 80kg

80kg x 0.3mg/kg/hr x 250ml/400mg

= 15 ml/hr

mcg/kg/min to gtts/min

kg x { mcg/kg/min} x{ mg/mcg x ml/mg}x{ gtt/ml } = gtts/min

DF = gtt/ml

gtt/min to ml/hr

gtt/min x ml/gtt x min/hr = ml/hr

DF = gtt/min

7/29/2019 The Nursing Process and Client Teaching

14/15

Pediatric Drug Calculations

a. by BWb. by BSAc. by from Adult Dosaged. by calculations for injections

Frieds Rule: Safe dose for Infant

Age of the infant (months)X Adult Dose

Adult age (months)

Youngs Rule:

Age of child in yearsX Adult dose

Age of child + 12 years

ml/hr to gtt/min

ml/hr x hr/min x gtt/ml = gtt/min

IV Rate: ml/min

7/29/2019 The Nursing Process and Client Teaching

15/15

Clarks Rule:

Childs weight (lbs)X Adult Dose

Adult weight (lbs)