Nursing Diagnosis

Question 1

Nursing Diagnosis

Answer 1

This list of
nursing diagnoses may apply during medication administration in a
variety of se􀄴ings:
• Impaired Health Maintenance
• Lack of Knowledge (Medication)
• Nonadherence (Medication Regimen)
• Adverse Medication Interaction
• Complex Medication Regimen (Polypharmacy)
After selecting the diagnosis, identify the related factor (if applicable)
that drives the selection of nursing interventions. In the example of
Nonadherence, the related factors of financial barriers versus lack of knowledge
about the regimen require different interventions. If a patient’s nursing
diagnosis is related to inadequate finances, you collaborate with family
caregivers, social workers, case managers, or community agencies to
connect the patient with necessary financial resources and develop a
medication regimen the patient can afford. If the related factor is lack of
knowledge, you implement a teaching plan with appropriate follow-up.

Question 2

Planning

Answer 2

Goals and Outcomes- For example, a
nurse establishes the following goal and related outcomes for a patient
with newly diagnosed type 2 diabetes who has the diagnosis of Lack of
Knowledge related to insufficient medication information:
Goal: The patient will safely self-administer all ordered medications
before discharge.
Outcomes:
• The patient verbalizes understanding of desired and adverse
effects of medications.
• The patient states signs, symptoms, and treatment of
hypoglycemia.
• The patient can monitor blood glucose levels to determine whether
it is safe to take medication or an alteration in dose is needed.
• The patient prepares a dose of ordered medication.
• The patient describes a daily routine that will integrate timing of
medication with daily activities.

Setting Priorities
Prioritize care when administering medications. Use patient assessment
data to determine which medications to give first, whether it is time to
evaluate a patient’s response to a medication, or whether it is appropriate
to administer prn medications. For example, if a patient is in pain, it is
important to provide pain medication as soon as possible.If the patient’s
blood pressure is elevated, administer the blood pressure medication
before other medications.

Question 3

Implementation

Answer 3

Health promotion 
Patient and family caregiver teaching
Acute care
Receiving, transcribing, and communicating medication orders.
Accurate dose calculation and measurement
Avoidance of distractions
Correct administration
Recording medication administration
Special considerations
Infants and children
Older adults
Polypharmacy

Question 4

Patient Teaching Safe Insulin

Administration - implementation example

Answer 4

Objective
• Patient will correctly self-administer subcutaneous insulin.
Teaching Strategies
• Teach patient how to determine whether insulin is expired.
• Instruct patient to keep medication in its original labeled container
and refrigerated if needed.
• Demonstrate how to prepare insulin in a syringe, assessing visual
acuity to ensure that patient can draw up the correct amount of
insulin.
• Coach patient through the steps of administering subcutaneous
insulin injection.
• Demonstrate how to rotate insulin injection sites.
• Help patient determine the amount of insulin required based on the
results of home capillary glucose monitoring as ordered by the health
care provider.
• Show patient how to keep a daily log for insulin injections, including
results of home capillary glucose monitoring, type and amount of
insulin given, expiration date on insulin vial, time of insulin injection,
and injection site used.
Evaluation
Use the principles of teach-back to evaluate patient/family caregiver
learning:
• Describe for me the procedure you use at home for determining the
correct dose of insulin you need and how you select your injection
site.
• Please show me how you draw up your insulin based on the results of
your capillary glucose monitoring result. Show me how you select
your injection site and administer your insulin.
• Review your log with me so I can evaluate it for completeness.

Question 5

Tips for Administering Medications to

Children

Answer 5

Oral Medications
• Liquids are safer to swallow than pills to avoid aspiration.
• Use calibrated droppers for administering liquids to infants; the use
of straws often helps older children or patients who have difficulty
swallowing pills.
• Offer juice, a soft drink, or frozen juice bar, if allowed, after the child
swallows a medication.
• When mixing medications in other foods or liquids, use only a small
amount. The child may refuse to take all of a larger mixture.
• Avoid mixing a medication in a child’s favorite foods or liquids
because the child may later refuse them.
• A plastic disposable oral syringe is the most accurate device for
preparing liquid doses, especially those less than 10 mL. (Cups, teaspoons, and droppers are inaccurate.)
Injections
• Use caution when selecting intramuscular (IM) injection sites. Infants
and small children have underdeveloped muscles. Follow agency
policy.
• Children are sometimes unpredictable and uncooperative. Make sure
that someone (preferably another nurse) is available to restrain a child
if needed. Have the parent act as a comforter, not restrainer, if
restraint is necessary.
• Always awaken a sleeping child before giving an injection.
• Distracting a child with conversation, bubbles, or a toy reduces pain
perception.
• If time allows, apply a lidocaine ointment (e.g., EMLA cream) to an
injection site before the injection to reduce pain perception during the
injection

Question 6

Focus on Older AdultsSafety in Medication

Administration

Answer 6

Frequently review a patient’s medication history, including use of
over-the-counter medications, and consult with health care provider
to simplify the medication therapy plan whenever possible (Rochon
et al., 2018).
• Keep instructions clear and simple, provide memory aids (e.g.,
calendar, medication schedule), and ensure that wri􀄴en information
about medications is in print large enough for a patient to see
(Rochon, 2019; Touhy and Je􀄴, 2017).
• Assess functional status (including vision, hand grasp, fine-motor
skills) to determine whether patient will require assistance in taking
medications (Touhy and Je􀄴, 2017).
• Some older adults have a greater sensitivity to medications, especially
those that act on the central nervous system. Therefore, carefully
monitor patients’ responses to medications and anticipate dosage
adjustments as needed (Touhy and Je􀄴, 2017).
• If patient has difficulty swallowing a capsule or tablet, ask the health
care provider to substitute a liquid medication or instruct patient to
place medication on the front of the tongue and then swallow fluid to
help wash it to the back of the throat. If the patient continues to have
problems, have him or her try taking medication with a very small
amount of semisolid food (e.g., applesauce) (Touhy and Je􀄴, 2017).
• Teach alternatives to medications such as a proper diet instead of
vitamins and exercise instead of laxatives (

effects of ageing on medication metabolism:
- drug receptor interaction - brain receptors overly sensitive - psychoactive drugs become more potent
- metabolism - liver mass shrinks - prolong drug half-life
- absorption - gastric emptying rate and gastrointestinal mobility slow - absorption capacity of cells decline
- circulation - vascular nerve control less stable - e.g. antihypertensives drop bp too low and digoxin slow heart rate too much
- excretion - kidney function decline
distribution - lean body mass falls - total body water decline raising water soluble drugs concentration lead to heart dysfunction and plasma protein diminishes.

Question 7

Evaluation

Answer 7

Through the patient’s eyes
Partner with your patients.
Ensure patients understand and can safely administer their medications.
Patient outcomes
Use knowledge of the desired effect and common side effects of each medication to compare expected outcomes with actual findings.