February 2, 2022 • 12 mins
When administering medications to special populations there are certain considerations that the nurse should be aware of. In this episode, we will explore how some normal processes of aging can affect our patients' pharmacokinetics and pharmacodynamics as well as other important consideration when administering medications to the geriatric population.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:00):
Hey, and welcome to nursing with Dr. Hobbick. Today
we're going to talk about thenursing process. I know this
probably should have been thefirst episode. So to keep it
brief, the nursing process is avariation on the scientific
method that allows nurses tofollow a systematic approach
that will allow us to usecritical thinking in order to
(00:21):
make a clinical judgment aboutour patients. So there are a
couple of variations on thenursing process, you may have
heard of add pi, which isassessment, diagnose, plan,
implement, and evaluate. There'sone that has analysis instead of
diagnosis. And then the NationalCouncil of State Boards of
Nursing has recently releasedthis clinical judgment
(00:42):
measurement model, which willprobably see take over the
field. And this is recognizedcues, analyze cues, prioritize
hypothesis, generate solutions,take action, and evaluate
outcomes. So you can see howthat's even more in line with
the scientific method. So it'sreally, it allows us to practice
(01:03):
nursing in a systematic way, sothat we can make inferences
about the meaning of ourpatient's condition about the
meaning of their response totheir conditions, so that we can
help them you know, we see apattern that helps us take care
of them or helps us to alleviatesymptoms. So we want to make
sure that we're thinking aboutthe patient, this individual
(01:25):
patient, we want to make surethat we are patient centered,
the first step is going to berecognized cues or assessment.
So the queues are the thingsthat you see when you do your
assessment. So this is going tobe your physical assessment
health history. Remember that wehave two different sources of
information primary source andsecondary, the patient is your
primary source unless they're aminor or unable to make their
(01:49):
needs known, in which case, itwill be a caregiver or a parent.
Everything else is a secondarysource. So the chart is a
secondary source that physician,the nurse before you giving
report, those are secondarysources. We have two types of
data, we have objective data andsubjective data. Objective data
is something that I canobjectively measure, I can see
(02:11):
or touch. subjective data issomething that patient has to
tell me because I cannotexperience it in any way. So for
example, vital signs that wemeasure, those are objective
data, the patient's pain orfeelings. Those are subjective
data. So we're going to collectall of our data. And we're also
going to validate and verify thedata. So the patient will tell
(02:34):
us things and we use those cuesto help us validate or verify,
we'll also use the diagnostictesting laboratory data, those
health history information toverify and make sure that we
have a full database. So thenext step, then is going to be
patient problem, or diagnosis oranalyze cues and prioritize
(02:57):
hypotheses. So this step iswhere we really define the
patient's problem with identifytheir need. And it allows us to
then create a plan of care. Sothis could be the patient has
abdominal pain, or they needteaching on a specific
medication or something else. Sothat's going to be our next
step. Then, from there, fromdefining it, we're going to
(03:20):
generate solutions or plan. Andthis, the current National
Council State Boards of Nursingclinical judgment measurement
model really kind of combinesprioritize hypothesis, because
at this point, we need toprioritize what we're going to
do, your patient will have a lotof problems or a couple anyway.
So we're going to classify ourpriorities based on high
(03:41):
intermediate and low, highpriorities or emergent things.
high priorities are things thatare going to imminently
threatened the patient life orlimb. Intermediate is mostly
what we deal with in nursing.
These are problems that patienthas right now. And then low
problems, low priority problems,and those are going to affect
(04:02):
the patient's future well beingso a high priority problem is a
patient who has sepsis, or apatient who is hypovolemic, a
patient that doesn't have enoughfluid in their body to help them
perfuse their their tissues,intermediate problems, or would
be impaired skin integrity, thepatient has a wound, the patient
has pain.
(04:23):
Low priority will be things likethe patient has a risk for
infection or the risk for falls.
Those are things that willaffect their future health. Now,
there's something that you'veidentified that is putting the
patient at risk, whatever thatthing is, that's your
intermediate problem. So wewould focus on that then to
prevent those bad outcomes likeinfection or false. So now that
(04:44):
we've prioritized we're going tochoose you know, the highest
priority item and we're going tomake a plan we're going to make
a goal so this is where we makea goal statement and then we
decide on interventions that wecan put in place. So we're still
in that planning process, right.
(05:05):
So when we set a goal, it needsto be specific, measurable,
attainable, or Achievable,Relevant or realistic, and time
bound students struggle the mostwith the time bound piece. But
here's, here's what it is,without this very specific type
of goal, this smart goal. It'slike a recipe with no
(05:25):
directions. So I can tell youthrow some flour, some water,
some yeast and some buttertogether, let it sit for a while
after you mix it up, make itinto a bowl shape, let it sit a
little bit longer, throw it inthe oven, take it out tonight,
you have bread, except youprobably have glue, because I
didn't give you enoughdirections you didn't have any
time frames, you didn't knowspecifically what temperatures
(05:49):
or amounts of stuff you needed.
So for all of us to be on thesame page to be providing the
same level of care and havingthe same goals. The goals need
to be smart goals. So we want tomake sure that we have effective
goals that are smart. So thenext thing that we're going to
think about is ourimplementation or intervention.
So we'll decide on interventionsthat will help us meet the goal.
(06:13):
That's the whole idea. The goalis something that the patient
will do. The goal is a change inpatient condition or behavior.
So the goal usually starts withthe patient will, interventions
or nursing interventions, andthese are things that the nurse
is going to do so the nurse willthe interventions or things the
nurse will do in order to helpthe patient meet the goal. So
(06:35):
interventions come in a coupleof different ways we have direct
and indirect care. Direct Careis where I am physically
interacting with the patient, Iam washing the patient and
providing medications I'mdiscussing things are providing
education to the patient.
Indirect care things that Ieither do to manage the
(06:56):
patient's environment, turningdown the temperature, leaving
the door closed documentation oreven something I've done on the
patient's behalf for I am askingfor a console of physical
therapy. So direct versusindirect direct is where I'm in
engaged with the patient,indirect is where I'm doing
something on their behalf ormanaging their environment. Now
(07:18):
we also have nurse initiated,provider initiated and other
provider initiatedinterventions. So nurse
initiated interventions areindependent, these are things
that you can do on your own, youdon't need a doctor's order or
providers order for these. Thisis raising the head of the bed,
closing the door, providingeducation on a topic, those are
(07:39):
all things that you can do onyour own health care provider
initiated, these are dependentinterventions. And of course,
they require an order from ahealthcare professional, other
provider initiated, these areinterdependent. So these would
be things like the nutritionistcomes and decides on a diet for
the patient, then we are theones who are making sure the
(07:59):
patient is following thosedirections. So we're going to do
our interventions. And the mostcommon interventions that we do
are education, medicationadministration, and patient
care. When you're thinking abouteducation, something that's
really important for you toassess is the patient's
readiness to learn. You have tohave good timing, you need to
(08:21):
make sure the patient isinvested and engaged. And you
want to make sure that youeliminate any barriers. So a
conducive environment that isquiet and comfortable. You need
to manage the patient's pain,nobody can learn anything if
they're in a lot of pain. So youwant to make sure that you
remove those barriers, if youneed an interpreter, get one,
don't let that be a barrierto your patients care. So we
also want to make sure that wetailor the care to the patient.
(08:45):
In other words, I'm not going towalk into a room of someone who
only has a high school educationand speak in medical ease,
right, we need to make sure thatwe have broken it down for the
patient. So you want to makesure that you have collaborated
with the patient and ifappropriate their family when
you're making your plan of careand selecting your
(09:06):
interventions, because again,they need to be part of the
process. Because if they don'tagree with what you're doing,
obviously, nothing's going tohappen. You also need to make
sure that you are able toprovide the care or intervention
that you are outlining, so it'sgot to be something that you are
competent with doing and if not,you need to be comfortable
asking for help or seekingsomeone else to perform that
(09:28):
procedure intervention for you.
And finally, evaluation. And thething I want everyone to know
about evaluation is we don'twait until we have gone through
this whole process to evaluate.
You're evaluating constantly.
It's an ongoing process. So if Iwalk in the room and the patient
seems short of breath, and Iraise the head of the bed, I'm
not going to wait until I do afull assessment and define the
(09:51):
problem and cut you know,prioritize what's going on and
create interventions and then dothem. Like I've done all that in
this in just a moment and I'mevaluating me What's going on in
the patient? So, once we havemet our goals, our patient
goals, then we can discontinuethe plan of care. But remember
that we probably have multiplethings that we're helping the
(10:11):
patient with. It's not just onething. So when we, when we
discontinue that plan of care,there's a maybe another plan of
care that we're also working onsimultaneously or we create a
new plan of care for the patientbased on their current
condition. And this is where wefull circle and we start again
with a new assessment. So I hopeyou enjoyed this discussion
(10:33):
about the nursing process and Ilook forward to having you
listen to more. Have a greatday.
Hey, and welcome to nursing with Dr. Hobbick. Today
we're going to talk about thenursing process. I know this
probably should have been thefirst episode. So to keep it
brief, the nursing process is avariation on the scientific
method that allows nurses tofollow a systematic approach
that will allow us to usecritical thinking in order to
(00:21):
make a clinical judgment aboutour patients. So there are a
couple of variations on thenursing process, you may have
heard of add pi, which isassessment, diagnose, plan,
implement, and evaluate. There'sone that has analysis instead of
diagnosis. And then the NationalCouncil of State Boards of
Nursing has recently releasedthis clinical judgment
(00:42):
measurement model, which willprobably see take over the
field. And this is recognizedcues, analyze cues, prioritize
hypothesis, generate solutions,take action, and evaluate
outcomes. So you can see howthat's even more in line with
the scientific method. So it'sreally, it allows us to practice
(01:03):
nursing in a systematic way, sothat we can make inferences
about the meaning of ourpatient's condition about the
meaning of their response totheir conditions, so that we can
help them you know, we see apattern that helps us take care
of them or helps us to alleviatesymptoms. So we want to make
sure that we're thinking aboutthe patient, this individual
(01:25):
patient, we want to make surethat we are patient centered,
the first step is going to berecognized cues or assessment.
So the queues are the thingsthat you see when you do your
assessment. So this is going tobe your physical assessment
health history. Remember that wehave two different sources of
information primary source andsecondary, the patient is your
primary source unless they're aminor or unable to make their
(01:49):
needs known, in which case, itwill be a caregiver or a parent.
Everything else is a secondarysource. So the chart is a
secondary source that physician,the nurse before you giving
report, those are secondarysources. We have two types of
data, we have objective data andsubjective data. Objective data
is something that I canobjectively measure, I can see
(02:11):
or touch. subjective data issomething that patient has to
tell me because I cannotexperience it in any way. So for
example, vital signs that wemeasure, those are objective
data, the patient's pain orfeelings. Those are subjective
data. So we're going to collectall of our data. And we're also
going to validate and verify thedata. So the patient will tell
(02:34):
us things and we use those cuesto help us validate or verify,
we'll also use the diagnostictesting laboratory data, those
health history information toverify and make sure that we
have a full database. So thenext step, then is going to be
patient problem, or diagnosis oranalyze cues and prioritize
(02:57):
hypotheses. So this step iswhere we really define the
patient's problem with identifytheir need. And it allows us to
then create a plan of care. Sothis could be the patient has
abdominal pain, or they needteaching on a specific
medication or something else. Sothat's going to be our next
step. Then, from there, fromdefining it, we're going to
(03:20):
generate solutions or plan. Andthis, the current National
Council State Boards of Nursingclinical judgment measurement
model really kind of combinesprioritize hypothesis, because
at this point, we need toprioritize what we're going to
do, your patient will have a lotof problems or a couple anyway.
So we're going to classify ourpriorities based on high
(03:41):
intermediate and low, highpriorities or emergent things.
high priorities are things thatare going to imminently
threatened the patient life orlimb. Intermediate is mostly
what we deal with in nursing.
These are problems that patienthas right now. And then low
problems, low priority problems,and those are going to affect
(04:02):
the patient's future well beingso a high priority problem is a
patient who has sepsis, or apatient who is hypovolemic, a
patient that doesn't have enoughfluid in their body to help them
perfuse their their tissues,intermediate problems, or would
be impaired skin integrity, thepatient has a wound, the patient
has pain.
(04:23):
Low priority will be things likethe patient has a risk for
infection or the risk for falls.
Those are things that willaffect their future health. Now,
there's something that you'veidentified that is putting the
patient at risk, whatever thatthing is, that's your
intermediate problem. So wewould focus on that then to
prevent those bad outcomes likeinfection or false. So now that
(04:44):
we've prioritized we're going tochoose you know, the highest
priority item and we're going tomake a plan we're going to make
a goal so this is where we makea goal statement and then we
decide on interventions that wecan put in place. So we're still
in that planning process, right.
(05:05):
So when we set a goal, it needsto be specific, measurable,
attainable, or Achievable,Relevant or realistic, and time
bound students struggle the mostwith the time bound piece. But
here's, here's what it is,without this very specific type
of goal, this smart goal. It'slike a recipe with no
(05:25):
directions. So I can tell youthrow some flour, some water,
some yeast and some buttertogether, let it sit for a while
after you mix it up, make itinto a bowl shape, let it sit a
little bit longer, throw it inthe oven, take it out tonight,
you have bread, except youprobably have glue, because I
didn't give you enoughdirections you didn't have any
time frames, you didn't knowspecifically what temperatures
(05:49):
or amounts of stuff you needed.
So for all of us to be on thesame page to be providing the
same level of care and havingthe same goals. The goals need
to be smart goals. So we want tomake sure that we have effective
goals that are smart. So thenext thing that we're going to
think about is ourimplementation or intervention.
So we'll decide on interventionsthat will help us meet the goal.
(06:13):
That's the whole idea. The goalis something that the patient
will do. The goal is a change inpatient condition or behavior.
So the goal usually starts withthe patient will, interventions
or nursing interventions, andthese are things that the nurse
is going to do so the nurse willthe interventions or things the
nurse will do in order to helpthe patient meet the goal. So
(06:35):
interventions come in a coupleof different ways we have direct
and indirect care. Direct Careis where I am physically
interacting with the patient, Iam washing the patient and
providing medications I'mdiscussing things are providing
education to the patient.
Indirect care things that Ieither do to manage the
(06:56):
patient's environment, turningdown the temperature, leaving
the door closed documentation oreven something I've done on the
patient's behalf for I am askingfor a console of physical
therapy. So direct versusindirect direct is where I'm in
engaged with the patient,indirect is where I'm doing
something on their behalf ormanaging their environment. Now
(07:18):
we also have nurse initiated,provider initiated and other
provider initiatedinterventions. So nurse
initiated interventions areindependent, these are things
that you can do on your own, youdon't need a doctor's order or
providers order for these. Thisis raising the head of the bed,
closing the door, providingeducation on a topic, those are
(07:39):
all things that you can do onyour own health care provider
initiated, these are dependentinterventions. And of course,
they require an order from ahealthcare professional, other
provider initiated, these areinterdependent. So these would
be things like the nutritionistcomes and decides on a diet for
the patient, then we are theones who are making sure the
(07:59):
patient is following thosedirections. So we're going to do
our interventions. And the mostcommon interventions that we do
are education, medicationadministration, and patient
care. When you're thinking abouteducation, something that's
really important for you toassess is the patient's
readiness to learn. You have tohave good timing, you need to
(08:21):
make sure the patient isinvested and engaged. And you
want to make sure that youeliminate any barriers. So a
conducive environment that isquiet and comfortable. You need
to manage the patient's pain,nobody can learn anything if
they're in a lot of pain. So youwant to make sure that you
remove those barriers, if youneed an interpreter, get one,
don't let that be a barrierto your patients care. So we
also want to make sure that wetailor the care to the patient.
(08:45):
In other words, I'm not going towalk into a room of someone who
only has a high school educationand speak in medical ease,
right, we need to make sure thatwe have broken it down for the
patient. So you want to makesure that you have collaborated
with the patient and ifappropriate their family when
you're making your plan of careand selecting your
(09:06):
interventions, because again,they need to be part of the
process. Because if they don'tagree with what you're doing,
obviously, nothing's going tohappen. You also need to make
sure that you are able toprovide the care or intervention
that you are outlining, so it'sgot to be something that you are
competent with doing and if not,you need to be comfortable
asking for help or seekingsomeone else to perform that
(09:28):
procedure intervention for you.
And finally, evaluation. And thething I want everyone to know
about evaluation is we don'twait until we have gone through
this whole process to evaluate.
You're evaluating constantly.
It's an ongoing process. So if Iwalk in the room and the patient
seems short of breath, and Iraise the head of the bed, I'm
not going to wait until I do afull assessment and define the
(09:51):
problem and cut you know,prioritize what's going on and
create interventions and then dothem. Like I've done all that in
this in just a moment and I'mevaluating me What's going on in
the patient? So, once we havemet our goals, our patient
goals, then we can discontinuethe plan of care. But remember
that we probably have multiplethings that we're helping the
(10:11):
patient with. It's not just onething. So when we, when we
discontinue that plan of care,there's a maybe another plan of
care that we're also working onsimultaneously or we create a
new plan of care for the patientbased on their current
condition. And this is where wefull circle and we start again
with a new assessment. So I hopeyou enjoyed this discussion
(10:33):
about the nursing process and Ilook forward to having you
listen to more. Have a greatday.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!