Open Resources for Nursing (Open RN)
Evaluating the Effects
The nurse is responsible for assessing the client, monitoring lab values, and recognizing side effects and/or adverse effects of medications. Drug dosages should be verified to ensure all are within recommended safe ranges according to the client’s current status, as well as for their potency.
Potency refers to the amount of the drug required to produce the desired effect. A drug that is highly potent may require only a minimal dose to produce a desired therapeutic effect, whereas a drug that has low potency may need to be given at much higher concentrations to produce the same effect. Consider the example of opioid versus nonopioid medications for pain control. Opioid medications often have a much higher potency in smaller doses to produce pain relief; therefore, the overall dose required to produce a therapeutic effect may be much less than that for other analgesics.
The nurse preparing to administer medications must also be cognizant of drug selectivity and monitor for potential side effects and adverse effects. Selectivity refers to the separation between the desired and undesired effects of a drug. Drugs that are selective will search out target sites to create a specific drug action, whereas nonselective drugs may impact many other types of cells and tissues, thus increasing the risk for unintended side effects and/or adverse effects. For example, in Chapter 4 selective and nonselective beta-blockers will be discussed. Selective beta-1 blockers search out specific receptors on the heart to create their effect, whereas nonselective beta-blockers may affect receptors in the lungs in addition to those in the heart, causing potential respiratory side effects like a cough.
A side effect occurs when the drug produces effects other than the intended effect. A side effect, although often unintended, is generally anticipated by the provider and is a known potential consequence of the medication therapy. Examples of common side effects are nausea, vomiting, diarrhea, and drowsiness. In some situations, however, side effects may have a beneficial impact. For example, a side effect of hydrocodone is drowsiness. A client who is having difficulty sleeping due to pain and takes hydrocodone at bedtime may find the drowsiness beneficial in helping them fall asleep.
Conversely, unanticipated effects can occur from medications that are harmful to the client. These harmful occurrences are known as adverse effects. Adverse effects are relatively unpredictable, severe, and are reason to discontinue the medication.[1] For example, an adverse effect of ciprofloxacin is tendon rupture. Adverse effects should be reported to the pharmacy and tracked as a client safety concern according to agency policy.
- This work is a derivative of Principles of Pharmacology by LibreTexts and is licensed under CC BY-NC-SA 4.0 ↵
American Nurses Association (ANA): The professional organization that represents the interests of the nation's four million registered nurses.
Beneficence: To “do good.”
Boxed Warnings: The strongest warnings issued by the Federal Drug Association (FDA) that signify a drug carries a significant risk of serious or life-threatening adverse effects.
Code of Ethics for Nurses: Developed by the American Nurses Association as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.
Cultural competence: The process by which nurses demonstrate culturally congruent practice.
Cultural humility: A humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they can't possibly know everything about other cultures, and approach learning about other cultures as a lifelong goal and process.[1]
Culturally congruent practice: The application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care consumer and other stakeholders.
Do Not Crush list: A list of medications that should not be crushed, often due to a sustained-release formulation.
Drug diversion: The transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use.
Error-prone abbreviations: Abbreviations, symbols, and dose designations that are frequently misinterpreted and involved in harmful medication errors.
Five rights of medication administration: Standards of practice that require the following information is confirmed prior to each administration of medication: right patient, right drug, right dose, right time, and right route.
Health literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.
High-risk medications: Drugs that bear a heightened risk of causing significant client harm when they are used in error.
Inappropriate polypharmacy: Present when one or more medicines are prescribed that are not or no longer needed.
Look-alike and sound-alike (LASA) drugs: Medications that require special safeguards to reduce the risk of errors and minimize harm.
Maleficence: Causing harm to patients.
National Patient Safety Goals (NPSGs): Goals established by The Joint Commission to help accredited organizations address specific areas of concern related to patient safety.
Nursing: The protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations, as defined by the American Nurses Association.
Nursing process: Standards of Practice that include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing client care.
Nursing Scope and Standards of Practice: A document created by the American Nurses Association that outlines professional nursing performance according to national standards.
Polypharmacy: The concurrent use of multiple medications.
Prescription Drug Monitoring Programs (PDMP): A statewide electronic database that collects designated data on substances dispensed in a state to address prescription drug abuse, addiction, and diversion.
Professional assistance procedure: A voluntary nondisciplinary program to provide support for credentialed professionals in Wisconsin with a substance abuse disorder who are committed to their own recovery.
Registered Nurse (RN): An individual who is educationally prepared and licensed by a state to practice as a registered nurse.
Root cause analysis: An analysis after an error occurs to help identify not only what and how an event occurred, but also why it happened. When investigators are able to determine why an event or failure occurred, they can create workable corrective measures that prevent future errors from occurring.
Safety culture: The culture of a health care agency that empowers staff to speak up about risks to clients and to report errors and near misses, all of which drive improvement in client care and reduce the incident of client harm.
Scheduled medications: The Controlled Substances Act (CSA) places all substances that are regulated under existing federal law into one of five schedules, ranging from Schedule I drugs with a high potential for abuse and the potential to create severe psychological and/or physical dependence, to Schedule V drugs with the least potential for abuse.
Social determinants of health (SDOH): Conditions in the places where people live, learn, work, and play that can affect a wide range of health risks and outcomes.
Standards of practice: Authoritative statements of duties by the American Nursing Association that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. Standards of Practice include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing client care.
Standards of professional performance: Describe a competent level of behavior in the professional role, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice, and quality of practice as defined by the American Nursing Association.
State Board of Nursing: A group of officials who enforce the State Nurse Practice Act.
State Nurse Practice Act: Law enacted by state legislatures setting professional standards of nursing care to which nurses are held accountable by the State Board of Nursing.
Substance use disorder: A pattern of behaviors that ranges from misuse to dependency or addiction, whether it is alcohol, legal drugs, or illegal drugs. Addiction is a complex disease with serious physical, emotional, financial, and legal consequences.
The Joint Commission: A national organization that accredits and certifies health care organizations in the United States.
American Nurses Association (ANA): The professional organization that represents the interests of the nation's four million registered nurses.
Beneficence: To “do good.”
Boxed Warnings: The strongest warnings issued by the Federal Drug Association (FDA) that signify a drug carries a significant risk of serious or life-threatening adverse effects.
Code of Ethics for Nurses: Developed by the American Nurses Association as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.
Cultural competence: The process by which nurses demonstrate culturally congruent practice.
Cultural humility: A humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they can't possibly know everything about other cultures, and approach learning about other cultures as a lifelong goal and process.[2]
Culturally congruent practice: The application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care consumer and other stakeholders.
Do Not Crush list: A list of medications that should not be crushed, often due to a sustained-release formulation.
Drug diversion: The transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use.
Error-prone abbreviations: Abbreviations, symbols, and dose designations that are frequently misinterpreted and involved in harmful medication errors.
Five rights of medication administration: Standards of practice that require the following information is confirmed prior to each administration of medication: right patient, right drug, right dose, right time, and right route.
Health literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.
High-risk medications: Drugs that bear a heightened risk of causing significant client harm when they are used in error.
Inappropriate polypharmacy: Present when one or more medicines are prescribed that are not or no longer needed.
Look-alike and sound-alike (LASA) drugs: Medications that require special safeguards to reduce the risk of errors and minimize harm.
Maleficence: Causing harm to patients.
National Patient Safety Goals (NPSGs): Goals established by The Joint Commission to help accredited organizations address specific areas of concern related to patient safety.
Nursing: The protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations, as defined by the American Nurses Association.
Nursing process: Standards of Practice that include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing client care.
Nursing Scope and Standards of Practice: A document created by the American Nurses Association that outlines professional nursing performance according to national standards.
Polypharmacy: The concurrent use of multiple medications.
Prescription Drug Monitoring Programs (PDMP): A statewide electronic database that collects designated data on substances dispensed in a state to address prescription drug abuse, addiction, and diversion.
Professional assistance procedure: A voluntary nondisciplinary program to provide support for credentialed professionals in Wisconsin with a substance abuse disorder who are committed to their own recovery.
Registered Nurse (RN): An individual who is educationally prepared and licensed by a state to practice as a registered nurse.
Root cause analysis: An analysis after an error occurs to help identify not only what and how an event occurred, but also why it happened. When investigators are able to determine why an event or failure occurred, they can create workable corrective measures that prevent future errors from occurring.
Safety culture: The culture of a health care agency that empowers staff to speak up about risks to clients and to report errors and near misses, all of which drive improvement in client care and reduce the incident of client harm.
Scheduled medications: The Controlled Substances Act (CSA) places all substances that are regulated under existing federal law into one of five schedules, ranging from Schedule I drugs with a high potential for abuse and the potential to create severe psychological and/or physical dependence, to Schedule V drugs with the least potential for abuse.
Social determinants of health (SDOH): Conditions in the places where people live, learn, work, and play that can affect a wide range of health risks and outcomes.
Standards of practice: Authoritative statements of duties by the American Nursing Association that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. Standards of Practice include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing client care.
Standards of professional performance: Describe a competent level of behavior in the professional role, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice, and quality of practice as defined by the American Nursing Association.
State Board of Nursing: A group of officials who enforce the State Nurse Practice Act.
State Nurse Practice Act: Law enacted by state legislatures setting professional standards of nursing care to which nurses are held accountable by the State Board of Nursing.
Substance use disorder: A pattern of behaviors that ranges from misuse to dependency or addiction, whether it is alcohol, legal drugs, or illegal drugs. Addiction is a complex disease with serious physical, emotional, financial, and legal consequences.
The Joint Commission: A national organization that accredits and certifies health care organizations in the United States.
Learning Objectives
- Identify cues related to alteration in comfort across the life span
- Identify standards of care for the client experiencing pain
- Identify interventions to increase client comfort
- Contribute to a plan of care for clients with comfort alterations
Pain is a universal sensation that everyone experiences, and acute pain is a common reason why clients seek medical care. Nurses work with the interdisciplinary team to assess and manage pain in a multidimensional approach to provide comfort and prevent suffering. This chapter will review best practices and standards of care for the assessment and management of pain.
