3.4 Applying the Nursing Process to Administering Antimicrobials
3.4 Applying the Nursing Process to Administering Antimicrobials
Now that we have reviewed basic concepts of antimicrobials and administration considerations, let’s apply the nursing process. The nursing process consists of the steps of assessment, diagnosis, outcome identification, planning, implementation of interventions, and evaluation. For more information about the nursing process, refer to the “Ethical and Professional Foundations of Safe Medication Administration by Nurses” section in Chapter 1. This book will broadly discuss considerations related to the nursing process steps of assessment, implementation, and evaluation because the steps of diagnosis, outcome identification, and planning steps are specifically tailored to each individual client.
Assessment
Although there are numerous details to consider when administering medications, it is important to first think about what you are administering and why.
First Think WHY?
Antimicrobials are prescribed to prevent or treat infection. If a client is prescribed an antimicrobial, the nursing assessment should include looking for signs and symptoms of infection. The nurse should always know WHY the client is receiving an antimicrobial in order to evaluate if the treatment is resulting in the client improving or deteriorating.
The nurse collects pre-administration information as part of the assessment process. Typical data collected at the start of a shift for a client receiving an antimicrobial for an infection include a baseline temperature, heart rate, blood pressure, and respiratory rate. The nurse also reviews the most recent white blood cell count. Focused assessments are then made based on the type of infection. For example, if a client has a wound infection, the wound should be assessed. If a client has a respiratory infection, the nurse should assess the client’s lung sounds. If a client has a urinary tract infection (UTI), symptoms related to a UTI should be assessed.
Additionally, whenever a client has an infection, it is important to continually monitor for the potential development of sepsis, a life-threatening condition caused by severe infection. Early signs of sepsis include new onset confusion, elevated heart rate, decreased blood pressure, increased respiratory rate, and fever.
Additional baseline information to collect prior to the administration of any new medication order includes a patient history, current medication use including herbals or other supplements, and history of allergy or previous adverse response. Many clients with an allergy to one type of antimicrobial agent may experience cross-reactivity to other classes. This information should be appropriately communicated to the prescribing provider prior to the administration of any antimicrobial medication.
Implementation of Interventions
With administering antimicrobial medication, the nurse anticipates additional interventions associated with the effects of the medications. For example, antimicrobials often caus