Evaluation

Evaluation is a decision-making process that involves determining the effectiveness of the nursing interventions in meeting the expected outcomes. When related to the administration of a drug, this phase of the nursing process is used to evaluate the patient's response to drug therapy. The evaluation is positive if the expected outcomes have been accomplished or if progress has occurred. If the outcomes have not been accomplished, different interventions are needed. During the administration of the drug the expected response is alleviation of specific symptoms or the presence of a therapeutic effect. Evaluation also may be used to determine if the patient or family member understands the drug regimen.

To evaluate the patient's response to therapy, and depending on the drug administered, the nurse may check the patient's blood pressure every hour, inquire whether pain has been relieved, or monitor the pulse every 15 minutes. After evaluation, certain other decisions may need to be made and plans of action implemented. For example, the nurse may need to notify the primary health care provider of a marked change in a patient's pulse and respiratory rate after a drug was administered, or the nurse may need to change the bed linen because sweating occurred after a drug used to lower the patient's elevated temperature was administered.

The nurse can evaluate the patient's or family's understanding of the drug regimen by noting if one or both appear to understand the material that has been presented. Facial expression may indicate that one or both do or do not understand what has been explained. The nurse also may ask questions about the information that has been given to further evaluate the patient's or family's understanding.

• Critical Thinking Exercises

1. Mr. Hatfield, age 69 years, confides to you that he is not taking the drug prescribed by his primary health care provider. He states he took the drug for a while and then quit. Explain some possible reasons Mr. Hatfield could have for not taking his drug. Discuss questions you could ask too assess the reason for Mr. Hatfield's noncompliance.

2. Ms. Heggan is 82 years old and lives alone. She is prescribed several drugs by the primary health care provider but is worried about taking the drugs and the side effects that might occur. She comes to the outpatient clinic after 1 week, and you learn that she has not filled her prescription and is not taking the drugs. Your nursing diagnosis is Ineffective Management of the Therapeutic Regimen related to anxiety about taking the prescribed drugs. Determine what information you would seek to obtain from Ms. Heggan. Identify important nursing interventions for this diagnosis.

3. Ms. Taylor is receiving three drugs for the treatment of difficulty breathing and swelling of her legs. You are giving these drugs for the first time. Discuss what questions you would ask Ms. Taylor to obtain subjective data.

• Review Questions

1. A patient states that he does not understand why he had to take a specific medication. The most accurate nursing diagnosis for this man would be .

A. ineffective management of therapeutic regimen

B. anxiety

C. noncompliance

D. deficient knowledge

2. When the nurse enters subjective data in the patient's record, this information is obtained from .

A. the primary care provider

B. other members of the health care team

C. the patient or family

D. laboratory and x-ray reports

3. During the evaluation phase of the nursing process the nurse makes .

A. decisions regarding the effectiveness of nursing interventions

B. sure nursing procedures have been performed

C. notations regarding the patient's response to medical treatment

D. a list of all adverse reactions the patient has experienced while taking the drug chapter

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