Medication Management: A Nursing Assignment on ADPIE Framework

This assignment delves into the critical aspects of medication management within a nursing context, employing the ADPIE (Assessment, Diagnosis, Planning, Implementation, and Evaluation) framework to guide the process. Focusing on the assessment, implementation, and evaluation phases, the assignment explores the responsibilities of a registered nurse in managing medications for a patient, including assessing drug history, patient lifestyle, and cultural considerations. The implementation phase emphasizes communication, adherence to the 'eight rights' of medication administration, and patient education on drug profiles, side effects, and cultural appropriateness. The evaluation phase involves monitoring patient responses, assessing therapeutic and adverse effects, and providing discharge planning and safe medication administration guidance, including storage instructions and potential drug interactions. The assignment highlights the importance of culturally sensitive care and the role of nurses in ensuring safe and effective medication administration, particularly for patients with diverse backgrounds and limited health literacy. The assignment also provides detailed information on the medications Metformin, Glibenclamide, and Atorvastatin, including their uses, mechanisms of action, and side effects.

Running head: MEDICATION MANAGEMENT ASSIGNMENT
Medication management assignment
Name of the student:
Name of the university:
Author note:

1MEDICATION MANAGEMENT ASSIGNMENT
Application of clinical decision making process:
ADPIE is a framework for clinical decision making for the nurses that provides the
nurses with a set of systemtic step by step process, following which the nurse will be able to
complete a thorough assessment analysis, diagnosis and intervention implementation in order to
address each and every concerns of the patient (Alfaro-LeFevre, 2012). ADPIE stands for
assessment, diagnosis, planning, implementation and evaluation in a care scenario. As this
assignment focuses majorly on the medication management, only three sections of the ADPIE
frame work will be used namely assessment, implementation and evaluation.
Assessment phase:
The first step is the assessment step, where the medical professional attempts to discover
the care issue of the patient and establishes a database of the care cues of the patient by
interviewing the patient or their family members. Registered nurse will have two core nursing
responsibility in this segment of care delivery. The first responsibility of the nurse will be to
assess the drug history of the patient, including the prescription drugs and the over-the-counter
drugs and the hypersesnsitivity of the patient to drug agents (Inzucchi et al., 2012). The patient
had been taking metformin 500mg for her diabetes but she kept forgetting to take her medication,
while in admission she had been given metformin, glibenclamide, atorvastatin, and erythromycin
for wound infection management. The second responsibility of the nursing professional will be
to assess the patient history such as the biographical data, lifestyle and beliefs, sensory and
cognitive status as well. In regards to the cultural requirements, the nurse will have to ensure to
adhere to the culturally appropriate and traditional approach to care while approaching the
patient and be able to provide optimal cultural safety to the patient.

2MEDICATION MANAGEMENT ASSIGNMENT
Implementation phase:
In this case, the first responsibility of the registered nurse will be to incorporate constant
communication and collaboration with the health care team and follow the “eight rights” of the
medication administration, such as right patient, right medication, right dose, right route, right
time, right documentation, right reason and right response or all three medications. The second
core responsibility will be to analyze the pharmacologic profile of the medication and educate
the patient with a detailed account of the medication and how it is helping her. Metformin is a
biguanide antihyperglycemic agent which is used mainly for treating the non insulin dependent
Diabetes mellitus. The generic name is metformin with brand names Fortamet, Glucophage,
Glucophage XR, Glumetza, Riomet. This is a schedule two drug and for mechanism of action,
metformin decreases the blood glucose levels by reducing the hepatic glucose production (Bailey
et al., 2010). The side effects of the drugs like abdominal discomfort, cough, decreased appetite,
diarrhea, shallow breathing and fever may occur, for which Mavis will need to contact the care
facility. Similarly, for Glibenclamide, the generic name is glibenclamide or glyburemide and
brand names are Dionil, Glucovance, Glucobene, semi-dionil. Mavis will need to be educated on
how the medication binds to the ATP-sensitive potassium channels on the pancreatic cell surface
and causes membrane depolarization and stimulation of calcium ion influx inducing the secretion
and exocytosis of insulin (Seino et al., 2010). Mavis will need to be educated on the side of
effects of the medixation which are nausea, vomiting, constipation, diarrhea and hypoglycemic
attack. Lastly for atorvastatin as well, the generic name is atorvastatin and the brand name is
Lipitor. Mavis will need to be educated on how statin group of drugs selectively and
competitively inhibits the hepatic enzyme HMG-CoA reductase, in turn increasing hepatic
uptake of LDL-C and reducing serum LDL-C concentrations. The education will include the side

3MEDICATION MANAGEMENT ASSIGNMENT
effects like memory problems or confusion, rhabdomyolysis and autoimmune myopathy, muscle
pain, fever or unusual tiredness, changes in urine, etc. with regards to cultural appropriatenessm
the registered nurse will need to provide the education in a culturally appropriate manner in a
simple language that she will understand preferably taking the assistance of a cultural liaison
officer and language interpreter (Kirmayer, 2012).
Evaluation phase:
The third stage of this process is the evaluation where the nursing professional will be
needed to evaluate the success of the planning and implementation procedure. In this case, the
nurse will have to monitor the response of the patient to the drugs administered, monitor the
difference between expected and unexpected responses and assess the therapeutic effects, side
effects, adverse effects and toxic effects (Nursingmidwiferyboard.gov.au 2018). This is the last
step before the discharge and here the nurse will have to ensure that the patient understand all
aspects associated with the safe and effective medication administration. The nursing
responsibilities will include discharge planning and safe medication administration guidance.
The nurse must educate the patient to take the right dosage at the right time and in case she
missed a dosage the nurse will have to ensure taking the next dose according to the regular
dosing schedule and that Mavis is not supposed to take double dosage of any medication to make
up for missed dosage. The nurse will educate Mavis further on storing metformin is a closed
container at room temperature, away from heat, moisture, and direct light (Inzucchi et al.,
2012). The nurse will also educate Mavis to not consume alcohol while taking metformin. For
Glybenclamide, the nurse will educate the patient to take the medication in the morning
immediately after breakfast and if missed a dose, not to take double doses either. Mavis will need
to be educated to seek medical advice if the patient experiences nauseam vomiting, constipation,

4MEDICATION MANAGEMENT ASSIGNMENT
diarrhea and hypoglycemic attack (White et al., 2013). Nurse will also need to educate Mavis to
store the medicine in a cool, dry place, away from direct heat and light. For atorvastatin, Mavis
will need to know to store the medication room temperature between 68-77 degrees F (20-25
degrees C) away from light and moisture and especially away from the bathroom (Jin et al.,
2012). Along with that Mavis will be strictly advised to never skip a dose and in case she forgets
to move on to next dosage and never overdose to make up for missed dose as well. Lastly the
nurse will have to educate Mavis to keep the medication in a secure locked cabinet so that her
granddaughter cannot access them at all (Roth et al., 2012). For the cultural appropriateness the
nurse will have to ensure involving a cultural liaison officer and a language expert in the
discharge planning and implementation session to ensure that Mavis understands the entire
procedure and can equally participate in it. The RN will also have to ensure that the patient
education details are provided in a written format in a culturally and linguistically appropriate
manner using aboriginal language and symbols. Lastly the RN will have to ensure approaching
the patient in a culturally safe and appropriate manner with utmost respect to the patient
autonomy and dignity (Kirmayer, 2012).
Conclusion:
On a concluding note, it has to be mentioned that self medication administration can be a
very risky procedure, especially for the culturally diverse populations with limited health literacy
and lack of English language proficiency which can lead to the patient missing doses and
administering wrong dosages and storing the medication in inadequate manner. Hence the role of
a nursing professional is monumental in educating and guiding the patient for safe and effective
medication administration. This essay had utilized the ADPIE clinical decision framework with

5MEDICATION MANAGEMENT ASSIGNMENT
respect to medication administration and safe application of drug therapy along with
incorporating cultural safety guidelines for an aboriginal patient.

6MEDICATION MANAGEMENT ASSIGNMENT
References:
Alfaro-LeFevre, R. (2012). Applying nursing process: the foundation for clinical reasoning.
Lippincott Williams & Wilkins.
Bailey, C. J., Gross, J. L., Pieters, A., Bastien, A., & List, J. F. (2010). Effect of dapagliflozin in
patients with type 2 diabetes who have inadequate glycaemic control with metformin: a
randomised, double-blind, placebo-controlled trial. The Lancet, 375(9733), 2223-2233.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... &
Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-
centered approach. Position statement of the American Diabetes Association (ADA) and
the European Association for the Study of Diabetes (EASD). Diabetologia, 55(6), 1577-
1596.
Jin, D., Wu, Y., Zhao, L., Guo, J., Zhang, K., & Chen, Z. (2012). Atorvastatin reduces serum
HMGB1 levels in patients with hyperlipidemia. Experimental and therapeutic
medicine, 4(6), 1124-1126.
Kirmayer, L. J. (2012). Rethinking cultural competence.
Nursingmidwiferyboard.gov.au. (2018). Nursing and Midwifery Board of Australia -
Professional standards. [online] Available at:
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx [Accessed 15 May 2018].

7MEDICATION MANAGEMENT ASSIGNMENT
Roth, E. M., McKenney, J. M., Hanotin, C., Asset, G., & Stein, E. A. (2012). Atorvastatin with
or without an antibody to PCSK9 in primary hypercholesterolemia. New England Journal
of Medicine, 367(20), 1891-1900.
Seino, Y., Rasmussen, M. F., Nishida, T., & Kaku, K. (2010). Efficacy and safety of the once-
daily human GLP-1 analogue, liraglutide, vs glibenclamide monotherapy in Japanese
patients with type 2 diabetes. Current medical research and opinion, 26(5), 1013-1022.
White, W. B., Cannon, C. P., Heller, S. R., Nissen, S. E., Bergenstal, R. M., Bakris, G. L., ... &
Wilson, C. (2013). Alogliptin after acute coronary syndrome in patients with type 2
diabetes. New England journal of medicine, 369(14), 1327-1335.