8.4 Nursing Process: CNS Medications

Now that we have reviewed various CNS disorders and the anatomy and physiology underlying them, let’s review the importance of the nursing process in guiding the nurse who administers CNS medication to treat these disorders.

Assessment

When thinking about administering CNS medication, there are many things to consider. Each medication is given for a specific purpose for your patient, and it is your job as a nurse to assess your patients and collect important data before safely administering medication. As a nurse, you will be not only performing the skill of administering medications, but also be expected to think critically about your patient and the safety of any medication at any particular time.

A nursing assessment completed prior to administering CNS medication will likely look different than an assessment for other types of medication because most of the associated assessments are done by collecting subjective data rather than objective data. For example, prior to administering a cardiac medication, a nurse will obtain objective data such as blood pressure and an apical heart rate. However, prior to administering CNS medication, a nurse will use therapeutic communication to ask questions to gather subjective data about how the patient is feeling. After reviewing the possible diseases connecting with the CNS system, you probably noticed that there is usually an associated imbalance of a neurotransmitter. As a nurse, you cannot directly measure a neurotransmitter to determine the effects of the medication, but you can ask questions to determine how your patient is feeling emotionally and perceiving the world, which are influenced by neurotransmitter levels. An example of a nurse using therapeutic communication to perform subjective assessment is asking a question such as, “Tell me more about how you are feeling today?” The nurse may also use general survey techniques such as simply observing the patient to assess for cues of behavior. Examples of data collected by a general survey could be assessing the patient’s mood, hygiene, appearance, or movement.

Implementation of Interventions

With the administration of any medications, it is important to always perform the five rights (right patient, medication, dose, route, and time) and to check for allergies prior to administration. It is important to anticipate any common side effects and the expected outcome of the medication. When you administer CNS medication, it is key to perform assessments before administering medication because many patients may have changing behaviors and habits that influence the way they think and feel about taking their medication. Additionally, some medications require assessment of lab values before administration. Many CNS medications may also have cumulative effects when used in conjunction with other medications, so careful assessment of the impact of the medications on one another is needed.

Evaluation

Finally, it is important to always evaluate the patient’s response to a medication. Some CNS medications will take weeks to become therapeutic for the patient. It is key to teach the patient about when the medication is expected to produce an effect. Nurses should assess for mood, behavior, and movement improvement. If medications are effective, then patients should report fewer negative thoughts, worry, and symptomatic behaviors, as well as demonstrate fewer abnormal movements. Nurses also need to continually monitor for adverse effects, some of which can be life threatening and require prompt notification to the prescribing provider. Additionally, if symptoms are not improving or the patient’s condition is worsening, the nurse should promptly notify the prescribing provider for further orders. For example, a symptom and/or adverse reaction of several CNS medications is increased thoughts of suicide. If a patient is experiencing thoughts of suicide, immediate assistance should be obtained to keep them safe. For more information about suicide, see the link to information about suicide prevention below.

Suicide Prevention

Now that we have reviewed CNS basics and how to use the nursing process related to CNS medications, we will take a closer look at specific classes of CNS medications. We will review classes and specific administration considerations, therapeutic effects, adverse/side effects, and teaching needed for each class of medications.

Medication grids are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Detailed information on a specific medication can be found for free at Daily Med. On the home page, enter the drug name in the search bar to read more about the medication.

Prototype/generic medications listed in the grids are also hyperlinked directly to a Daily Med page.