8.4 Applying the Nursing Process to Administering CNS Medications

Now that we have reviewed CNS anatomy and physiology and common disorders, let’s apply the nursing process to administering CNS medications.

Assessment

When administering CNS medication, there are many things a nurse must consider. Each medication is given for a specific purpose, and important data must be collected to safely administer medication.

A nursing assessment completed prior to administering CNS medication is different than an assessment for other body systems because most of the 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 client is feeling.

After reviewing common CNS disorders, you probably noticed there is often an associated neurotransmitter imbalance. Although nurses cannot directly measure neurotransmitters to determine the effects of CNS medications, they can ask questions to determine how the client is feeling emotionally and perceiving the world, both of which are influenced by neurotransmitter levels.

An example of a nurse using therapeutic communication to perform subjective assessment is, “Tell me more about how you are feeling today.” While listening to the client, the nurse also uses general survey techniques to observe the client to assess for cues of behavior. Examples of data collected by a general survey are assessing the client’s energy level, hygiene, or movement.

Implementation

With the administration of any medications, it is important to always check the rights of medication administration and anticipate common side effects. When administering CNS medications, pre-assessments must be performed because clients may have changing behaviors and moods that influence their need for medication. Additionally, some medications, such as lithium, require lab value monitoring. Many CNS medications interact with other medications, so careful assessment for potential drug interaction is required.

Evaluation

It is important to always evaluate the client’s response to a medication. Some CNS medications will take weeks to become therapeutic for the client. It is key to teach the client when the medication is expected to produce an effect. Nurses should assess for mood, behavior, and movement improvement. If medications are effective, then clients should report fewer negative thoughts, worry, and symptomatic behaviors, as well as demonstrate fewer abnormal movements. Nurses must also continually monitor for adverse effects, some of which can be life-threatening and require prompt notification to the prescribing provider. Additionally, if symptoms are
improving or the client’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 client is experiencing thoughts of suicide, immediate assistance should be obtained to keep them safe.