Introduction to Clinical Pharmacology Chapter 02- Administration of Drugs

1. Introduction to Clinical PharmacologyChapter 02-Administration of Drugs

2. Introduction • Drug administration • Understand basic concepts • Nurse’s role: • Monitor the therapeutic response • Report adverse reactions • Teach the patient and family members

3. *The Five +1 Rights of Drug Administration • Right patient: Check patient’s wristband; ask patient to identify himself, DOB, pictures • Right drug: Compare medication; container label; medication record • Right dose • Right route : Obtain written order • Right time • Right documentation: Record immediately*

4. Considerations in Drug Administrations • General principles of drug administration • *Factual knowledge of each drug given: Reasons for use; general action; common adverse reactions; special precautions in administration; normal dose ranges • Check current and approved references for all drug information • *Consider before administering a drug: *Patient’s allergy history; previous adverse reactions; patient comments; change in patient condition

5. Considerations in Drug Administrations (cont’d) • The medication order: To administer medication a physician’s order is essential • *Common orders: Standing; single; PRN; STAT • Once-a-Week drug: Doses designed to replace daily doses of drugs; beneficial for those experiencing mild adverse reactions • Example: Alendronate (Fosamax) - Treat osteoporosis

6. Considerations in Drug Administrations (cont’d) • Guidelines for preparing a drug for administration • Check health care provider’s written orders and compare label of the drug with MAR • Wash hands and do not let hands touch capsules or tablets • Never remove a drug from: An unlabeled container; a package with an illegible label • Never crush tablets or open capsules or administer a drug prepared by someone else • Alert: Drugs with similar names

7. Considerations in Drug Administrations (cont’d) • Guidelines for preparing a drug for administration (cont’d) • Return drugs requiring special storage to the storage area immediately after they are prepared for administration • Unit dose: Remove wrappings when the drug reaches the patient; chart immediately after administering the drug

8. Considerations in Drug Administrations (cont’d) • *Precautions taken by the nurse: • Confirm any questionable orders • verify calculations with another nurse • listen to the patient • Never administer a drug until you answer the patients questions • concentrate on only one task at a time • Most common occurrence of errors: Insulin and heparin

9. Considerations in Drug Administrations (cont’d) • Drug Errors - patient receives: • The wrong dose • The wrong drug • An incorrect dosage of the drug • A drug by the wrong route • A drug given at the incorrect time • Nurses: Last defense against detecting drug errors; if error occurs, report immediately

10. Considerations in Drug Administrations (cont’d) • Drug dispensing system • Computerized Dispensing System • Unit Dose System • Bar Code Scanner • Bar codes are used to identify the patient and to record and charge routing and PRN drugs • Provider identification badges are scanned during the procedure, identifying the nurse giving the medication

11. Administration of Drugs by Oral Route • Most frequent route of drug administration • Oral Drug Forms: Tablets; capsules; liquids • Sustained-release drugs • **Nursing responsibilities: • Verify the drug • identify the patient • assess; keep water readily available • instruct; never leave a drug at the patient’s bedside to be taken later

12. NGT or g-tubes* • Always check for placement • Dilute and flush liquid drugs through the tube • Crush tablets and dissolve them in water before administering them through the tube • Flush tube with water after the drugs are placed in the tube to clear the tubing completely

13. Administration of Drugs by Parenteral Route • Parenteral drug administration routes: Subcutaneous (SC); intramuscular (IM); intravenous (IV); intradermal route; intralesional; intra-arterial; intracardiac; intra-articular • Nursing responsibilities: Wear gloves; use standard precautions; cleanse skin

14. Administration of Drugs by Parenteral Route (cont’d) • Administration of drugs by subcutaneous route: Places the drug into the tissues between the skin and the muscle • Nursing responsibilities: • Volume of injection: Single/multiple sites • SC injection sites: Upper arms; upper abdomen; upper back-ROTATE sites • Needle length and angle of insertion: Obese/thin patients-23-25 gauge needle

15. Administration of Drugs by Parenteral Route (cont’d) • Administration of drugs by intramuscular route: Administration into a muscle • Nursing responsibilities: 20-22 gauge needle • Volume of injection: Single/multiple sites; 1-3 mls • Injection sites, needle length and angle of insertion: Deltoid muscle; ventrogluteal or dorsogluteal sites; *vastus lateralis-infants and small children • Z-Track technique: Prevents backflow of drug into the SC tissue

16. IM route • Wash hands • Don gloves • Verify drug allergies • Aspirate 5-10 seconds • Place pressure on area after removing needle

17. Administration of Drugs by Parenteral Route (cont’d) • Drug administration- intravenous route: Directly into blood; needle inserted into a vein • Methods of administration: Slow; rapid; piggyback infusions; existing IV line; using intermittent venous access device; added to an IV solution; venipuncture • Intravenous infusion controllers, pumps: Detectors, alarms alert the nurse • Possible problems: Air in line; occlusion; low battery; completion of infusion; inability to deliver preset rate

18. Administration of Drugs by Parenteral Route (cont’d) • Administration of drugs by intravenous route (cont’d) • Nursing responsibilities: • Record type of IV fluid and drug added to the IV solution after start of infusion; check infusion rate and inspect needle site • Swelling around the needle: Extravasation or infiltration

19. Administration of Drugs by Parenteral Route (cont’d) • Drug administration- intradermal route: Sensitivity tests - Tuberculin; skin allergy • Nursing responsibilities: • Injection sites: Inner part of forearm; upper back; hairless; avoid areas near moles, scars, or pigmented skin • 1-mL syringe; 25- to 27-gauge needle; 1⁄4 to 5⁄8 inch • Needle insertion: 15-degree angle; do not aspirate syringe or massage the area

20. Administration of Drugs by Parenteral Route (cont’d) • Other parenteral routes of drug administration: Intracardial; intralesional; intra-arterial; intra-articular • Nursing responsibilities: • Prepare drug for administration; Ask primary care provider • Venous access ports: For chemotherapy or long-term therapy

21. Administration of Drugs Through the Skin and Mucous Membranes • Application to the skin and mucous membranes • Several routes • Topical • Transdermal • Rotate patch sites • Inhaled through the membranes of the upper respiratory tract

22. Administration of Drugs Through the Skin and Mucous Membranes (cont’d) • Administration of drugs by the topical route • Act on the skin; not absorbed through the skin • Nursing responsibilities: • Follow special instructions: Drug action may depend on correct administration of the drug

23. Administration of Drugs Through the Skin and Mucous Membranes (cont’d) • Administration of drugs by the transdermal route • Readily absorbed from the skin • Drug dosages: Implanted in a small patch-type bandage • Drug system maintains: Constant blood concentration; reduces the possibility of toxicity

24. Administration of Drugs Through the Skin and Mucous Membranes (cont’d) • Administration of drugs by the transdermal route (cont’d) • Nursing responsibilities: • Wear gloves; apply patch on clean, dry, nonhairy areas of intact skin; apply next dose to new site: Remove old patch • Commonly used sites: Chest, flank, and upper arm

25. Administration of Drugs Through the Skin and Mucous Membranes (cont’d) • Administration of drugs through inhalation • Drug droplets, vapor, or gas: Through mucous membranes of the respiratory tract • Use face mask, nebulizer, or positive-pressure breathing machine • Nursing responsibilities: • Provide proper instructions

26. Nursing Responsibilities after Drug Administration • Record: Administration of the drug; IV flow rate, site used for parenteral administration; problems with administration; vital signs taken immediately before administration • Evaluate and record: Patient’s response to the drug • Observe and record: Adverse reactions and frequency

27. Administration of Drugs in the Home • Home setting caregivers: Patient or family members • Ensure: Patient or caregiver understands the treatment regimen • Home care checklist: For administering drugs safely in the home