Medication Administration

1. Medication Administration Teresa V. Hurley, MSN, RN

3. Pharmacological Concepts • Drug Names • Chemical Name: molecular composition • N-acetyl-para-aminophenol • Generic Name: common name • acetaminophen • Trade Mark: official name, brand name • tylenol

4. Pharm Concepts • Classification • Effects on body system • Symptoms relieved • Desired effect • Oral hypoglycemic agents • Aspirin (analgesic, antipyretic, anti-inflammatory)

5. Pharm Concepts • Medication Forms: determines route • Examples • Tablets • Capsules • Elixirs • Suppositories

6. Regulatory Bodies FDA (Food and Drug Administration) enforcement of laws • State and Local (regulate tobacco and alcohol) • Health Care Institutions • Nurse Practice Acts

7. Pharmocokinetics • Absorbed • Administration route • Rate differs (skin, mucous membranes, respiratory airways, GI system) • Dissolved (acidic versus base) • Blood Flow to site of administration • Body Surface Area • Lipid Solubility, with or between meals

8. Distribution • Circulation • Membrane Permeability • Protein Binding (free form does not bind to albumin and is the active form of medication) • What happens in liver disease, malnurtition and elderly?

9. Metabolism • Bio-tranformation (detoxify) medications • Liver main organ • Less extent lungs, kidneys, intestines • Excretion • Kidneys( main) and liver, bowel, lungs, skin • Gases and alcohol through the lungs

10. Medication Action • Therapeutic Effect • ASA • Analgesic • Antipyretic • Anti-inflammatory • Reduces platelet agglutination • Anti-hypertensives and Mood elevators in small doses given for night sweats • Nitroglycerine to increase o2 supply to heart and reduce cardiac workload

12. Side Effects • Minimal or serious effect • Adverse Effects • Severe response as coma • Toxic • Prolonged use, metabolism or excretion impairments lead to build-up Opiod Toxicity: morphine leads to respiratory depression and death; antagonist narcon to reverse

13. Idiosyncratic Reaction is Unpredictable

14. Allergic Reactions • Medication acts as antigen • Antigen triggers release of antibodies • Mild (uriticaria; rash, pruritus, rhinitis) • Anaphylactic • constriction muscles, pharyngeal and laryngeal edema, wheezing, SOB, hypotension, • Medic Alert Bracelet

15. Medication Interactions • One medication increases or lessens effect the other • Synergistic: combined effect produces greater effect than if given separately • Alcohol and antihistamines, antidepressants, barbiturates and narcotics

16. Therapeutic Ranges • Onset: time it takes to produce a response • Peak: highest effective concentration • Trough: lowest concentration just before next scheduled dose • Duration: concentration great enough to produce a response • Plateau: concentration reached and maintained after administration of fixed doses

17. Administration Routes Oral Medications • PO • Buccal • Sublinguinal

18. Parenteral Administration (Injections) Intradermal (ID) dermis layer

19. Parenteral • Subcutaneous (Sub-Q) Tissues below the Dermis

20. Parenteral • Intramuscular (IM)

21. Parenteal • Intravenous

22. Topical Administration • Transdermal: 24 hours to 7 days with a systemic effect (nitroglycerine, estrogens) • Topical provide local effects (eye, ear, nose gtts, gargling, swabbing; rectal or vaginal suppositories; flushing or spraying)

23. The Five Rights • Right Drug • Right Dose • Right Route • Right Time • Right Client • Three checks before administration

24. Types of Orders • Standing or Routine • Tetracycline 500 mg PO q6h • prn: when ever necessary is a subjective and objective determination • Morphine sulfate 2 mg IV 12 hr prn for incisional pain • Document assessment, time given, effectiveness

25. Order Types • Single (one time only) as pre-op or pre-diagnostic • Valium 10 mg PO at (9:00 am) • STAT (single dose, immediately) • Surgery Automatically cancels all of client’s existing medication orders • New Orders Written: Transfer to another Health Care Facility; from 1 unit to another

26. Distribution Systems • Must be kept under lock and key • Must be under surveillance • Stock Supply Delivery: costly and extremely high incidence of errors • Unit Dose System: mandated by states and regulatory agencies (NYS) and supply only for 24 hours

27. Newer Technological Systems • Automated Medicine Dispensing Systems (AMDS) • Computer control of unit doses and narcotics via client profile • Access via nurse security code, client ID, desired med, dosage, route from computer screen and drawer opens, records and charges • Bar Code Scans (client and medication (name, dosage and strength) and nurse administering

28. Medication Administrative Records • Check written order against the MAR • Check written order when administering IV solutions • Document all medications given on MAR • Document unusual side effects in nurses notes • Document IV solutions given on I and O sheet and in nurses notes • Document amount of fluid given PO with medications on the I&O sheet if client on intake and output

29. Administer Medications Safely • Never recap a needle Place in Sharps Container

31. Medication Orders • Name of Drug • Dosage • Route • Frequency • Colace 100mg PO every hs • Demerol 50 mg IM every 4 h for x • MOM 30 mL PO prn for constipation

32. Prevention of Errors • Check orders • Clarify illegible orders • Check B/P • Check A or A/R pulse • Check for allergies • Check lab results • Check calculations

33. Calculation Conversions • Not always exact between systems • 60 mg = gr 1 • 65 mg = gr 1 • ASA gr V = 300 mg • ASA gr V = 335 mg