Medication Administration

1. 1 Medication Administration

2. 2 Medication Substance administered for the diagnosis, treatment, or relief of a symptom or for the prevention of diseases Used interchangeably with the word drug Drug also has the connotation of an illegally obtained substance

3. 3 Prescription Written directions for the preparation and administration of a drug

4. 4 Generic name of a drug Name given before a drug becomes officially approved as a medication

5. 5 Official name of a drug Name under which it is listed in one of the official publications

6. 6 Chemical name of a drug Name by which a chemist knows the drug

7. 7 Trade or brand name Name given by the drug manufacturer Usually short and easy to remember

8. 8 Pharmacology Study of the effect of drugs on living organisms

9. 9 Pharmacy Art of preparing, compounding, and dispensing drugs Also refers to the place where drugs are prepared

10. 10 Legal Aspects of Administering Medications Nursing practice acts Responsibility for actions Question any order that appears unreasonable Refuse to give the medication until the order is clarified

11. 11 Controlled Substances Kept under lock Special inventory forms Documentation requirements Counts of controlled substances Procedures for discarding

12. 12 Nurses need to know how nursing practice acts in their areas define and limit their functions and be able to recognize the limits of their own knowledge and skills. Under the law, nurses are responsible for their own actions regardless of whether there is a written order. Therefore, nurses should question any order that appears unreasonable and refuse to give the medication until the order is clarified.

13. 13 Another aspect of nursing practice governed by law is the use of controlled substances. Controlled substances are kept under lock. Special inventory (list of items) forms are used for recording the use of these substances

14. 14 The information usually required on these forms include the name of the client, date and time of administration, name of the drug, dosage, and signature of the person who prepares and gives the drug. The name of the primary care provider who ordered the drug may also be listed.

15. 15 A verifying signature of another RN may be required by the agency when a drug is administered. Careful inventory control is maintained. When a portion or all of a controlled substance is discarded, the nurse must ask another nurse to witness the discarding. In most agencies, counts of controlled substances are taken at the end of each shift and the count total should tally with the total at the end of the last shift minus the number used.

16. 16 Factors Affecting Medication Action Developmental Gender Cultural, ethnic, and genetic Diet Environment Psychologic Illness and disease Time of administration

17. 17 Medication action may be affected by developmental factors, gender, culture, ethnicity, genetics, diet, environment, psychologic factors, illness and disease, and time of administration.

18. 18 The nurse needs to be aware of developmental factors. Pregnant women must be careful about taking medications, especially in the first trimester, because of the possible adverse effects on the fetus. Infants usually require smaller doses because of their body size and the immaturity of their organs.

19. 19 Older adults have different responses to medications due to physiologic changes that accompany aging and because they may be prescribed multiple drugs and incompatibilities may occur.

20. 20 Gender differences in medication action are chiefly related to the distribution of body fat and fluid and hormonal differences. In addition, most research studies on medications have been done on men. In addition to gender, a client�s response to drugs is also influenced by genetic variations such as size and body composition (pharmacogenetics).

21. 21 Ethnopharmacology is the study of the effects of ethnicity on response to prescribed medications. Cultural factors and practices (values and beliefs) can also affect a drug�s action; for example, an herbal remedy may speed up or slow down the metabolism of certain drugs (see Culturally Competent Care).

22. 22 The diet may contain nutrients that can interact with medications and increase or decrease action. It is important to consider the effects of a drug in the context of the client�s personality, milieu (surroundings ), and environmental conditions (e.g., temperature, noise).

23. 23 Psychological factors, such as a client�s expectations about what a drug can do, can affect the response to the medication. Illness and disease can affect how a client responds to a medication. For example, aspirin can reduce body temperature of a feverish client but has no effect on body temperature of a client without a fever.

24. 24 Time of administration is important because medications are absorbed more quickly if the stomach is empty; however, some medications irritate the gastrointestinal tract and are given after a meal.

25. 25 Routes of Medication Administration Oral (PO) Sublingual (SL) Buccal Parenteral Subcutaneous (SC) Intramuscular (IM) Intradermal (ID)

26. 26 Intravenous (IV) Intra-arterial (IA) Intracardiac (IC) Intraosseous (IO) Intrathecal (intraspinal) (IT) (IS) Epidural (ED) Intra-articular

27. 27 Topical Dermatological Instillations and irrigations Inhalation Ophthalmic, otic, nasal, rectal, and vaginal

28. 28 Routes of medication administration include oral, sublingual, buccal, parenteral, and topical. In oral administration the drug is swallowed. It is the most common, least expensive, and most convenient route for most clients

29. 29 In sublingual administration a drug is placed under the tongue, where it dissolves.

30. 30 Buccal means �pertaining to the cheek.� In buccal administration a medication is held in the mouth against the mucous membranes of the cheek until the drug dissolves.

31. 31 Some common routes for parenteral administration include subcutaneous (hypodermic), into the subcutaneous tissue just below the skin; intramuscular, into the muscle; intradermal, under the epidermis (into the dermis)

32. 32 intravenous, into a vein; intra-arterial, into an artery; intracardiac, into the heart muscle; intraosseous, into the bone; intrathecal or intraspinal, into the spinal canal; epidural, into the epidural space; and intra-articular, into a joint.

33. 33 Topical applications are those applied to a circumscribed surface area of the body. Routes for topical applications include dermatologic, applied to the skin; instillations and irrigations, applied into body cavities or orifices such as the urinary bladder, eyes, ears, nose, rectum, or vagina

34. 34 ophthalmic, otic, nasal, rectal, and vaginal topical preparations; and inhalations, administered into the respiratory system by a nebulizer or positive pressure breathing apparatus.

35. 35

36. 36 Parts of a Medication Order Full name of the client Date and time the order written Name of drug to be administered Dosage Frequency of administration Route of administration Signature of person writing the order

37. 37 Types of Medication Orders and Examples Stat order Demerol 100 mg IM stat Single order Seconal 100 mg hs before surgery Standing order Multivitamin 1 capsule po daily Demerol 100 mg IM q 4 h x 5 days prn order Amphojel 15 mL prn

38. 38 A stat order indicates that the medication is to be given immediately and only once (e.g., Demerol 100 mg IM stat). The single order or one-time order is for medication to be given once at a specified time (e.g., Seconal 100 mg hs before surgery).

39. 39 The standing order may or may not have a termination date, may be carried out indefinitely (e.g., multiple vitamins daily) until an order is written to cancel it, or may be carried out for a specified number of days (e.g., Demerol 100 mg IM q4h � 5 days). A prn order or as-needed order permits the nurse to give a medication when, in the nurse�s judgment, the client requires it (e.g., Amphojel 15 mL prn).

40. 40 Systems of Measurement Metric Apothecary Household

41. 41

42. 42 Six Essential Steps for Administering Medications Identify the client Inform the client Administer the drug Provide adjunctive interventions as indicated Record the drug administered Evaluate the client�s response to the drug

43. 43 When administering any drug, regardless of the route of administration, the nurse must identify the client, inform the client, administer the drug, provide adjunctive interventions as indicated, record the drug administered, and evaluate the client�s response to the drug.

44. 44 The nurse must use at least two client identifiers whenever administering medications. Acceptable identifiers may be the person�s name, an assigned identification number, a telephone number, a photograph, or another personal identifier.

45. 45 If the client is unfamiliar with the medication, the nurse should explain the intended action as well as any side effects or adverse reactions that might occur. It is also very important to listen to the client.

46. 46 Before administering the drug, the nurse should read the medication administration record (MAR) carefully and perform three checks with the labeled medication (See Box 35�3). In addition the ten �rights� of medication administration must be observed

47. 47

48. 48 The nurse should provide adjunctive interventions as indicated. Clients may require physical assistance in assuming positions for parenteral medications or may need guidance about measures to enhance drug effectiveness and prevent complications.

49. 49 The nurse must record the drug administered, following agency regulations.

50. 50 In order to evaluate the client�s response to the drug, the nurse should know the kinds of behavior that reflect the action or lack of action of the drug and its untoward effects (both minor and major) for each medication the client is receiving. The nurse may also report the client�s response directly to the nurse manager and primary care provider.

51. 51 Ten �Rights� of Accurate Medication Administration Right medication (Drug) Right dose Right time Right route Right client Right documentation Right client education Right to refuse Right assessment Right evaluation

52. 52

53. 53 Elder Considerations Altered memory Decreased visual acuity Decrease in renal function

54. 54 Less complete and slower absorption from the gastrointestinal tract Increased proportion of fat to lean body mass Decreased liver function Decreased organ sensitivity Altered quality of organ responsiveness Decrease in manual dexterity (physical skill)

55. 55 Physiologic changes in older adults that alter medication administration and effectiveness include altered memory; decreased visual acuity; decreased renal function, resulting in slower elimination of drugs and higher drug concentration in the bloodstream for longer periods; less complete and slower absorption from the gastrointestinal tract;

56. 56 increased proportion of fat to lean body mass, which facilitates retention of fat-soluble drugs and increases the potential for toxicity; decreased liver function, which hinders biotransformation of drugs;

57. 57 decreased organ sensitivity, which means that the response to the same drug concentration in the vicinity (surrounding region) of the target organ is less in older people than in the young; altered quality of organ responsiveness, resulting in adverse effects becoming pronounced before therapeutic effects are achieved

58. 58 and decreased manual dexterity due to arthritis and/or decreased flexibility .

59. 59  steps required to administer oral medications safely. Prior to administering oral medications, the nurse should assess for allergies to medications ,the client�s ability to swallow the medication;

60. 60 presence of vomiting or diarrhea; specific drug action, side effects, interactions, and adverse reactions; the client�s knowledge of and learning needs about the medication; and determine if assessment data influences administration of the medications.

61. 61 In preparation for administering the medication, the nurse should know the reason why the client is receiving the medication, the drug classification, contraindications, usual dosage range, side effects, and nursing considerations for administering and evaluating the intended outcomes for the medication. The nurse should check the MAR, verify the client�s ability to take medication orally, and organize the supplies.

62. 62 Outline steps required for nasogastric and gastrostomy tube medication administration. Nasogastric/Gastrostomy Tube Medication Administration Check with the pharmacist for a liquid form Check to see if medication may be crushed Crush a tablet into a fine powder and dissolve in at least 30 mL of warm water

63. 63 Open capsules and mix the contents with water only with the pharmacist�s advice Do not administer whole or undissolved medications Assess tube placement Aspirate stomach contents and measure the residual volume

64. 64 Nasogastric/Gastrostomy Tube Medication Administration Remove the plunger from the syringe and connect the syringe to a pinched or kinked tube Put 15 to 30 mL (5 to 10 mL for children) of water into the syringe barrel to flush the tube before administering the first medication

65. 65 Pour liquid or dissolved medication into the syringe barrel and allow to flow by gravity into the enteral tube Administer each medication separately and flush with at least 15 to 30 mL water between each medication

66. 66 When you have finished administering all medications, flush with another 15 to 30 mL (5 to 10 mL for children) of warm water to clear the tube If the tube is connected to suction, disconnect the suction and keep the tube clamped to enhance absorption

67. 67 equipment required for parenteral medications.  Parenteral Medications Common nursing procedure Absorbed more quickly than oral Requires careful and accurate administration Aseptic technique

68. 68 Syringes Parts Ruber plunger Tip Barrel Plunger

69. 69 Types of Syringes Standard hypodermic syringe Insulin syringe Tuberculin syringe Disposable prefilled unit-dose or prefilled cartridges

70. 70 Needles Stainless steel Most disposable Parts Hub Cannula or shaft Bevel

71. 71

72. 72 Characteristics of Needles Slant or length of the bevel Length of the shaft Gauge

73. 73 To administer parenteral medications, nurses use syringes and needles to withdraw medications from ampules and vials. Syringes have three parts: the tip, the barrel, and the plunger. There are several kinds of syringes, differing in size, shape, and material.

74. 74 The three most commonly used types are the standard hypodermic syringe, the insulin syringe, and the tuberculin syringe. Injectable medications are frequently supplied in disposable prefilled unit-dose systems available as a prefilled syringe ready for use or prefilled sterile cartridges (container for liquid or powder) and needles that require attachment to a reusable holder. Needleless systems are also available.

75. 75 Needles are made of stainless steel, and most are disposable. A needle has three parts: the hub, the cannula or shaft, and the bevel. Needles used for injections have three variable characteristics: the slant or length of the bevel, the length of the shaft, and the gauge

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78. 78 Drug Dose Calculations Several formulas may be used by the nurse when calculating drug doses. One formula uses ratios based on the dose on hand and the dose desired. For example, cephalexin (anti-infective cephalosporin) 500 mg PO q.i.d. (dose desired) is ordered by the health care practitioner; the dose on hand is 250 mg/5 ml. The formula is as follows: 250 mg (dose on hand) 500 mg (dose desired) 5 ml (dose on hand) x (dose desired) (cross-multiply)

79. 79

80. 80 Guidelines for Safe Administration of Medications Never administer medications that are prepared by another nurse. You are responsible for a medication error if you administer a medication that was inaccurately prepared by another nurse.

81. 81 Nurses should listen carefully to the client who questions the addition or deletion of a medication. Most clients are aware of their prescribed medications. If a client questions the drug or dose you are preparing to administer, recheck the order.

82. 82 if a medication is withheld, indicate the exact reason why in the client�s record. Legally you are accountable for giving ordered medications to the client; however, circumstances may prevent you from giving a medication as ordered. Medications may be held for some diagnostic tests, or the client receiving antihypertensive medications may have a blood pressure that is lower than normal. If you gave the antihypertensive, the blood pressure would decrease, causing further hypotension.

83. 83 Do not leave medications at the client�s bedside for any reason. The client may forget to take the medication, medications can accumulate, and the client could take two or more of the same medication, causing an overdose, or another client who is confused could take the medicine.

84. 84 Do not leave medications at the client�s bedside for any reason. The client may forget to take the medication, medications can accumulate, and the client could take two or more of the same medication, causing an overdose, or another client who is confused could take the medicine.

85. 85 Advise clients not to take medications belonging to others and not to offer their medications to others. Medications are ordered for each client on the basis of the history, physical examination, and effectiveness of the medication.

86. 86 Ampules and Vials Drugs for parenteral injections are sterile preparations. Drugs that deteriorate in solution are dispensed as tablets or powders and dissolved in a solution immediately before injection. Drugs that remain stable in a solution are dispensed in ampules and vials in an aqueous or oily solution or suspension. Ampules are glass containers of single-dose drugs

87. 87 The glass container has a constriction in the stem to facilitate opening the

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89. 89

90. 90  angle and site of injections.  Angle of Injection The angle of insertion depends on the type of injection. Figure 29-18 illustrates the angle of insertion for each type of parenteral injection.

91. 91 Angles of Insertion for Parenteral Injections

92. 92 Intradermal Injection Sites: A. Inner Aspect of the Forearm; B. Upper Chest; C. Upper Back

93. 93 Subcutaneous Injection Sites: A. Abdomen; B. Lateral and Anterior Aspects of Upper Arm and Thigh; C. Scapular Area on Back; D. Upper Ventrodorsal Gluteal Area.

94. 94 Z-Track Injection The Z-track (zigzag) technique refers to a method used in administering IM injections This technique was traditionally used when administering imferon, an iron preparation, which can cause permanent discoloration in the subcutaneous tissue. Today, the technique is used commonly when administering ventrogluteal and dorsogluteal injections. This method can help reduce pain even with nonstaining or irritating substances.

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97. 97  Calculation of Flow Rate The flow rate is the volume of fluid to infuse over a set period of time as prescribed by the health care practitioner. The health care practitioner will identify either the amount to infuse per hour (such as 125 ml per hour or 1000 ml over an 8-hour period).

98. 98 Calculate the hourly infusion rate as follows: