Chapter 30

1. Chapter 30 Medication Administration

2. Drug Standards and Legislation • Standards have been developed to ensure drug uniformity so that the effects of the medication are predictable. • The Pure Food and Drug Act (1906) designated official references. • United States Pharmacopeia (USP) • National Formulary (NF) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

3. Drug Standards and Legislation • Official Canadian references • British Pharmacopeia • Canadian Formulary Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

4. Federal Standards and Legislation • Harrison Narcotic Act (1914) classified habit-forming drugs as narcotics and regulated the dispensing of prescription drugs. • Comprehensive Drug Abuse Prevention and Control Act (Controlled Substance Act, 1970) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

5. Federal Standards and Legislation • Comprehensive Drug Abuse Prevention and Control Act (Controlled Substance Act, 1970) • Defines a drug-dependent person. • Established five categories of scheduled drugs (controlled substances). • Provides for strict regulation of controlled substances. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

6. Federal Standards and Legislation • Drug Enforcement Administration (DEA) • Employs pharmacists to inspect all types of records, including prescriptions. • Detects the illicit distribution of controlled substances. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

7. State and Local Legislation • State practice acts define required education and skill levels of all state-licensed nurses. • States have the power to enforce additional regulations beyond federal mandates. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

8. Health Care Institution Regulations • Required to meet minimum standards set by federal, state, and local agencies. • Institutional policies are typically more restrictive. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

9. Medication Names • Drug, medication, and medicine are oftenused interchangeably. • The term drug is basically defined as anysubstance that can modify one or more of the body’s functions. • A medication (or medicine) is a drug that is used for a therapeutic effect. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

10. Medication Names Chemical Generic Trade (brand or proprietary) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

11. Classification of Medications • Medications are commonly classified by the body system that they interact with, or in accordance with therapeutic usage. • Medications with multiple therapeutic uses are usually classified in accordance with their most common usage. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

12. Forms of Medication Preparations • Drugs are available in many forms for administration by a specific route. • The route refers to how the drug is absorbed. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

13. Forms of Medication Preparations • Oral Solids • Tablets • Capsules • Caplets • Powder and granules Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

14. Forms of Medication Preparations • Oral Solids • Troches, lozenges, and pastilles • Enteric-coated tablets • Time-release capsules • Sustained-release compound substances Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

15. Forms of Medication Preparations • Topical • Powder • Liniments • Ointments • Pastes • Transdermal patches • Suppositories Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

16. Forms of Medication Preparations • Inhalants • Drugs administered by the nasal or oral respiratory route for a local or systemic effect Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

17. Forms of Medication Preparations • Solutions • Enemas • Douches • Suspensions • Emulsions Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

18. Forms of Medication Preparations • Solutions • Syrups • Gargles • Mouthwashes • Nasal solutions • Optic (eye) and otic (ear) • Elixirs Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

19. Pharmacokinetics • The study of the absorption, distribution, metabolism, and excretion of drugs to determine the relationship between the dose of a drug and the drug’s concentration in biological fluids Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

20. Pharmacokinetics • Absorption • Passage of a drug from the site of administration into the bloodstream. • Physicochemical effects • Dosage form • Route of administration • Interactions with other substances • Client characteristics Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

21. Pharmacokinetics • Distribution • Movement of medications from the blood into various body fluids and tissues. • Blood flow • Cell membrane permeability • Protein-binding capacity of the medication Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

22. Pharmacokinetics • Metabolism (biotransformation) • Inactivates the medication and changes it into a form that can be excreted more easily. • Presence of enzymes in the liver • Diseases and other conditions • Genetic factors Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

23. Pharmacokinetics • Excretion • The process in which drugs are eliminated from the body. • Excretion occurs primarily through the liver/biliary system and the kidneys. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

24. Medication Action • Local action at the cellular or organ level • Systemic action, effecting changes throughout the body • Both local and systemic actions • Drug action is based on the half-life of a drug. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

25. Medication Management of Drug Levels • Maintaining a constant drug level within the therapeutic range. • Therapeutic range is the range of drug concentration in the blood, which gives the desired effect without causing serious side effects or toxicity. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

26. Factors Which Alter Medication Action • Medication Interaction • Food and Drug Interactions • Client Factors Influencing Drug Action • Client’s diet • Renal and liver function • Genetic factors • Amount of body fat Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

27. Nontherapeutic Drug Actions • Side Effects • Adverse Reactions • Toxic Effects • Drug Allergy • Idiosyncratic Reaction • Drug Tolerance Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

28. Routes of Medication Administration • Oral Route • Parenteral • Intradermal (ID) • Subcutaneous (SC or SQ) • Intramuscular (IM) • Intravenous (IV) • Other parenteral routes Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

29. Nontherapeutic Drug Actions • Topical Route • Local effect on the skin or mucous membrane • Systemic effect by absorption into the blood stream • Inhalants • Intraocular Route Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

30. Professional Roles in Medication Administration • Health Care Practitioner • Nurse • Pharmacist Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

31. Professional Roles in Medication Administration • Types of Medication Orders • Stat Orders • Single-Dose Orders • Standing Orders • prn Orders Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

32. Professional Roles in Medication Administration • Parts of a Medication Order • Name of the client • Date and time when the order is written • Name of the drug to be administered • Dosage • Route by which it is to be administered and special directives about its administration • Time of administration and frequency • Signature of person writing the order Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

33. Medication Administration Record (MAR) • The MAR is a medical record form that contains the drug’s name, dose, route, and frequency of administration. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

34. Systems of Medication Measure • Metric System (Decimal System) • Apothecary System • Household System Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

35. Metric System • Measurement Conversions within the Metric System • Milligrams to grams • Milliliters to liters • Grams to milligrams • Liters to milliliters Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

36. Systems of Medication Measure • Drug Dose Calculations • Several formulas are available to calculate drug doses for adults and children. • Pediatric Dosages • The nurse should realize that dosages are approximate and often need adjustment based on the child’s response. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

37. Medication Storage and Distribution • Narcotics and Controlled Substances • Federal regulations require recording of specific information for each drug administered. • Nurses count narcotics and controlled substances at specified intervals. • Narcotics and controlled substances are kept in double-locked storage. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

38. Medication Storage and Distribution • Narcotics and Controlled Substances • If a narcotic has to be discarded, a second person acts as a witness, and that person also signs the narcotic sheet. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

39. Narcotics and Controlled Substances • Drug Abuse in Health Care Professionals • State boards of nursing are developing impaired nurse programs for nurses with addictive behaviors and has increased the reporting of nurses with addiction problems. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

40. Safe Medication Administration • Interpretation of Medication Order • The nurse is responsible and held accountable for questioning any medication order if, in the nurse’s judgment, the order is unclear or in error. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

41. Safe Medication Administration • The “Five Rights” of Medication • Right medication • Right dose • Right client • Right route • Right time Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

42. Safe Medication Administration • Documentation of Medication Administration • The nurse responsible for administering the medication must document on the MAR the time the medication was given and initial it. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

43. Documentation of Medication Administration • If the client refuses to take a medication or was unable to take it, the nurse must indicate that a dose was missed and why. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

44. Safe Medication Administration • Medication Errors • Documented in a variance or incident report. • Health practitioner must be notified promptly. • Implementation of an organization-wide system for promoting safety and in identifying potential errors. • Clients and families are informed about outcomes of care including adverse events. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

45. Safe Medication Administration • Prevention of Medication Errors • Following the Five Rights and three checks • Correct dosage calculation • Documenting and knowing the client’s health and medication history • Not giving medications that have been removed from their unit dose package or drawn up in a syringe by anyone else Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

46. The Nursing Process in Medication Administration • Assessment • Health History • Medication History • Physical Examination • Diagnostic and Laboratory Data Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

47. Assessment • Medication History • Allergies • Prescription, Over-the-Counter Drugs • Herbals and Alternative Therapies • Biographical Data • Pregnancy and Lactation Status • Culture and Lifestyle • Sensory and Cognitive Status Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

48. Nursing Diagnoses • Deficient Knowledge • Ineffective Therapeutic Regimen Management • Ineffective Health Maintenance • Impaired Physical Mobility Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

49. Nursing Diagnoses • Disturbed Sensory Perception • Impaired Swallowing • Impaired Memory • Noncompliance Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

50. Outcome Identification • Client Education • Safe self-administration in the community setting • Purpose of the medications • Adherence to schedule • Self-monitoring for side effects • Potential for interactions from over-the-counter medications Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.