Drug Administration Practices

• Assist. Prof. Dr. Funda KARAMAN is the lecturer for this subject

Aim

• To enable the ability to fulfill the necessary practices for drug administration.

Learning Objectives

• Comprehend the definition of a "drug."
• Classify different drugs.
• Understand the effects drugs have on the body.
• Be able to explain how to request, supply, and store drugs correctly.
• Know the various methods of administering drugs.
• Be competent in applying drug practices.

Course Content Overview

• Description of what a drug is.
• Drug classifications.
• Modes of action of drugs.
• Factors influencing how drugs affect a patient.
• Proper supply and storage of medicine.
• Understanding physician medication orders.
• Methods of administering drugs.
• Drug applications, including enteral and parenteral routes.

Definition of a Drug

• Substances from animal, vegetable, mineral, or synthetic sources.
• Chemical changes that diagnose, cure, or prevent disease.
• Substances that change the body's functions when ingested.
• Medicines available in different forms to achieve their purpose.
• Drug administration is a technical skill that requires knowledge of medications and the skills to administer them.

Classification of Drugs

• Drugs are available in solid, liquid, semi-solid, and gaseous forms

Factors Affecting Drug Activity

• Growth period (newborn, elderly):
• Weight
• Gender
• Genetic factors
• Cultural factors
• Psychological factors
• Illnesses
• Environment
• Treatment time
• Adverse effects of the drug
• Individual differences.

Drug Interactions

• Synergism: Combining drugs enhances their efficiency, like in Tuberculosis treatment.
• Additional Effect: The combined effect of multiple drugs increases the overall effect on the body.
• Potentialization: The effect exceeds the sum of individual drug effects.
• Antagonism: One drug reduces the effect of another; naloxone reducing narcotics.

Drug Metabolism

• Occurs in four stages: absorption, transport (distribution), change (disintegration), and excretion (elimination).

Proper Supply and Storage

• Drugs should be locked up in a designated room.
• Storage must be in a clean, enclosed, dry, and cool area.
• Bottles should be sealed tightly.
• Oily, diluted medications need refrigeration, watching expiration dates.
• Vaccines and serums need to be refrigerated.
• Replace medicines with dirty labels.
• Expired, discolored, or medicines with changed odors should be discarded.
• Medicine cabinets must be artificially lit.
• Emergency medications require a separate compartment.
• Keep medicines with like effects together.
• Medicine cabinets should be large enough for all patient medicines.
• Addictive drugs need a double-locked cabinet, a signature when accessed.
• Poisonous drugs should have red labels.

Physician Medication Order

• Must be written for safety.
• Exceptions include emergencies, but unwritten orders are illegal

Physician Medication Order Details

• Regular request, request of necessary, and urgent requests are possible.
• An order should include the patient’s name, date, time, drug name/dose, administration routes/frequency, and doctor's signature.

Following Orders

• Doctor's orders must be reviewed by health care staff and transferred to a personal recording system.
• Use observation sheets for recording.
• If there is any doubt about a request, consult a physician.
• Add the date, time, and sign the doctor's order.

The 10 Rights of Medication Administration

• These should be know before application of the drug
• Right patient.
• Right medication.
• Right dose.
• Right Time
• Right Route
• Right Documentation
• Right Client Education
• Right to Refuse
• Right Assessment
• Right Evaluation

Basic Principles

• Wash hands, using gloves.
• Introduce yourself to the patient.
• Inform the patient about the process.
• Get verbal consent.
• Patient confidentiality must be regarded, position them appropriately.
• Use a medicine tray.
• Assure patients get their prescriptions.
• Monitor patients to before and after administration.
• Healthcare staff need to prepare medications themselves.
• Incorrect/illegible orders should be verified.
• Question patient allergies to drugs.

Preparing for Drug Administration

• A well-lit preparation area must be used.
• Keep the medicine tray neat.
• After preparing, keep drugs in safe area.
• Accuracy calls for a triple medication check.
  • Comparing the label to the MAR/order while retrieving
  • When drawing up the medication and preparing
  • Before administering at the bedside/in the patient’s presence
• Patient ID must be checked.
• Oral medications: Confirm the patient swallowed.
• If medications are delayed, give as soon as possible.
• Be knowledgeable about the drug, informing family.

Narcotic Drug Management

• Must be under lock.
• Inventory with shift changes, record numbers in a log.
• Two nurses must sign when accessed.
• Partially used ampules should be discarded/stored in syringes up to 24 hours.
• Includes green and red prescription drugs.

Drug Absorption Rates

• Vary by administration route
• Intracardiac: 15 seconds
• Intravenous: 30-60 seconds
• Inhalation: 3 minutes
• Endotracheal: 3 minutes
• Sublingual: 3-5 minutes
• Intramuscular: 10-20 minutes
• Subcutaneous: 15-30 minutes
• Rectal: 5-30 minutes
• Intradermal: 15-30 minutes
• Oral: 30-90 minutes
• Dermal: Varies

Measurement Conversions

• 1 cc = 1 ml = 10 dizy = 100 units = 20 drops
• 4-5 ml = 1 dessert spoon
• 15 ml = 1 tablespoon
• 250 ml = 1 glass of water
• 100 ml = 1 tea glass

Drug Effects

• Can be local or systemic once absorbed.
• Effects depend on method of administration.
• Patient characteristics, drug dose, route, and metabolism alter outcome.

Local Administration Routes & Forms

• Epidermal application with ointments, creams, lotions, powders, or solutions.
• Conjunctival sac application with ophthalmic drops and ointments.
• Intranasal application with nasal sprays and drops.
• Intravaginal application using vaginal ovules, suppositories, tablets, gels, or foams.
• External ear canal application with otic drops (solutions, suspensions).

Systemic Administration & Forms

• Enteral covers tablet/capsule oral intake, and liquid/suppository rectal administration.
• Parenteral covers injected solutions or emulsions.
• Inhalation utilizes gases and aerosols.
• Transdermal route utilizes patches.

Epidermal Application

• Absorption depends on site.
• Can give systemic effects, typically with corticosteroids.
• Lotions, ointments need clean, dry skin.
• Remove past residue, also shake lotions well, warming medicines in palm.

Ophthalmic Application

• Eye care must come before application (inner to outer canthus).
• Avoid dropper contact with the eyeball, using a clean applicator.
• Do not reuse another patient's medication, administering healthy eye first, before the sick one.
• Delay applications of different drops by 5 minutes.
• Suspension drops need shaking.

Intranasal Application

• Place patient supine or in semi-Fowler's.
• Keep drug away from nasal mucosa.
• Tilt head during a few administration.

Intravaginal Application

• Patient privacy is important.
• Drugs are as tablets, creams, gels, and suppositories.
• Suppositories must kept in the fridge and warmed before use.

Ear Application

• In children, pull the ear down/back.
• In adults, pull the ear up/back.
• Warm drops before administering.

Enteral Application, Oral Route

• Medication must be appropriate for digestive tract action.
• This is the most common route.
• Oral administration cannot occur with unconscious patients or those exhibiting swallowing difficulty, nausea, vomiting, severe diarrhea, convulsions.

Sublingual Administration

• Placing drugs stay under the tongue to prevent chewing or swallowing.
• Sublingual administration’s drug absorption quick, effective in emergencies by directly enter blood.

Buccal Administration

• The gums and cheek provide a route where the drug can access and achieve desired effect.
• Drugs should not be chewed or swallowed.

Rectal Administration

• Perform with privacy, Sim's position.

Transdermal Patch

• A patch applied to the skin.
• Used for hormone replacement, extended pain relief.
• Note the drug and application date.

Inhalation Administration

• Alveoli provide increased surface area and permeability, and the lungs have a high blood flow rate
• This method is for absorption.

Inhalation Benefits

• Target one location and faster effects are possible.
• Low doses can be used along with fewer side effects.

Types of Inhalers

• Turbuhaler
• Aerolizer
• Handihaler
• Discus
• Metered Dose Inhaler (MDI)
• Reservoir (Spacer or Chamber)
• Nebulizer-Nebul

Nebulizer Drug Application

• Used for brans and reducing mucus in respiratory illness like asthma
• Two medicines showdn’t be combined

Intramuscular and Intravenous Injection Consideration

• The Mouth must be clear
• Rinse after application, and wounds should be avoided

Parenteral Drug Application

• Medication through any route but the digestive system.

Subcutaneos Injection

• Delivered under the skin, usually in small volumes.
• Used for insulin, hormones, anticoagulants, often for pain management.

Injection Sites

• Lateral Upper Arm: Below the shoulder or above the elbow.
• Laterofemoral: Upper/outer thigh.
• Abdomen: 5 cm from the bellybutton.
• Under the Scapula.
• Dorsagluteal: Outer/upper buttocks.

Subcutaneous Procedure Considerations

• Rotate injection sites.
• Aspirate for blood control, avoid tissue damage with insulin and heparin.
• Slowly inject.

To Administer a Subcutaneous Injection

Wash Hands Verify identity with the 10 rights. Prepare tools within a sterile field.

• Withdraw drug. After drawing the drug up Add 0.2 - 0.3 cc of air for an “air lock” injection. This ensures all the drug is injected.
• Angle needles at 45 or 90 degrees.
• Don't massage the area following. Use new needles.

Intradermal Injection

• Injects into the dermis (just below the epidermis)
• Used for sensitivity tests and some vaccines like BCG.
• The inner forearm should be hair/lesion/scar free.
• Clean area, holding skin taut
• Using 10-15 degree angle. Inject slowly.
• Do not massage area.

Intramuscular Injection

• Injects into muscle of the upper arm, thigh, or buttock.

Intramuscular Injection

• Dorsogluteal area cannot be used if potential for sciatic nerve is present.
• Ventrogluteal safest, and the injection should go into the side and center.
• Vastus Lateralis and Rectus Femoris: Should inject into the side and enter.
• Deltoid Muscle: Deltoid muscle is for vaccines. Locate by injecting near the top of arm.

Intramuscular Injection Dosage by Site

• Deltoid Muscle: 1mL
• Ventrogluteal: 2.5 mL
• Rectus Femoris and Vastus Lateralis: 2.5 mL
• Dorsogluteal Site: 4 mL

Safe Procedure - Intramuscular

• Review washing process, get tools, and ensure communication with the team.
• Clear air in syringes, ensure proper tool placement (sterile)
• Clean Injection, make sure are to use alcohol, and make sure to hold needle with correct posture. Check identity.

Intramuscular and Intravenous Injection Procedure

• Insert needle into syringe and hold for 90 degrees.
• Use piston hand and inject slowly, must use new syringe, must have help.

Air-lock Intramuscular Injection Technique

• Creates barrier that keeps the drug in place.
• First provide a needle and then the injection

Z-Track Technique

• This method is a type of injection that uses an easy method and only requires one hand.
• Technique requires injection is done, the difference is using one hand to pull on skin.
• Airtight seal should be added before administering.

Intravenous Route

• Used for quick results.
• Delivers drugs, fluids, and blood products directly into blood.
• The aseptic/surgical processes are used, and must be sterile.
• This will only be preferred if patient has gastrointestinal issues.

Vessels

• Veins of antecubital areas are often a point of reference.

Use of IVs

• In the presence of absorption problem, this can be an option.
• In cases of deficiencies in body and patient period of time
• To prevent treat in the result of a situation.

IV Cannulas

• Cannulas require a sterile package and are only used once, made of plastic.
• Can be put under skin of one or several of the vessels.
• Come in several sizes, determine the effect by looking to the color.
• Orange and Gray should be bigger while others should remain the same.

Tourniquets

• It can open the vessel and enter, should take up to 2 minutes

Sterile Patches

• Transparency allows for simple administration and can be used with simple products, and can allow for fixation.

IV Administration Set Up

• Set must be sterile

IV Fluid Setup

• IV Fluid should be used safely and sealed from elements
• All must be properly protected
• There will need to be a clamp for safety usage of fluids
• When used with patients the bag will be filled 1/3 with fluids, can remove as necessary

Infusion Tools

• Dosi-flowmeter tools are added to the IV that deliver liquids
• All air is to be removed .

Administering Several Medicines

• To administrator several drugs with easy, the way of tap is to set the fluid at easy.

Infusion Pumps

• Provide safe levels that delivered at the specified dosages.

IV Precautions

• Before using IV, consult with the water to sterilize as needed.
• Air must be cleared -Cannula must be changed often in the adult at the given time
• First should be tested before, consult your physician before.

Taking Blood Samples

• In cases such as in arteries and capillaries.
• Using veins is also preferred if tested with procedure.

Taking Venous Blood

• Test with syringe tip can be used
• Do not use unless fully sterilized.

After Taking Patient Data

• Confirm patient details, can be easy done by taking name for data.
• Patient can not have eaten, can not be ill, must be in good behavior.
• Patient must allow arm to be used.
• Perform from lower arm and hold it to maintain.

Proper Cannula Usage

• Test via putting tool into patient skin with a smooth method

Blood with Vacutainer

• First pull the water, in the adapter put it and insert properly
• All samples must be clear and in the tube.

Proper Protocol

• Allow keep your heart levels when taking sample, by holding tampon
• When completed and tested, used can be throw or sterilized.
• After mix sample, wash hands
• Put glove on.

About Blood and Transfusion

• Administration by the doctor, as needed and consult fully with them.
• All blood should be listed

Blood Products

• Blood and product cells should list elements in blood.
  • Whole blood: All elements
  • Erythrocytosis: Suspension, and blood
  • Plasma: Frozen fresh or in clotting
  • Platelets: Lymphatic system platelets
  • Granulocites: Several cell groups

Signs of Reactions.

• Fever or heat
• High rate in heart

Transfusion reactions.

• Blood and reaction may be related and have side results.

Proper Blood Procedure

• Check and test with doctor.

Hemolytic Reaction

• Is when testing the reaction for the specific elements.
  • Testing if you have a reaction or burning.
  • Fever, and some forms of shock to a patient with issues.

Allergic Reactions

• Patient might have some unknown element to the cells, causing issues and breathing problems, and can create rashes as response

Circulatory Overload

• Results when the patient has issues with the heart or has had a overload of water to the points where patient gets heat failure

Infection

• Several infection in the body are cause issues when can’t protect one body
• Has several problems in specific time spans. Testing with doctor needed

Protocol

• Stop test, then consult the hospital for details.