Drug Administration Practices

• Assist. Prof. Dr. Funda KARAMAN is the lecturer.
• Aim is to fulfill necessary practices for drug administration.
• The objectives are to understand the definition of the drug; classify drugs; know the body effects; explain how to request, supply and store drugs; know how to administer drugs and to apply drug practices.
• The presentations contents are description of the drug; classification of drugs; modes of action of drugs; factors affecting the patient; supply and storage of medicine; physician medication order and ways of administering drug.

DRUGS

• Drugs are obtained from animal, vegetable, mineral, and synthetic sources.
• Drugs are chemical changes used to diagnose, cure, or prevent disease.
• Drugs change body functions when taken into a living organism.
• Medicines have different forms and special content.
• Drug administration is a core function requiring technical skills and medication knowledge.

CLASSIFICATION OF DRUGS

• Dosage forms include solid, liquid, semi-solid, and gaseous.
• Solid dosage forms include unit dosage (tablets, capsules) and bulk dosage (tooth powder, dusting powder).
• Liquid dosage forms include monophasic liquids (syrups, lotions) and biphasic liquids (suspensions, emulsions).
• Semi-solid dosage forms include creams, ointments, pastes, gels, suppositories, and pessaries.
• Gaseous dosage forms include aerosols and inhalations.

FACTORS AFFECTING DRUG ACTIVITY

• Factors include growth period (newborn, elderly); weight, gender, genetic/cultural factors, psychological factors, illnesses, environment, treatment time, drug adverse effects, and individual differences.
• Babies and elderly always risky for drug administration, and may have different dosages than adults.

INTERACTIONS OF DRUGS

• Synergism shows more efficacy when two or more drugs are used together, like in tuberculosis treatment.
• Additional interaction results in increased drug effects on the body when drugs are taken together.
• In potentialization, two drugs together have a greater effect than the sum of their individual effects.
• Antagonism reduces the drug's effect via another drug and like naloxone reducing the effect of narcotics.
• Drug metabolism involves absorption, transport (distribution), change (disintegration), and excretion (elimination).

SUPPLY AND STORAGE OF DRUGS

• Drugs must be kept locked in the same room.
• Drugs are stored in a clean, closed, dry, and cool place.
• Bottles should be tightly closed to prevent evaporation/moisture.
• Oily or diluted medicines must be refrigerated and used before the expiration date.
• Vaccines and serums need refrigeration.
• Dirty medicine labels should be replaced.
• Expired medicines or those with changed color/odor/appearance shouldn't be used.
• Medicine cabinets should have artificial lighting.
• Emergency medications should be stored separately.
• Medicines with the same desired effect must be stored together.
• Chemotherapy medications shouldn't be exposed to light.
• Medicine cabinets must have enough space for all patients' medications.
• Addictive drugs (narcotics) should be in double-locked cabinets, and signature is needed for access.
• Poisonous drugs need red labels.

PHYSICIAN MEDICATION ORDER

• For safe drug administration, a physician medication order must be in writing.
• Drug administration without a written order is prohibited.
• The necessary requests are regular, urgent (single dose), and only if necessary request. The parts include the patient's name, date and time, drug name to be administered, drug dose, administration routes, application frequency, and doctor's signature.
• Examples of prescriptions are Norvasc tablet 1x5mg and Duocid tablet 3x1.
• Doctor orders must be written to indicate the count as well as the order.
• Doctor's orders are checked every morning, and the hours are transferred to the recording system.
• Observation sheets are used for recording.
• Consult a physician if there is any doubt about the request.
• Put the date/time on and sign the doctor's order.

RIGHTS OF MEDICATION ADMINISTRATION

• Doctor's orders are checked every morning, transferring to the recording system and contacting a doctor if there is a question of use.
• The rights of medication administration are patient, medication, dose, route, time, documentation, education, refuse, assessment, and evaluation.

The 10 Rights Explained

• Always reference the patient's identification bracelet, ask for their name and birth date, and compare their chart with it, as well as their allergies.
• Always triple check the medication label, when retrieving, preparing, and before administering to the patient.
• Compare all the information from the medication order, label, and with the client, along with having another nurse compare medications.
• Check the label's concentration, and that the drawn dose is correct, that the medications were not prepped by any other person.
• Check last time and that the person has been informed with any orders, any differences, and possible medication side effects.
• Inform of effects and ask for any allergies with their medications, documenting when administering their medications.
• Check the possible risks before the administering, and evaluate their physical condition.
• Separate same named patients to avoid confusion, and never document the medication before its given.
• These MUST be verified, known, and done before giving the medications.

Basic Principles of Drug Applications

• Hands should be washed & gloves should be worn.
• Introduce yourself.
• Inform patient on the actions and get their consent, and position them for proper access for medications.
• Keep information confidential, and don't use medications on patients that have been used before.
• Verify they can swallow, check for allergies, follow procedure, and let them sign and date their actions as well
• Put materials in the tray.
• The healthcare worker should prepare the medicines themselves.
• Allergies questioned.

DRUG APPLICATIONS

• The drug preparation environment should be bright and have a tidy medicine tray.
• Medications need to be checked 3 times.
• Patient ID should be checked and wait for the patient to swallow the medication.
• Should know knowledge about medications.
• Patient should be given medications as soon as possible.
• They should be counted after shifts and accounted for.
• Green and red medication should be kept in the double locked cabinet and signed.

DRUG ABSORPTION RATES

• Rates go from fastest to slowest: Intracardiac, Intravenous, Inhalation/Endotracheal, Sublingual, Intramuscular, Subcutan, Rectal, Intradermal, Oral, Dermal.

MEASUREMENTS

• Measurements should be kept in check.
• 1cc = 1 ml = 10 dizy = 100 unit = 20 drops.
• 4-5 ml = 1 dessert spoon.
• 15 ml = 1 tablespoon.
• 250 ml = 1 glass of water.
• 100 ml = 1 tea glass.
• Drugs can have local or systemic effects after being taken into the body.
• Their effectiveness is closely linked to the administration method.
• Individual patient factors affect the effect of the drug.

LOCAL VS SYSTEMIC ADMINISTRATION SITES

• Local Applications: Epidermal, conjuctival sac, intranasal, intravaginal, and the external ear conal.
• Systemic Applications: Enteral (tablets, granules), oral administration, Sublingual and Buccal Applications, and Rectal Applications (Syrup), Parenteral, Solution in injections (gas, vape for aserolzation).
• Epidermal absorption varies.
• Systemic/topical applications: powder, ointments, oil, and lotions and most important skin should be clean and dry
• Previous drug residue removed, lotions must be shaken, medicine in the palm.
• Do an eye car (from canus) for application and don't contact eyeball and don't use medication again on other patients , but do use eyes first and use after eye cleaning, especially 5 minutes before.

INTRANASAL ADMINISTRATION

• The patient is in supine or semi-fowler position.
• The drug mustn't be on the nasal.
• The head needs to be in hypertension.

INTRAVAGINAL ADMINISTRATION

• Patient must be put in safe, specific personal spot (Privacy first and given the proper tablet, solution when heated in hand for position,

EAR ADMINISTRATION

• Keep ear straight for children but bent for anyone over it

SYSTEMIC APPLICATIONS

• Enteral is most common and is applying a drug based on the digestive system.
• Don't administer on the unconscious, and people with swallowing issues.
• Sublingual applications are best used where it should not be swallowed in the mouth, and they cannot be crushed.
• Rectal involves a pre administration of an IV.

ENTERAL APPLICATIONS

• Preparations include making sure you have the tablets, patient and medications and proper equipment, such check to make sure they are on the bed and identity with those on the orders.
• These medications also avoid food, or other drugs with each other at different sites.

DRUG TRANS

• For medication like Nicotine patches and used for a more specific medication based with hormone therapy but need time to take into effect but keep a clock on usage.

INHALATION ADMINISTRATION

• Inhalation is done in the lungs, with a easy way for absorption.
• This is to target organs and use a lower dosage.

PARENTERAL ADMINISTRATION

• Is injecting a solution through the tissues with special instruments to use the effects with medicine, at different speeds.

Intramuscular

• 90 degree muscle at upper arm, thigh and butt.

Subcutaneous

• Just under skin (only 1 cm), and with insulin or hormones, at belly, outer thigh, low butt, scapula.

intradermal (10-15 degree)

• Local application- for local aesthetic, allergen test

Intravenous

• Direct bloodstream is fastest and you must have sterile technique

• Syringes with alcohol and cotton pads for a sterile field, with bandages and alcohol and correct application

• You may only administer that specific syringe.

INTRAMUSCULAR (IM) INJECTION SITES:

• Hold the like you would a dart for a smooth throw to prevent infection and harm

1. Dorsogluteal.
2. Ventrogluteal,
3. vastus lateralis.
4. rectus formis,
5. deltoid.

INTRAVENOUS (IV) ADMINISTRATION SITES AND INSTRUCTIONS:

• Hold and apply pressure until there are no reactions and seal it out and follow ups

1. The arm basilic and cephalix veins. 2)Median and cephalx basilic viens too if available. 3)Popite, and foot dorsalis

GENERAL DIRECTIONS

• Keep 10 degrees and make sure to watch your steps for no infections
• Wash hands with gloves. have supplies out do the step in a smooth motion with the patient still and ready and check before use that their chart is read.
• The patient will then be ready while to use the medication.
• Use a 45- 90 degree angle then clean before use and remove cap from needle at end.
• Do not touch
• You are to follow up and see if their bloods match their records and if symptoms are proper to dose.
• If there is nothing in the chart or any questions you MUST stop for consult for safety

Transfusion of BLOOD

• It's the IV administration of blood.

Transfusion Reaction:

1. Hemolytic.
2. Febrile.
3. Anaphylaxis.
4. Infectious.

• The blood should be mixed with Nacl. • Monitor the chart for intervals and follow the bloods for any chance of the infection

• After you are to contact doctors to confirm the plans for dose at the area

CALCULATIONS:

Calculate based on what the doctor recommends or is written.