Medication Administration Practices: Flushing and Transdermal Applications

Pharmacokinetics

• Study of the absorption, distribution, metabolism, and excretion of medication in the human body
• Factors affecting absorption:
• Route of administration
• Ionization (pH of medication and site of absorption)
• Dissolution (medication must be dissolved before absorption)
• Blood flow (medication absorbs rapidly when blood flow is high)
• Lipid solubility (medication formation can have high or low lipids)
• Surface area of the absorptive site
• Client-specific factors (e.g. vomiting, diarrhea)

Distribution

• Process of delivering medication to the target organ or tissue
• Factors affecting distribution:
• Circulatory status (blood flow, medication solubility, and protein binding ability)
• High vascular areas (heart, brain, liver, and kidney receive the greatest blood supply)
• Low vascular areas (bone, skin, and adipose tissue receive less blood supply)

Metabolism

• Chemical process of converting medication structure
• Factors affecting metabolism:
• Liver enzyme (cytochrome P450) transformation
• Age (e.g. infant, child, adult)
• Genetic characteristics (e.g. race, ethnicity)
• Disease states (e.g. liver, kidney, or heart failure)

Excretion

• Process of removing medication from the body
• Factors affecting excretion:
• Kidney function
• Liver function
• Heart function

Pharmacodynamics

• Study of how medication works in relation to medication concentration and body response
• Therapeutic drug monitoring:
• Used by healthcare providers to monitor medication levels
• Important to ensure accurate medication administration and avoid adverse reactions

Adverse Drug Reactions (ADR)

• Unintended and undesired effects of medication
• Types of ADR:
• Allergic reactions
• Hypersensitivity reactions
• Anaphylaxis
• Medication interactions

Medication Administration

• Right client:
• Verify client identity
• Check medical record number
• Right medication:
• Verify medication order
• Check brand name or generic name
• Right dose:
• Calculate correct dosage
• Check concentration and dosage form
• Right route:
• Verify administration route (e.g. oral, IV, topical)
• Right time:
• Check administration schedule
• Verify timing of medication administration

Medication Errors

• Any avoidable event that results in incorrect medication use or client injury
• Factors contributing to medication errors:
• Interruptions during medication administration
• Distractions (e.g. phone calls, conversations)
• Lack of knowledge or education
• Similar medication names or packaging

Medication Reconciliation

• Process of reviewing and verifying client medication lists
• Important to ensure client safety and accurate medication administration

Route of Administration

• Three major categories: enteral, topical, and parenteral
• Factors affecting route of administration:
• Medication attributes (e.g. solid, liquid, gas)
• Location of desired action (e.g. local, systemic)
• Client conditions and adherence

Medication Forms

• Tablet:

• Pressing and making sure of substance

• Can be chewable or half-scored

• Can be quick release, delayed release, or extended release

• Capsule:

• Soft and hard gelatin

• Can be enteric-coated

• Liquid:

• Can be difficult to swallow

• May be used for oral or enteral administration

• Transdermal:

• Allows for slow, sustained release of medication

• Patches can be rotated to different sites

• Ophthalmic:

• Used for local infection or inflammation

• Administered to the eye or conjunctiva

• Otic:

• Used for local infection or inflammation

• Administered to the outer ear

• Nasal:

• Used for local infection or inflammation

• Administered to the nostrils

• Intravaginal:

• Used for infections or to administer estrogen

• Rectal:

• Used for infections or inflammation

• Administered to the rectum

• Parenteral:

• Includes intradermal, intramuscular, subcutaneous, and IV administration

• Factors affecting parenteral administration:

• Needle size and type

• Viscosity of medication

• Client's age, size, and condition### Selecting an Injection Site

• Avoid inflamed areas to prevent false positive results

• Deliver medication into adipose tissue due to abundant capillaries

• Medications include insulin and low molecular weight heparin

Factors to Consider for Medication Administration

• Condition of the skin
• Presence of lipohypertrophy
• Amount of audible tissue
• Age and size of the client
• Amount of medication to be given (older adults: maximum of 1 ML)
• Condition of the anticipated site (pain, mobility, edema, inflamed, bruises)

Routes of Medication Administration

• Intradermal
• Subcutaneous
• Intramuscular
• IV (deliver fluid, nutrients, blood, and blood products)

IV Infusion

• Administer via an IV infusion set with 0.9% sodium chloride or dextrose 5% in water
• Volume: 50-250 mg
• Administer over a specific period of time: 30-90 minutes

Central Access Devices

• CBD (central access device) inserted into a large central vein
• Directly delivers into central blood circulation
• Examples: PIC, central catheter, and CVC (central venous catheter)

Assessing for Complications

• Flavis (inflammation of the vein): redness, pain, heat, and swelling
• Infiltration: pain, swelling, redness, cool skin temperature around the insertion site
• signs of IV fluid or medication leakage around the insertion site

Administering Medication to Infants and Children

• Infants: use a syringe without a needle or a dropper, held in a semi-reclining position to prevent aspiration
• Toddlers and early school-age children: use a syringe or medicine cup
• School-age children: able to swallow pills, tablets, and capsules

Injection Sites for Infants and Children

• Infants: deltoid and gluteus maximus muscles not fully developed, use vastus lateralis muscle instead
• Use small gauge (25-30 G) needle to reduce pain
• Inject 0.5-1 ML at a 90° angle, 1 inch deep
• Toddlers: use deltoid muscle starting at 18 months, injecting 0.5-2 ML

Transdermal Medication in Infants

• High risk of toxicity due to thin skin and rich blood supply
• Client education is crucial to ensure active role in medication regimen

Medication Literacy

• Average reading level of adult medication instructions: 8-9th grade level
• 1/5 of Americans read at a 5th-grade level or lower
• Recommended client education material: written at a 6th-grade level

Role of the Nurse

• Educate clients about medications and encourage active role in regimen