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

Learn about the importance of flushing before giving medication and between administering multiple medications. Understand the recommended flushing volumes and techniques for different routes of administration. Explore the benefits and considerations of transdermal applications for slow, long-lasting medication release.