Medication Administration Practices

Medication Administration Routes

• Parenteral medications are not administered through the gastrointestinal (GI) tract.
• Enteral medications are administered through the GI tract (e.g., oral, buccal, sublingual, intravenous, intramuscular, intradermal, intracardiac, intraspinal, intraosseous, subcutaneous, topical, transdermal, inhalation).

Rights of Medication Administration

• Right patient, right time, right medication, right dose, right route, right education, right to deny, right reason, right response, right documentation, and right assessment data.

Medication Administration Prepared by Another Provider

• Do not administer medications prepared by another provider unless the provider agrees.
• It is best to prepare your own medications to ensure accuracy and safety.

Medication Orders

• Standing orders are pre-approved orders for a patient who meets the criteria.
• PRN orders are as-needed medication orders.
• STAT orders are single, one-time orders, typically for emergent situations.

STAT Medication Administration and Timelines

• Medications given for STAT orders must be given immediately after the provider approves it, within a specified time limit.
• This typically applies to antibiotics used before surgery.

Medication Orders Components

• The order should include the medication name, dose, route, date, and time.
• Include any special instructions.
• The doctor's signature is required.
• The frequency of administration should be included.

Patient Refusal of Medication

• Educate the patient about the effects of not taking the medication.
• Respect the patient's right to autonomy.
• Document the refusal and notify the provider.

Allergic Reactions to Medications

• Signs of an allergic reaction could include skin rash (hives, wheals, or patches), itching (pruritus), swelling (angioedema), nasal irritation (rhinitis), tearing from the eyes, nausea (N), vomiting (V), diarrhea (D).
• Additional signs include wheezing, or shortness of breath, depending on the reaction.

Monitoring/Lab Values for Liver and Kidney Function

• Liver function is monitored with AST/ALT values,
• Kidneys function is monitored with BUN/creatinine.

Proper Technique for Administration Routes

• Ensure proper technique for all routes, including transdermal, oral, subcutaneous, intramuscular, intravenous, inhaled, nasal, eye drops, ear drops, and rectal.

Pros and Cons of Medication Routes

• Considerations for oral routes: LOC, ability to swallow, discoloration, staining, odors, medications that cannot be crushed, client should be sitting up.
• Considerations for sublingual/buccal: avoid swallowing, drugs dissolve in the mouth.
• Considerations for rectal: alternative to oral route, dose absorption is unpredictable, unpleasant for patients, wear gloves.
• Considerations for topical routes: wear gloves to protect yourself, and surgical asepsis are needed.
• Considerations for transdermal routes: rotate sites to prevent skin irritation, wash site.
• Considerations for eye/ear drops: aseptic technique, use medical asepsis, sit upright.

Pain Assessment

• Pain is subjective and individualized.
• Pain assessment should include both subjective and objective measures.
• Effective assessment methods include the patient's report (0-10 scale), the Wong-Baker FACES pain rating scale, and the CRIES pain scale.

Types of Pain

• Somatic pain: pain that arises from the musculoskeletal system.
• Visceral pain: pain originating from internal organs.
• Phantom pain: pain felt in a limb that has been amputated.
• Neuropathic pain: pain caused by damage to or dysfunction of the peripheral or central nervous system.

Acute Pain (Sympathetic Response)

• Mild to severe pain, higher HR/RR/BP, dilated pupils, diaphoresis, restless, anxious, crying, guarding, and splinting of the area.

Chronic Pain

• Mild to severe, lasting longer than 3 months, parasympathetic response, usually normal vital signs, but patient may appear withdrawn or depressed. It is typically not mentioned unless directly asked.

Opioid Use

• Opioids are used for moderate to severe pain.
• Side effects include sedation, dizziness, nausea (N), vomiting (V), constipation, respiratory depression, physical dependence, and tolerance.
• Educate patients on the signs and symptoms to monitor.
• Always have a reversal agent (e.g., Narcan) available.

PCA (Patient Controlled Analgesia)

• Continuous IV infusion, controlled by the patient.
• Monitor for overdosing, and administer reversal agent if necessary.
• Continuously monitor vital signs and sedation level.

Non-Pharmacological Pain Management

• Heat and cold therapy
• Massage
• Acupuncture
• Acupressure
• Relaxation techniques

IV Solutions and Types

• Isotonic solutions have the same solute concentration as blood.
• Hypotonic solutions have a lower concentration of solutes than blood plasma, and cause cellular swelling.
• Hypertonic solutions have a higher concentration of solutes than blood plasma. This draws fluid out of the cells.

IV Complications

• Infiltration, phlebitis, infection, embolism.
• Report any signs of complications, appropriate measures when detected.

Blood Administration Procedures

• Four main blood types (A, B, AB, and O), and two Rh factors, and Cultural significance like avoiding blood products.
• Blood should not be administered continuously for more than 4 hours.
• Close monitoring for adverse reactions.
• The blood unit number, the IV catheter size, the drip rate, and the site of the IV catheter are documented.

Test your knowledge on medication administration routes and the rights involved in safe medication delivery. This quiz covers essential concepts like enteral and parenteral medications, medication orders, and safe practices. Perfect for healthcare students and professionals.