Medication Administration Rights and Protocols

Medication Administration Rights

• Right medication, right dose, right route, right time, right patient, right to refuse, right to assessment, right for evaluation, right for education, and right documentation are crucial for safe medication administration.

Unit Dose Method

• Individual packaging of single doses for each patient minimizes medication errors.

Long Half-Life Medications

• Administer once daily if the medication has a long half-life.

Basic Medication Protocol

• Assess swallowing and NPO status.
• Do not crush extended-release (XR) tablets.
• Inform the patient if mixing medication is necessary.
• Administer with water, except iron and vitamins, which should be taken with juice.
• Stay with the patient until the medication is swallowed.

Documentation of Medication Response

• Document responses to sedatives, opioids, antiemetics, and analgesics.

Medication Administration Recording

• Record medication administration immediately after giving it, including name, dose, time, route, and initial.

Medication Evaluation

• Assess the effectiveness of the medication and any side effects.

Sentinel Events

• Unexpected occurrences involving death or serious injury due to medication errors.

Nurse's Rights in Medication Administration

• Nurses have the right to complete orders, have drugs correctly dispensed, receive information, adhere to safe administration policies, recognize problems, stop, think critically, and remain vigilant.

Culture of Safety

• Avoid punitive measures in reporting medication errors. Report errors to improve systems.

Drug Reconciliation

• Maintain a current list of all medications; update the list whenever a change occurs. Carry the list with the patient at all times and share it with all doctors.

Medication Disposal

• Follow specific instructions on medication disposal.
• Place the drug in an undesirable substance in a container and dispose of it appropriately.
• Cross out identifiable information on the drug container.
• Flush if permissible.
• Return unused medications to drug centers.

Medication Safety Risks

• Avoid splitting tablets.
• Do not purchase medications from unlicensed sources.

Counterfeit Medications

• Counterfeit drugs may appear genuine but lack active ingredients, contain incorrect ingredients, or have packaging or contamination issues.

High-Alert Medications

• High-alert medications, including insulin, magnesium sulfate, potassium, epinephrine, and vasopressin, can cause significant harm if given incorrectly.

High-Alert Medication Containment

• Simplify storage, limit access, improve education, require double checks from two nurses, use labels, monitor patients, and use appropriate procedures.

Look-Alike/Sound-Alike Medications

• Use "tall man lettering" to differentiate look-alike/sound-alike medications.

Other Medication Error Prevention Factors

• Create a distraction-free environment.
• Establish medication safety zones.
• Never administer medications prepared by another nurse.
• Use two forms of patient identification.
• Follow the six medication rights.
• Refuse medications deemed unsafe.
• Employ critical thinking.

General Medication Administration Guidelines

• Assess for allergies and concurrent medications.
• Perform medication calculations.
• Check expiration dates.
• Never leave medications unattended.
• Administer only prepared medications.
• Use two identifiers for patients.
• Stay with patients until medication is taken.
• Record medication effectiveness and side effects.

Anticholinergic Medications for Motion Sickness

• Antihistamines such as dimenhydrinate (Dramamine), cyclizine, scopolamine (transdermal scopolamine patches), and meclizine HCL (Antivert).

Cholinergic Crisis

• Symptoms include salivation, lacrimation, urination, and defecation.

Oral Tablet/Capsule Medication Information

• Do not give to patients who are vomiting, lack a gag reflex, or are in a coma.
• Avoid mixing with excess food or formula, as it slows absorption.
• Swallow extended-release (XR) capsules whole.
• Take irritating medications with food.
• Take medications that require an empty stomach on an empty stomach.
• Leave sublingual or buccal medications in place until fully absorbed, no food until absorption is fully complete.

Elixirs

• Sweetened oral liquids.

Emulsions

• Mixtures of two liquids.

Suspensions

• Liquids where particles remain mixed but not dissolved.

Transdermal Medications

• Systemic effect.
• Consistent drug levels over 12 hours to 7 days.
• Clean the application site before placing the patch. Do not cut the patch.

Topical Medications

• Use gloves, tongue blades, or cotton-tipped applicators.
• Apply to clean, dry skin.
• Avoid cross-contamination.

Instillations - Examples

• Eye ointments and drops, ear drops, and nose drops or sprays.

Eye Drops

• Pull down the lower eyelid.
• Apply drops to the middle third of the conjunctival sac.
• Apply pressure to the lacrimal duct after.

Eye Ointments

• Squeeze a quarter-inch of ointment into the conjunctival sac, inner to outer eye.
• Close eyelids for 2-3 minutes.
• Expect blurred vision.

Ear Drops (Children Under 3)

• Downward and backward for drop administration.

Ear Drops (Adults and Children Over 3)

• Upward and outward for drop administration.

Nose Drops

• Blow nose before administration.
• Tilt head back.
• Remain in position for 5 minutes after administration.

Nose Sprays

• Blow nose beforehand.
• Tilt head toward chest.

Inhalations (Metered-Dose Inhalers)

• Shake inhaler.
• Exhale completely.
• Press down and inhale slowly.
• Hold for 10 seconds.
• Exhale slowly.
• Wait 1-5 minutes for the next dose.

Nebulizers

• Liquid medications aerosolized to reach the lower airways more effectively.

NG Tube Medication Administration

• Verify tube placement by aspirating contents.
• Elevate the head of the bed.
• Ensure medications can be crushed.
• Clamp the tube for 30 minutes before reconnecting.
• Flush with water in between different medications.

Rectal Suppositories - Suitable Patients

• Infants
• Vomiting patients
• Non-compliant patients

Rectal Suppository Administration

• Place patient in left lateral recumbent position.
• Lubricate suppository and insert past the internal anal sphincter.
• Stay in position for 30 minutes after insertion.

Vaginal Suppositories

• Use an applicator (consider patient self-administration).

Parenteral Medications

• Medications delivered via injection; bypass the gastrointestinal tract.

Z-Track Injection Method

• Pull skin to one side, insert needle, wait 10 seconds, withdraw, and release skin.
• Used for iron dextran.

Preferred Injection Sites (Adults)

• Ventrogluteal.

Pediatric Considerations

• Children may perceive medical procedures as punishments.
• Consider stranger anxiety and procedure-related fears.
• Allow the patient to interact with equipment and use a patient-centered approach.

Proper Patient Education Regarding Medications

• Safe administration and storage.
• Laboratory results.
• Drug interactions.
• Side effects.
• Necessary lifestyle changes.

Rounding Rules

• Oral medications below 1 are rounded to the hundredths place.
• Oral medications above 1 are rounded to the tenths place.
• Convert pounds to kilograms to the tenths place.
• Use whole numbers for intravenous (IV) fluids.
• Use tenths place for IV medications.
• Never use trailing zeros.

NG Tube Medication Mixing

• Do not mix with feeding solutions. Dilute medications in water, and flush the tube between medications.

Fluid Replacement Considerations

• Daily fluid needs.
• Fluid gains and losses.
• Electrolyte and protein requirements.
• Patient weight, calorie needs, and body surface area.
• Underlying illness, including blood loss.

Crystalloids

• Isotonic, hypertonic, hypotonic solutions.

Colloids

• Blood products.

Isotonic Fluids - Purpose

• Increase extracellular volume.
• Treat dehydration.
• Used with blood transfusions.

Isotonic Fluids - Potential Complications

• Edema.
• Alkalosis or acidosis.
• Hypernatremia if infused too rapidly.

Isotonic Fluids - Examples

• 0.9% sodium chloride (normal saline).
• 5% dextrose in water.
• Lactated Ringer's solution.

Isotonic Fluids - Nursing Care

• Monitor I/O and electrolytes.
• Observe for signs of fluid overload.
• Be cautious with liver patients.

Hypotonic Fluids - Examples

• 0.45% NaCl (1/2 NS).
• 0.25% NS (1/4 NS).
• 0.33% NaCl (1/3 NS).

Hypotonic Fluids - Indications

• Treat hypernatremia and hyperglycemia.

Hypotonic Fluids - Potential Complications

• Fluid overload and electrolyte imbalance.
• Rapid infusion can cause red blood cell hemolysis.

Hypotonic Fluids - Nursing Care

• Monitor I/O and electrolytes.
• Watch for fluid overload.
• Use caution with liver disease, shock, or trauma. Avoid in patients with increased intracranial pressure.

Hypertonic Fluids - Examples

• 3% NaCl.
• 5% NaCl.
• D5LR or D5 1/2 NS (5% dextrose in Lactated Ringer's solution or 5% dextrose in 0.45% sodium chloride).

Hypertonic Fluids - Indications

• Treat hyponatremia. Reduce intracranial pressure.

Hypertonic Fluids - Contraindications

• Renal failure.
• Heart failure.
• Cell dehydration.

Hypertonic Fluids - Nursing Care

• Use an infusion pump.
• Monitor for fluid overload, hypernatremia, and respiratory distress.

Colloid Volume Expanders - Examples

• Dextran solutions.
• Albumin.
• Hetastarch.

Colloid Volume Expanders - Purpose

• Increase plasma volume.

Colloid Volume Expanders - Nursing Care

• Monitor I/O.
• Watch for anaphylaxis or renal dysfunction.

Monitoring Lab Values with MTP

• Calcium.

Blood Administration Policies

• Administer blood products within 30 minutes of receipt.
• Require two nurses to verify the order, blood type, and patient identity.
• Do not add medications to blood products.
• Use an 18- or 20-gauge IV catheter for administration and normal saline as the IV fluid.
• Monitor for severe reactions (within 15 minutes) .
• Do not warm the blood product.
• Administer for 2 to 4 hours, maximum 4 hours.

Whole Blood - Benefits

• Treat extreme blood loss to restore intravascular volume.

Packed Red Blood Cells (PRBCs) - Use

• Treat anemia to increase oxygen-carrying capacity.
• Suitable for patients with blood loss of up to 25%.

Fresh Frozen Plasma (FFP)

• Used to replace coagulation factors.

Cryoprecipitate

• Used to manage acute bleeding.

Adverse Effects of Blood Products

• Incompatibility.
• Transfusion reactions.
• Anaphylaxis.
• Transmission of pathogens (e.g., hepatitis, HIV).

Potassium - Function

• Major intracellular cation.

Sodium - Function

• Major extracellular cation; maintains fluid balance, plasma osmolality, neuromuscular excitability, and nerve impulses.

Normal Potassium Range

• 3.5 to 5.0 mEq/L

Potassium-Rich Foods

• Bananas, strawberries, oranges, avocados, tomatoes, cucumbers.

Drugs Affecting Potassium

• Corticosteroids.
• Laxatives.

Body Fluid Percentage

• Intracellular fluid (ICF): 40%.
• Extracellular fluid (ECF): 20%.
  • Interstitial fluid: 15%.
  • Intravascular fluid: 5%.

Severe Hyperkalemia Treatment

• Sodium bicarbonate.
• Calcium gluconate.
• Glucose and insulin.
• Polystyrene sulfonate.

Normal Calcium Range

• 8.6 to 10.2 mg/dL

Ionized Calcium Range

• 4.6 to 5.3 mg/dL

Potassium Toxicity Symptoms

• Peaked T waves, slow/irregular heart rate, wide QRS complex, absent P waves.

Hypocalcemia Treatment

• Oral calcium supplements for mild cases.
• Calcium gluconate for severe cases.

Hypercalcemia Treatment

• Bisphosphonates for malignancy patients.
• Normal saline, calcitonin, or diuretics.

Normal Magnesium Range

• 1.5 to 2.5 mg/dL

Hypomagnesemia Symptoms

• Tremors, facial twitching. Severe cases: cardiac arrest.

Hypermagnesemia Symptoms

• Lethargy and weakness.
• Paralysis, loss of deep tendon reflexes (DTRs), hypotension, and heart block.

Hypomagnesemia Treatment

• Oral or intravenous magnesium replacement.

Hypermagnesemia Treatment

• Discontinue magnesium supplements.
• Administer calcium gluconate.
• Dialysis, if needed.

Hypermagnesemia Causes

• Laxatives and antacids containing magnesium (especially in patients with renal failure).

Magnesium Nursing Care

• Monitor laboratory values.
• Monitor vital signs and electrocardiogram (ECG).
• Monitor urine output.

Potassium Nursing Care

• Monitor vital signs and ECG.
• Monitor urine output.
• Monitor serum potassium levels.

Nutrition Benefits

• Early enteral nutrition promotes intestinal motility, helps maintain intestinal function, aids wound healing, reduces bacterial translocation, and shortens hospital stays and improves health outcomes.

Enteral vs. Oral Nutrition

• Enteral nutrition is delivered via a feeding tube directly into the gastrointestinal tract.

Parenteral Nutrition

• Provides nutrition through intravenous (IV) lines or central venous catheters (CVCs) when the gastrointestinal tract is not functioning.

Enteral Feeding Methods

• Continuous pump.
• Cyclic pump.
• Bolus.
• Gravity.

Test your knowledge on the essential rights and protocols of medication administration. This quiz covers important concepts such as the unit dose method, long half-life medications, and proper documentation processes. Ensure you’re up to date with the best practices for safe medication delivery.