Drug Administration Notes PDF

**DEFINITION OF TERMS** **Medication** = a substance administered for the diagnosis, cure, treatment, or a relief of a symptom or for prevention of diseases, something that treats or prevents or alleviates the symptoms of a disease Usually dispensed on the order of physicians and dentists **Drug**...

**DEFINITION OF TERMS** **Medication** = a substance administered for the diagnosis, cure, treatment, or a relief of a symptom or for prevention of diseases, something that treats or prevents or alleviates the symptoms of a disease Usually dispensed on the order of physicians and dentists **Drug** = has the connotation of an illicitly obtained substance such as heroin, cocaine or amphetamines, a substance that is used as a medicine or narcotic, use recreational drugs. **Prescription** = a written direction for the preparation and administration of a drug **Generic name**= is given before a drug becomes officially an approved medications **Official name** = the name after which the drug is listed in one of the official publication **Chemical name** = the name which describes the constituents of drugs precisely **Brand name** = the name given to a drug by the manufacturer **Pharmacology** = the study of the effects of drugs on living organisms **Legal aspects of drug administration** Nurses need to (a) know how nursing practice acts in their areas; define and limit their functions and be able to recognize the limits of their own knowledge and skill Another aspect of nursing practice governed by law is the use of controlled substances. **therapeutic effect of a drug,** also referred to as the desired effect, is the primary effect intended, that is, the reason the drug is prescribed. Palliative - Relieves symptoms but does not affect the disease itself (ex. Morphine sulfate, aspirin for pain) Curative - Cures a disease or condition (Cures a disease or condition) Supportive - Supports body functions until other treatments or the body response can take over (Norepinephrine bitartrate for low blood pressure, aspirin for high blood pressure) Substitute - Replaces body fluids or substances (Thyroxine for hypothyroidism, insulin for diabetes mellitus) Chemotherapeutic - Destroys malignant cells (Busulfan for leukemia) Restorative - Returns the body to health (Returns the body to health) - A**side effect, or secondary effect, of a drug is one that is unintended.** Side effects are usually predictable and may be either harmless or potentially harmful. - For example, digitalis increases the strength of myocardial contractions (desired effect), but it can have the side effect of inducing nausea and vomiting. - more severe side effects, called **adverse effects or reactions,** may justify the discontinuation of a drug. **Drug toxicity -** results from overdosage, ingestion of a drug intended for external use, or buildup of the drug in the blood because of impaired metabolism or excretion. toxic effects are apparent immediately; some are not apparent for weeks or months. **Drug allergy -** immunologic reaction to a drug. When a client is first exposed to a foreign substance (antigen), the body may react by producing antibodies. A client can react to a drug in the same manner as an antigen and thus develop symptoms of an allergic reaction. Is an immunologic response to a drug which can be either mild or severe An allergic reaction can occur anytime from a few minutes to 2 weeks after the administration of a drug - **Mild reactions** with variety of symptoms : skin rash, pruritus, rhinitis, nausea, vomiting, and dyspnea and diarrhea - **Severe reactions** usually occurs immediately after the administration of the drug and is called anaphylactic reaction - The earliest symptoms are a subjective feeling of swelling in the mouth and tongue, acute shortness of breath, acute hypotension and tachycardia **Drug tolerance -** Exists in a person who has unusually low physiologic response to a drug and who requires increases in the dosage to maintain a given therapeutic effects. Drugs that commonly produce tolerance are opiates, barbiturates, ethyl alcohol, and tobacco **Drug misuse -** Is the improper use of common medications in ways that lead to acute and chronic toxicity. prescription drugs may be misused. Laxatives, antacids, vitamins, headache remedies, and cough and cold medications are often self-prescribed and overused. For example, a client might use an OTC cough medicine to treat a cough that might be caused by a serious underlying problem such as throat cancer. **Drug abuse -** an inappropriate intake of a substance, either continually or periodically. By definition, drug use is abusive when society considers it abusive. For example, the intake of alcohol at work may be considered alcohol abuse, but intake at a social gathering may not. Drug abuse has two main facets, drug dependence and habituation. **Pharmacodynamics -** process by which the drug changes the body, which require the drug interact with specific molecules and chemicals normally found in the body. **Pharmacokinetics** may be simply defined as what the body does to the drug, as opposed to **Pharmacodynamics** which may be defined as what the drug does to the body. **Factors affecting medication action** - Developmental factors - Gender - Cultural, ethnic, genetic factors - Diet - Environment - Time of administration - Psychological factors - Illness and diseases **\ The "The ten Rights" of Drug Administration** 1. Right medication 2. Right dose 3. Right time 4. Right route 5. Right client 6. Right client education 7. Right documentation 8. Right to refuse 9. Right assessment 10. Right evaluation **Medication order -** a written order by a physician, dentist, nurse practitioner, or other designated health professional for a medication to be dispensed by a pharmacy for administration to a patient. - Stat order = indicates that the medication is to be given immediately and only once - Single order = or one time order is for medication to be given once at a specified time - Standing order = may or may not have a termination date until an order is written to cancel it, or it may be carried out for a specified number of days (e.g., KCl twice daily 2 days). In some agencies, standing orders are automatically cancelled after a specified number of days and must be reordered. - PRN order = or as needed, permits the nurse to give a medication when, in the nurse judgment , the client requires **Essential Parts of a Medication Order** - Full name of the client - Date and time the order is written - Name of the drug to be administered - Dosage of the drug - Frequency of administration - Route of administration - Signature of the person writing the order **Process of administering medications** - Identify the client - Inform the client - Administer the drug - Provide adjunctive intervention as indicated - Record the drug administered - Evaluate the client's response to the drug **Medicine card/ticket** - Is a guide in preparing medications by the medication nurse - Standard size is 1"x3" - Color coded : white( stat, single dose, hs, prn special timing such as q 8 hours etc) green(quid q4h) pink (tid) yellow (bid) red - **D desired dose** (i.e., dose ordered by primary care provider) - **H dose on hand** (i.e., dose on label of bottle, vial, ampule) - **V vehicle** (i.e., form in which the drug comes, such as tablet or liquid). - **Formula : [DxV] = amount to be administered**\ **H** - *Order: Erythromycin 500 mg* - *On hand: 250 mg in 5 mL* - D 500 = mg H 250 = mg V = 5 mL - [500 mg] x 5ml = [2,500]\ 250 mg 250 = 10 mL **\ Oral / Parenteral Medications: Liquids** - **[Desired dose] x dilution = Quantity of drug** **Pediatric Doses** **a. Clark's Rule** **b. Fried's Rule** **c. Young's Rule** **Oral administration** - is a route of administration where a substance is taken through the mouth - is an adverbial phrase meaning literally from Latin \"**by mouth\" or \"by way of the mouth."** - The expression is used in medicine to describe a treatment that is taken orally. - The abbreviated P.O. is often used on medical prescriptions. P.O rendered per orem, - Most common - Least expensive - Most convenient - Safe, does not break skin barrier - an unpleasant taste of the drugs, irritation of the gastric mucosa, irregular absorption from the gastrointestinal tract, slow absorption, and, in some cases, harm to the client's teeth. - For example, the liquid preparation of ferrous sulfate (iron) can stain the teeth. **Sublingual administration** - In **sublingual administration** a drug is placed under the tongue, where it dissolves In a relatively short time - drug is largely absorbed into the blood vessels on the underside of the tongue. - The medication should not be swallowed. Nitroglycerin is one example of a drug commonly given in this manner. - Drug can be administered for local effect - More potent than oral route because drug directly enters the blood and bypasses the liver - If swallowed drugs may be inactivated by gastric juice - Drug must remain under the tongue until dissolved and absorbed - May cause stinging or irritation of the mucous membranes - Drug is rapidly absorbed into the bloodstream **Buccal administration** - Means "pertaining to the cheek" - Held in the mouth against the mucous membranes of the cheek until the drug dissolves - The drug may act locally on the mucous membranes of the mouth systematically when it is swallowed in the saliva - Same as sublingual - Drug can be administered for local effect - More potent than oral route because drug directly enters the blood and bypasses the liver - Same as sublingual - If swallowed drugs may be inactivated by gastric juice - Drug must remain under the tongue until dissolved and absorbed - May cause stinging or irritation of the mucous membranes - Drug is rapidly absorbed into the bloodstream **Topical administration** - Are those applied to a circumscribed surface area of the body and they affect only the area to which they are applied - Dermatologic preparations = applied to the skin - Instillations and irrigations = applied into body cavities or orifices, such as urinary bladder, eyes, ears, nose, rectum or vagina - Inhalations = administered into the respiratory tract by a nebulizer or positive pressure breathing apparatus **Otic medication** - Instillations or irrigations of the external auditory canal generally for cleaning purposes - Position of external auditory canal varies with age - Child under 3 years of age, it is directed upward then back - Adult: it is directed downward then back **Nasal medications** - Nasal instillations (nose drops, and sprays) usually instilled for their astringent effect ( to shrink swollen mucous membranes), to loosen secretions and facilitate drainage or to treat infections of the nasal cavity or sinuses - Nasal decongestants are the most common nasal installations **Vaginal medications** - Are inserted as creams, jellies, foams or suppositories to treat infections to relieve vaginal discomforts - Aseptic techniques is usually used - Vaginal creams, jellies and foams are applied by using a tubular applicator with a plunger - Suppositories are inserted with the index finger of a gloved hand **Vaginal irrigations** - Douche, is the washing of the vagina by a liquid at a low pressure - Used to prevent infection by applying an antimicrobial solution that discourages the growth of microbes; to remove an offensive odor and irritating discharges and to reduce inflammation **Rectal administration** - Can be used when the drug has objectionable taste or odor - One disadvantage is that the dose absorbed is unpredictable - Suppositories tend to soften at room temperature, need to be refrigerated **Irrigations** - Lavage, is the washing out of a body cavity by a stream of water or other fluid that may or may not be medicated - Different kind of syringe is used for irrigation, the most common are the asepto and the rubber bulb - Asepto syringe is a plastic or glass syringe with a rubber bulb (30 ml- 120 ml/ 4 oz) - Squeezing the air out of the bulb produces negative pressure and fluid can be sucked into the syringe. **Parenteral administration** - Administered by any way other than through the mouth, outside the intestine: applied, for example, to the introduction of drugs or other agents into the body by injection **Common routes of parenteral administration** - **Subcutaneous (**hypodermic) = into the subcutaneous tissue, just below the skin - **Intramuscular** = into the muscle - **Intradermal** = under the epidermis - **Intravenous** = into the vein **Less commonly used for parenteral** - Intracardiac= into the heart muscle - Intra arterial = into an artery - Intra osseous = into the bone - Intra ethical or intra spinal = into the spinal canal - Intra pleural = into the pleura space\\intra Articular = into the joints **Equipments** **Syringes** - The tip which connects with the needle - The barrel or outside part on which the scales are printed - Plunger which firs inside the barrel **3 most commonly used syringe** - **Standard hypodermic syringe** = comes in 2,2.5, 3 and 5 ml sizes; may have 2 scale marked on it; the minim scale used for very small dosages and the milliliter scale one normally used. - **Insulin syringe** = scale is specially designed for insulin: a 100 unit calibrated scale - **Tuberculin syringe**= designed to administer tuberculin solution, calibrated in tenths and hundredths of a milliliiter (up to 1 mL) **Needles** - Made of stainless steel and most are disposable - 3 parts: hub which fits onto the syringe; the Cannula or shaft which is attached to the hub; and the bevel, which is slanted part at the tip of the needle **Variable characteristics of needles** - Slant or length of the bevel : short or long; longer bevels provides less discomfort commonly used for SQ and IM; short bevels are used for ID and IV - Length of shaft: varies from ½ to 2 inches - Gauge of the shaft: varies from \#18 t0 \# 28, the larger the gauge number the smaller the diameter of the shaft **General principles in Parenteral administration of medications:** 1. Use separate needles for aspiration and injection of medication 2. Introduce air into the vial before aspiration 3. Allow a small air bubbles in the syringe to push the medication that may remain in the hub and lumen of the needle 4. Introduce the needle in a quick thrust **General principles in Parenteral administration of medications:** 1. Either spread or pinch when introducing the needle 2. Minimize discomfort 3. Aspirate before introduction of medication 4. Support the tissues with cotton swabs before withdrawal of needle **General principles in Parenteral administration of medications:** 1. Massage the site of injection to hasten absorption 2. Apply pressure at the site for few minutes 3. Evaluate effectiveness of the procedure and make relevant documentation 4. NEVER recap a used needle **Preparing injectable medications** - Can be prepared by withdrawing the medication from an ampule or vial into a sterile syringe - Ampule is a glass container usually designed to hold a single dose of a drug made of clear glass and has a distinctive shape with a constricted neck - Vial is a small glass bottle with a sealed rubber cap usually have a metal or plastic cap that protects the rubber seal - Reconstitution = adding a different a diluents to a powdered drug to prepare it for administration **\ Mixing medications in one syringe** - To spare the client from the experience of being injected twice, two drugs (if compatible) are often mixed in one syringe and given in one injection - To combine two type of insulin in this manner or to combine injectable pre operative medications such as morphine or meperidine with atropine or scopolamine **\ INTRAMUSCULAR INJECTIONS (IM)** - is the injection of a substance directly into a muscle - the medication may either be absorbed fairly quickly or more gradually. Intramuscular injections are often given in the deltoid, vastus lateralis muscles and the Ventrogluteal and Dorsogluteal areas. - Needle length:: 1",, ½", 2" (3" may be used if the patient is adult) - Needle gauge: 20, 21, 22, 23 - Inject the medication slowly 20 seconds - **Ventrogluteal site** - Uses the gluteus minimus muscle - The area contains no large nerves, or blood vessels and less fats - Farther from the rectal area, so less contaminated - Position can be back or side-lying with the knee and hip flexed to relax the gluteus muscle - **Dorsogluteal site** - Uses the gluteus medius muscle - Not to be used for children under 3 years of age unless the child has been walking for 1 year - Avoid hitting the sciatic nerve, major blood vessel or bone - **Vastus lateralis** - Recommended site for infants - Located at the midline third of the anterior latera aspect of the thigh - Assume back lying position or sitting position - **Deltoid site** - Not used often for IM injection because it is relatively small muscle and is very close to the radial nerve and radial artery - Z tract injection, for parenteral iron preparation (to seal the drug deep into the muscle and prevent permanent staining of the skin) **Subcutaneous injection** - Sites; outer aspect of the upper thigh; anterior aspect of thighs; scapular areas of the upper back; upper Ventrogluteal and Dorsogluteal areas - Use 5/8" needle for adults at 45 degree angle - For thin patients: 45 degree angle of needle - For obese patients: 90 degree angle - For insulin: do not massage the site to prevent rapid absorption which may result to hypoglycemic reaction **Intradermal injection** - The administration of a drug into the dermal layer of the skin just beneath the epidermis - This is indicated for allergy, tuberculin testing, and for vaccinations - Sites: inner lower arm; upper chest; back, beneath the scapulae - Needle gauge: 25,26,27 - Needle at 10-15 degrees angle; bevel up - Inject a small amount of drug to form a wheal or bleb; do not massage **Definition of terms** 1. **Intravenous Therapy-intravenous therapy** requires parenteral fluids(solutions) and special equipment: administration set-IV pole, filter, regulators to control flow rate and an established venous route. 2. **Parenteral-** administered by means other than through the alimentary tract (as by intramuscular or intravenous injection) **4. IV pole**-a metal pole wherein intravenous solutions are placed or hanged. ***5.*Drip chamber-** comes in two types, first is Macro drip which releases 10-20 drops per milliliter of solution and Micro drip, which releases 60 drops per milliliter. **6. Regulator-** is a roller clamp which compresses the plastic tubing to control the flow rate. ***7*. Injection port** - a specific site in the IV administration set wherein parenteral medications are introduced. **8. IV catheter-** are specialized needles that initiates access to the venous system**.** **12.Blood Transfusion-** The introduction of blood or blood plasma into a vein or artery. **13.Blood administration set** - tubing with in lined filter and Y for saline administration. **14.Blood Typing-** is a laboratory examination to determine a persons blood type. **15.Cross-matching**- is the process of determining compatibility between blood types. **16.Rh factor-** an inherited antigen ***17.*Priming =** the preparation of tubing that will transport fluids. **Intravenous therapy** or **IV therapy** - is the infusion of liquid substances directly into a vein. - The word **intravenous** simply means \"within a vein\". - It is commonly referred to as a **drip** because many systems of administration employ a drip chamber, which prevents air from entering the blood stream (air embolism), and allows an estimation of flow rate. - Intravenous therapy may be used to correct [electrolyte](http://en.wikipedia.org/wiki/Electrolyte) imbalances, to deliver medications, for [blood transfusion](http://en.wikipedia.org/wiki/Blood_transfusion) or as [fluid replacement](http://en.wikipedia.org/wiki/Fluid_replacement) to correct, for example, [dehydration](http://en.wikipedia.org/wiki/Dehydration). - Intravenous therapy can also be used for [chemotherapy](http://en.wikipedia.org/wiki/Chemotherapy) (The treatment for any kind of cancer.) - the intravenous route is the fastest way to deliver fluids and medications throughout the body. - To supply fluid when clients are unable to take in an adequate volume of fluids by mouth - To provide salts needed to maintain electrolyte balance - To provide glucose (dextrose), the main fuel for metabolism - To provide water-soluble vitamins and - medications - To establish a lifetime for rapidly needed medications