Medication Administration And Nursing Process Of Drug Therapy PDF

Chapter 3 Medication Administration and the Nursing Process of Drug Therapy “Rights” of Right drug Right reason Medication Right dose Right to Administration Right patient refuse the Rig...

Chapter 3 Medication Administration and the Nursing Process of Drug Therapy “Rights” of Right drug Right reason Medication Right dose Right to Administration Right patient refuse the Right medication assessment Right Right route documentati Right time on Right patient education Right evaluation 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  Follow “rights” consistently. Accurate Drug Learn essential information about medications Administration to be given. Principles #1 Interpret the prescriber’s orders accurately. oWrite down or enter into computer and read back verbal or phone orders. Read medication labels carefully. Use only approved abbreviations use to prevent errors. 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  Calculate doses accurately. Accurate Drug Measure doses accurately. Administration Use correct procedures and techniques for all Principles #2 administration routes. Learn about the patient’s diagnoses and condition in relation to medication administration. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Verify identity of all patients before Accurate Drug administering medications. Administration Omit or delay doses as indicated by the Principles #3 patient’s condition and document accordingly. Be especially careful when administering medication to children due to high risk of medication error. Maintain up-to-date drug administration skills and knowledge. 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Nurses’ legal responsibilities include Legal oSafe, accurate medication administration Responsibilities oRecognizing and questioning erroneous orders oRefusing to administer unsafe medications oDelegating in compliance with the law 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 It is the legal responsibility of a nurse to administer medications exactly as the prescriber has written it, without question. 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  False. Answer to Question #1 Rationale: It is the legal responsibility of a nurse to recognize and question erroneous orders. Additionally, if the nurse considers the administration of any medication unsafe, the nurse must refuse to give the drug. 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Medication errors can result in Medication Errors oSerious illness #1 oConditions that prolong hospitalization or require additional treatment oDeath 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Common medication errors include Medication Errors oGiving an incorrect dose #2 oNot giving an ordered medication oGiving an unordered medication Medications often associated with errors include oInsulin, heparin, and warfarin 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Systems vary by health care facility and Medication include Systems Unit dose system Computerized, locked cabinets Additional security for controlled substances Changes to prevent medication errors CPOE Bar coding Point of care Limiting use of abbreviations Medication reconciliation 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  Must include Medication oThe patient’s full name Orders oName of the medication (preferably generic) oDose, route, frequency of administration oDate, time, signature of the prescriber 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Typed into computer (preferred method) Medication Order Handwritten on an order sheet Transcription Verbal orders oSigned by the transcriber, countersigned by the prescriber Telephone orders oSigned by the transcriber, countersigned by the prescriber 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Which of the following is the preferred method Question #2 of order transcription? A. Telephone order B. Verbal order C. Handwritten order D. Computer entry 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  D. Computer entry Answer to Question #2 Rationale: Telephone and verbal orders must be signed by the transcriber and the prescriber; handwritten orders must be signed by the prescriber. Both types can involve interpretation and/or transcription errors. Direct computer-entry orders are the preferred method of order entry. 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Nurses must know commonly used Medication Order abbreviations. Interpretation Routes, dosages, and times of administration “Do not use” abbreviations Due to frequent misinterpretation Illegible, seemingly erroneous orders must be clarified before administration. 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  IM: Intramuscular Abbreviations: IV: Intravenous Routes of Drug PO: By mouth, oral Administration SL: Sublingual Sub-Q: Subcutaneous 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  Medications may be available in various Drug Preparation forms. and Dosage Forms Systemic medication forms include oLiquids oTablets, capsules oSuppositories, transdermals oInjections 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  Pump delivery systems Medication Delivery Systems By mouth (PO) #1 oTablets oCapsules oSublingual 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Controlled release Medication Timed-release, sustained-release, extended Delivery Systems release #2 Names usually include CR, SR, XL Enteric coated (to prevent stomach upset) Maintains more consistent serum drug levels Allows less frequent administration More convenient for patients 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Controlled release (cont.) Medication Tablets, capsules Delivery Systems Contain high amount of drug #3 Intended to be absorbed slowly over prolonged period of time Should never be broken, open, crushed, chewed 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Transdermal Medication Systemic absorption through skin Delivery Systems #4 Pump delivery systems External or implanted Refillable or long-acting without refills Insulin, opioid analgesics, anticancer medications (antineoplastics), and other drugs 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  Topical Medication oSolutions Delivery Systems oCreams #5 oSuppositories oFrequently used for local treatment 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Accuracy is of utmost importance. Calculating Involves Medication oSystem of measurement Dosages #1 oMathematical calculations oKnowledge of common units of measurement oKnowing how to use data in performing calculations 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  D X Calculating H = V Medication D = desired dose (dose ordered, Dosages #2 often in mg) H = available dose (on drug label, often in mg per tablet/capsule/mL) X = unknown (number of tablets/capsules/mL) V = volume or unit 25 Copyright © 2025 Wolters Kluwer. All rights reserved. Equivalents 26 Copyright © 2025 Wolters Kluwer. All rights reserved.  Oral (by mouth) Routes of Parenteral (injected) Administration oSubcutaneous (Sub-Q) oIntramuscular (IM) oIntravenous (IV) Topical (applied to skin or mucous membrane) 27 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #3 The parenteral route of medication administration involves applying medication directly to the skin or mucous membrane. 28 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #3 Rationale: The parenteral route of medication administration involves injecting medication into a blood vessel, muscle, or spinal column. The topical route involves applying medication directly to the skin or mucous membrane. 29 Copyright © 2025 Wolters Kluwer. All rights reserved.  Must be prepared, packaged, and Medications for administered maintaining sterility Injection Typical medication containers oVials (single or multiple dose) oAmpules oPrefilled syringes with attached needles 30 Copyright © 2025 Wolters Kluwer. All rights reserved.  Sterile needles Equipment for oVarious gauges (lumen size) Injections #1 Larger number = smaller lumen oVarious lengths, use depends on Route of administration Thickness (viscosity) of solution Size of the patient 31 Copyright © 2025 Wolters Kluwer. All rights reserved.  Needleless systems Equipment for oDeveloped to prevent injury and the spread Injections #2 of blood-borne pathogens Syringes oMade of plastic (disposable) oCalibrated to measure doses accurately oInsulin, tuberculin syringes for small doses 32 Copyright © 2025 Wolters Kluwer. All rights reserved.  Sub-Q common sites Injection Sites oUpper arms, abdomen, back, thighs IM common sites oDeltoid, ventrogluteal, vastus lateralis muscles IV common sites oBack of hands, forearms 33 Copyright © 2025 Wolters Kluwer. All rights reserved. Sub-Q Injection Sites 34 Copyright © 2025 Wolters Kluwer. All rights reserved. IM Injection Sites: Deltoid 35 Copyright © 2025 Wolters Kluwer. All rights reserved. IM Injection Sites: Ventrogluteal 36 Copyright © 2025 Wolters Kluwer. All rights reserved. IM Injection Sites: Vastus Lateralis 37 Copyright © 2025 Wolters Kluwer. All rights reserved. IV Injection Sites 38 Copyright © 2025 Wolters Kluwer. All rights reserved.  Nurses may perform Less Common oIntradermal (into layers of skin) Injection Sites oIntra-arterial (into arteries if established arterial line is present) Physicians must perform oIntra-articular (into joints) oIntrathecal (into spinal fluid) 39 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #4 Nursing process is rarely used in drug therapy. 40 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #4 Rationale: Nursing process, a systematic way of gathering and using information to plan, provide, and evaluate individualized care, is instrumental in effective drug therapy. 41 Copyright © 2025 Wolters Kluwer. All rights reserved.  Assessment Nursing Process Nursing diagnosis Planning/establishing goals Interventions Evaluation 42 Copyright © 2025 Wolters Kluwer. All rights reserved. Assessment: Medication History #1 43 Copyright © 2025 Wolters Kluwer. All rights reserved. Assessment: Medication History #2 44 Copyright © 2025 Wolters Kluwer. All rights reserved.  Current medication orders Medication The patient’s knowledge regarding current History Questions medications History of allergic reactions Can the patient swallow medications? Communicate verbally? Patient’s pathological condition that might influence drug therapy History of herbal/dietary supplement use 45 Copyright © 2025 Wolters Kluwer. All rights reserved.  Promoting health General Nondrug Preventing/decreasing need for drug therapy Interventions Using nondrug measures to enhance therapeutic effects or decrease adverse effects Patient teaching Individualizing care Administering drugs Observing patient responses 46 Copyright © 2025 Wolters Kluwer. All rights reserved.  Promoting healthful lifestyles regarding Specific Examples nutrition, fluids, exercise, rest, and sleep of Nondrug Conscientiously performing hand hygiene, Interventions infection prevention Ambulating, positioning, exercising Assisting to cough and deep breathe Applying heat or cold Scheduling activities to promote rest or sleep Recording vital signs, I&O, and other data 47 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #5 All drug therapy goals should be stated in terms of the nurse’s behavior. 48 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #5 Rationale: All drug therapy goals should be stated in terms of the patient’s behavior. 49 Copyright © 2025 Wolters Kluwer. All rights reserved.  Progress toward stated outcomes Drug Therapy oRelief of symptoms Evaluation Accurate administration Criteria Avoidance of preventable adverse effects Patient adherence Specific parameters measured to evaluate response to particular medications 50 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #6 Most drug administration outcomes will be evaluated over hours or days, not minutes. 51 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #6 Rationale: The nurse monitors responses to drug therapy, both therapeutic and adverse. 52 Copyright © 2025 Wolters Kluwer. All rights reserved.  Evidence-based nursing practice Evidence-Based Requires a conscientious and continuing Practice and effort to provide high-quality care to patients Nursing Process Obtaining and analyzing best scientific evidence from research oScientific evidence is integrated with the nurse’s clinical expertise and the patient’s preferences and values to yield best practice. 53 Copyright © 2025 Wolters Kluwer. All rights reserved.  Questionable safety due to unknown effect on Herbal/Dietary humans, nonstandardized ingredients Supplement Use of supplements may keep the patient Concerns from seeking medical care. Supplements may interact with prescription medications to decrease therapeutic effect or increase adverse effects. Use of supplements not communicated to the health care provider 54 Copyright © 2025 Wolters Kluwer. All rights reserved.