Medication Administration PDF

​ Component(s) of a written prescription 1.​ patient’s name 2.​ date the drug order was written 3.​ name of drug(s) 4.​ drug dosage amount 5.​ drug dosage frequency 6.​ route of administration 7.​ prescriber’s signature ​ What information to include when documenti...

​ Component(s) of a written prescription 1.​ patient’s name 2.​ date the drug order was written 3.​ name of drug(s) 4.​ drug dosage amount 5.​ drug dosage frequency 6.​ route of administration 7.​ prescriber’s signature ​ What information to include when documenting medication administration ▪​ “Nine Rights” : ​ Including the five rights above ​ Right documentation ​ Right reason or indication - appropriateness in use of the medication to the patient (confirming, through research of patient’s history, of why they are taking the drugs) ​ Right response - response to the drug and its desired response in the patient ​ Right to refuse o​ Medication errors should be noted in an accident report, but SHOULDN’T be documented as an “incident report.” (Always sent to a risk management) o​ The patient’s aghe is already part of the patient’s record and is not needed in the documentation of administration ​ Steps/phases of the nursing process – what is done in each phase of o​ Assessment (recognize cues) : ▪​ Allows you to organize the information and places it into meaningful o​ Diagnosis (Human Needs Statements, Analyze cues, priortize hypothesis) : ▪​ Identification o​ Planning (generate solutions) : ▪​ Prioritizes the nursing diagnoses and specific outcomes o​ Implemntation/Intervene (take actions) : ▪​ Consists of initating and completion of specific nursing actions as defined by nursing diagnoses o​ Evaluation : ▪​ Systemic, ongoing, and a dynamic phase of the nursing process as related to drug therapy. Includes monitoring the fulfilment of outcomes and the patient’s therapeutic response to the durg and its adverse effects and toxic effects ​ First pass effect o​ A pharmacological phenomenon in which a medication undergoes metabolism at a specific location in the body. It decreases the active drug’s concentration upon reaching systemic circulation (or site of action) o​ Oral medications are processed through the gastrointestinal tract, absorbed through the small intestines, and undergo the first-effect in the liver before the drug can reach the intended site of action.  ▪​ Medications given by any the parenteral route (like IV) have the advantage to bypass the first-pass effect of the liver ​ Differences in route of administration : ​ o​ Enteral drug administration : ▪​ Oral- Usually easier, more convenient, and less expensive; safer than injection, dosing more likely to be reversible in cases of accidental ingestion ▪​ Rectal- Provides relatively rapid absorption; good alternative when PO route not feasible; useful for local or systemic drug delivery; usually leads to mixed first-pass and non–first-pass metabolism ▪​ Sublingual- absorbed rapidly because the area under the tongue has a large blood supply. ▪​ Buccal- the oral mucosa between the cheek and the gum. Through these routes, drugs such as nitroglycerin are absorbed rapidly into the bloodstream and delivered to their site of action o​ Parenteral drug administration (fastest route) : ▪​ Intravenous- injection delivers the drug directly into the circulation, where it is distributed with the blood throughout the body. Drugs given by intramuscular injection and subcutaneous injection are absorbed more slowly than those given intravenously. These drug formulations are usually absorbed over a period of several hours; however, some are specially formulated to be released over days, weeks, or months. ​ IV is the fastest route of administration because it does not need to be absorbed (cause it is injected directly into the circulation) ▪​ Intramuscular- injections are indicated/used with drugs that are poorly soluble that are often given in “depot” preparation form and are then absorbed over a prolonged period; several drugs may be administered simultaneously if compatible in syringe and/or without contraindication; IM and SUBQ routes result in more rapid absorption as compared with oral route ▪​ Topical- Delivers medication directly to affected area; decreases likelihood of systemic drug effects ▪​ Transdermal- Provides relatively constant rate of drug absorption; one patch can last 1–7 days, depending on drug; avoids first-pass metabolism ▪​ Inhalational- Provides rapid absorption; drug delivered directly to lung tissues, where most of these drugs exert their actions ​ What is going on and factors affecting absorption, distribution, metabolism, and excretion related to drugs in the body o​ Absorption : ▪​ Factors that affect drug rate absorption : ​ How a drug is administered or its route of administration ​ Presence or absence of food or fluids administered with the drug ​ Dosage formulation ​ Status of the absorptive surface  ​ Blood flow to the small intestine ​ Acidity of the stomach and status of gastrointestinal motility ​ Time of day (affect the acidity in stomach) ​ Cautions when giving drugs to infants and elderly patients o​ Elderly (older adults) : ▪​ The HIGHEST priority for older adult patients with multiple medications (pholypharmacy) is the assesment for drug interactions ▪​ The more medications an older adult patient takes, the higher the risk for drug interactio0ns ▪​ While other options present a risk related to effective medication therapy, none have priority over the physical rish of drug interactions o​ Infants (pediatric) : ▪​ Albumin in neonates and infants has a lower binding capacity for medications and lower doses of particular drugs would minimize the risk of toxicity ​ Alubmin : a protein in the blood that helps maintain blood pressure and fluid volume (produced in the liver and transported throughout the body by the bloodstream) ▪​ A lower binding capacity leaves more drugs available for action; a lower dose would be required to precent toxicity ▪​ Nurses working in pre-natal setting need to know about the safety or potential harm of drug therapy during pregnancy relates to certan factors : ​ Factors that contribute to the safety or potential harm of drug therapy during pregnancy can be broadly broken down into three areas : drug properties, fetal gestational age, and maternal factors ​ Drug properties have a direct correlation to the safet or potential harm of drug therapy (during pregnancy) and nurses need to be aware of information related to drug properties ​ Any change in the mother’s physiology such as kidney and liver dysfunction can affect the amount of drug to which the fetus may be exposed ​ Medication errors – how to prevent, and what do you do if one occurs o​ Can happen at any point in the medication process : ▪​ Procuring, prescribing, transcribing, dispensing, and administration ​ Medication reconciliation o​ Medication reconciliation involves three steps: 1.​ Verification—Collection of the patient’s medication information with a focus on medications currently used (including prescription drugs as well as over-the-counter medications and supplements) 2.​ Clarification—Professional review of this information to ensure that medications and dosages are appropriate for the patient 3.​ Reconciliation—Further investigation of any discrepancies and changes in medication orders ​ Patient education and the Nursing Process o​ Patient Education : Domains of Learning :  ▪​ Teaching : a system of directed and deliberate actions intended to induce learning ▪​ Learning : the acquisition of knowledge or skill ​ Affective Domain : the most intangible domain of the learning process o​ Includes affective behavior (expresses feelings, needs, beliefs, values, and opinions); the feeling domain ​ Cognitive Domain : Involved in the learning and storage of basic knowledge o​ The thinking process and incorporates an individual’s previous experiences and perceptions ; the learning/thinking domain ​ Psychomotor Domain : Involved in the learning of a new procedure or skill; the doing domain o​ Need for Further Education : ▪​ When the patient has a lack or limited understanding about the medication (actions, indications, adverse reactions, oor cautions are related to any administration techniques) ▪​ Noncompliance : when the patient does not take the medicaiton (doesn’t adhere to the instructions given) ​ Not taking medication and not reporting adverse do not demonstrate need for further education o​ The Older Adult with Memory Problems : ▪​ Repeating instructions, providing written instructions, and encouraging use of daily medication containers (for short-term memory difficulties) ▪​ Conduct several brief teaching-learning sessions ▪​ Having patients take all the medicaiotn at once DOES NOT necessarilky ensure they will be taken or prevent overdosage Extra things to know : -​ Protein binding : -​ When administering two medications that are highly protein bound, the medications can compete for binding sites on plasma proteins -​ This competition results in either less or both or less of one of the drugs binding to the proteins (increasing the risk of toxicity or adverse effects -​ Race and Culture : -​ Drug polymorphism : drug therapy as it relates to different races of individuals -​ Refers to the effect of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs -​ The race of an indivisual may influence drug therapy decisions for the individual -​ Culture (continued) : -​ Knowledge about drugs that may elicit varied responses in specific racial or ethnic groups must remain current  -​ Ex : genetic changes in certain metabolic enzymes affect the rate of drug metabolism and thus affect drug levels and dosage amounts -​ Cultural practices vary among individuals and should be implemented as an integral part of holistic nursing care -​ Dietary habits and practices can affect the pharmacokinetics of medication (important for patient’s history) -​ Ethical Principles and Conflicts with Personal Ethics : -​ Beneficence is a duty to do good; withholding information from a patient is not only unethical, but also illegal and imposing your values onto a patient is never appropriate -​ If providing required care to a certain type of patient would violate your personl ethics, it’s your responsibility to transfer care of that patient to another professional nurse rather than not performing nescessary care (which would be a form of abandonment) -​ The Law and Patient Protection : -​ TRhe Health Insurance Portability and Accountability Act (HIPAA) officially requires all health-related organizations as well as schools to maintain the privacy of protected health information -​ Must protect improper discolsure of information to other family members, friends, other health care providers, and insurance providers -​ Private information CAN’T be discussed without patient’s permission -​ The Federal Food, Drug, and Cosmetic Act (FFDCA) requires drug manufacturers to provide data proving drug safety with the U.S. -​ Food and Drug Administration (FDA) review and established the investigational new drug application process -​ The Medicare Prescription Drug, Improvement, and Modernization Act provides seniors and disabled people with an insurance benefit program for prescription drugs -​ The Market for Medicinal Herbs (Patient Safety) : -​ It’s growinf with over-the-counter (OTC) medication for about 60% of all medications used in the U.S. -​ Herbal remedies are in traditional therapies -​ Largely unregulated market, generating billions of dollars (annually) -​ Safety Precautions : -​ Some are effective, some are not. A few can be harmful or lethal effects -​ Dietary supplements do not need FDA approval and are required no efficacy for standards and labeling -​ Ginseng and Prescription Drugs : -​ Must be used cautiously -​ Ginseng can alter drug metabolism (resulting in drug distribution and elimination) -​ The potential for altered pharmacokinetics of the patient’s prescription drugs, which the nurse should check the liver enzymes as an indicator for liver function (cause the liver is the main site of drug metabolism) -​ DNA and Nursing Knowledge : -​ Conditions like myocardial infarction, cancer, mental illnesses, diabetes, and Alzheimer’s disease are known of compolex interactions among a  number of factors (like influence of one or more genes, variety of environmental exposure, and genetic mutations) -​ DNA is the primary molecule that serves to transfer genes from parents to offspring and has four different organic bases -​ Adenine, Guanine, Thymine, and Cytosine -​ For RNA (ribonucleic acid) organic bases : -​ Adenine, Guanine, Cytosine, and Uracil