Medication Administration (NP01L007) PDF

Medication Administration NP01L007 · Version 2.0 Introduction to Clinical Pharmacology, 10th ed., Chapters 1 – 4 Pharmacology and the Nursing Process The Role of the LPN/LVN Provide nursing care across the lifespan Practice in acute, long-term, and community-based set...

Medication Administration NP01L007 · Version 2.0 Introduction to Clinical Pharmacology, 10th ed., Chapters 1 – 4 Pharmacology and the Nursing Process The Role of the LPN/LVN Provide nursing care across the lifespan Practice in acute, long-term, and community-based settings Provide safe, quality, and cost-effective care Safely administer medications Medication Administration The Nursing Process Guides the way nurse’s work Consists of 5 major steps Assessment Information about the patient Subjective data Objective data Medication reconciliation Allergies Contraindications Diagnosis Patient’s condition Use data to contribute to plan of care What are the major health-related problems of this patient? What drugs is the patient likely to require? What factors affect the patient’s ability for self-care? Planning Use collected data and nursing diagnoses to set goals Collaborate Multidisciplinary team Patient Patient’s family Verify medication administration orders Determine if ordered drugs and dose are correct Use good clinical judgment, hold if necessary Implementation Safely administer medications to the patient Apply your knowledge of the medication for the expected action Documentation Use the 9 Rights of Drug Administration Nine Rights of Medication Administration Strategy for nurses to safely administer medications Evaluation Process to determine right response Was the treatment effective? Were there any side effects? Were there any adverse effects? Check on Learning What is the best way to check that you are giving the drug to the right patient? Check on Learning What is the best way to check that you are giving the drug to the right patient? Check on Learning What is the best way to check that you are giving the drug to the right patient? Patient Scenarios Identify which of the 9 Rights of Medication Administration have been violated in each of the scenarios. Scenario Nurse Salazar is taking care of 4 patients on the medical-surgical unit. She has completed her 60 second initial assessment on each patient and has addressed any immediate needs. She has just completed her first medication pass (see patient chart) and is now moving onto her next patient. Patient list: Room: 3210 Room: 3222 Room: 3224 Room: 3254 Patient: Thor Odinson Patient: Peter B. Parker Patient: Robert Bruce Banner Patient: Steve Rogers DOB: Unknown DOB: August 10, 2001 DOB: December 18, 1969 DOB: July 4, 1918 Enabling Learning Objective: B Describe the legal, regulatory, and ethical aspects of medication administration Regulation of Drug Administration Federal laws Controlled substances Prescription drugs Over-the-counter drugs State laws and hospital and/or agency policies Require legal prescriptions Legal Prescription Patient’s full name Date of the prescription Name of the drug Route of administration Dose Frequency Duration Signature of the prescriber Aspects of Medication Administration How does this medication affect the patient’s health and safety? When administering the nurse must consider: What are the legal requirements for administering this medication? What regulations are associated with this medication? Is administering this medication create an ethical dilemma? Types of Medication Orders Standing order Emergency (STAT) order Single-drug order As needed (PRN) order Standing Order Medication will be given until it is discontinued Can also be prescribed for a certain number of doses Example: amoxicillin 500 mg orally every 8 hours for 10 days. STAT Order A one-time order to be given immediately. Example: diphenhydramine 50 mg IV STAT. Single-drug Order One-time order to be given at a specific time. Example: cefazolin 1 g IV at 1000 hrs. before surgery. PRN Order Given as needed based on a nurse’s judgement Consideration to safety and patient need Example: docusate 100 mg orally at bedtime as needed for constipation. Meet RaDonda Vaught Medication Errors & Injury Prevention Medication Errors Costly to patients Can cause death Can occur at three points: During medication preparation Bringing medication to the patient Administering medication to the patient Causes of Medication Errors Fast-paced work environment Low staffing Multi-tasking Interruptions during the process All medication errors MUST be reported Nursing Considerations Report medication error Monitor the patient Vital signs Labs Physical Assessment Follow agency policies Avoid use of abbreviations High-Alert Drugs Drug not prescribed to patient who received it Nurse administered too high of a dose Nurse administered too low of a dose Patient does not receive dose as prescribed Categories of High-Alert Drugs Black Box Designation Categorized by ability to do harm Assigned by the Food and Drug Administration Drug has higher-than-normal risk Regular patient monitoring Medication Reconciliation Comparing all medications patient is prescribed to the patient Helps to avoid medication errors (such as) Wrong doses Duplication of medications Omitting a medication Nurses compare the lists List includes over-the-counter, herbal, vitamins, and all prescription medications patient takes daily Protection of Healthcare Workers Protection for Unsafe Clinical Practices Protection from exposure to bloodborne pathogens Written plan to reduce needlestick injuries Equipment to prevent needlesticks Control plan reviewed annually Check on Learning Placeholder… Dennis Quaid video Enabling Learning Objective: C Understand the basic principles of pharmacology and the nurse’s roles and responsibilities in medication administration. The Principles of Pharmacology Basics of Pharmacology What the body does with the drug. What the drug does to the body. The use of drugs to treat disease. Pharmacokinetics Pharmacodynamics Pharmacotherapeutics Drug Names Generic name (most common – not capitalized) Trade name (i.e., Motrin, Tylenol) Example: Valium (trade name) Diazepam (generic name) Written as: diazepam (Valium) 2 mg PO BID for anxiety Drug Attachment Drug’s chemical reaction change the way the body acts Chemical bond at receptor site Basic Drug Processes Absorption – the way the drug enters the body and passes into circulation Distribution – the drug reaches the intended body part Metabolism – where the drug is metabolized Excretion – where the drug is eliminated from the body Passive Transport Molecules move from high to low concentration Diffusion – gas, liquid, or solid Osmosis – fluid from more concentration to less concentration Filtration – Substance filters to prevent certain molecules from passage  Active Transport Molecule moves from low concentration to high concentration with energy from ATP. Solubility The ability of the drug to dissolve Drug dissolves quickly or slowly Controlled by the form of the drug Route of administration influences absorption Enteral Parenteral IV Inhalation Distribution Drug reaches organ or tissue where it will have expected action Circulation – through blood or lymph systems How fast the drug reaches site dependent on vascularity Perfusion inhibits distribution of medications Drugs are attracted to tissues or target receptors Metabolism Biotransformation – enzymes in certain body sites break down the chemical in the drug and make it usable or unusable Prodrugs – activated by enzymes for the body to use Patient response – dictates tolerance and sensitivity Excretion and Elimination Metabolites Elimination and Excretion Unusable drugs are removed from the body through: Gastrointestinal tract (feces) Kidneys (urine) Exhalation (breathing) Evaporation (sweating) Timing of Medication Dose Responses Dose Responses Half-life is the time it takes for 50% of the drug to be removed from the body Half-life explains: How much drug should be taken How often it should be taken How long it will last If half-life is short patient needs frequent doses Medication Dosage Considerations Prescribed to keep medication dose at a constant level Time intervals – anticipate the effect of the medication Onset of medication action Peak action Trough Duration of action Plateau Fill-In-the-Blank 1. Onset of action _______________________________________ 2. Peak action __________________________________________ 3. Trough ______________________________________________ 4. Duration of action ______________________________________ 5. Plateau ______________________________________________ Check on Learning Drug Actions Desired Action – drug produces the expected response Idiosyncratic Response – drug produced a unique response Unexpected Reaction Paradoxical response – Drug produces the opposite action Hypersensitivity – Patient has increased reaction to the drug Anaphylactic reaction – Patient has life-threatening response to the drug Drug Actions Predictable and often unavoidable Expected Side Effects May stop if given with food or water May stop with help of an additional medication Adverse Unintended, undesired, and unpredictable response to a medication Mild or severe Nephrotoxic Effects Hepatotoxic Blood dyscrasias Drug Interactions When one drug changes the action of another Antagonistic effect One drug interferes with the action of another Synergistic effect Two drugs taken at the same time to enhance the desired action Food, Alcohol, and Drug Interactions Alcohol Cigarette smoking Caffeine Drugs Other Influences on Drug Therapy Medication tolerance Occurs over time (patient will need to receive higher doses) Dehydration, overhydration, low blood pressure, shock, heart failure, and reduced blood flow Alcohol intake Persons with liver and/or kidney problems Body size and lean-to-fat ratios Drug Therapy and Special Populations Alterations Pediatric patients Pregnant or breast-feeding patients Older adults Enabling Learning Objective: D Write 5 – 7 drug (medication) cards that will include the trade name and generic name of the drugs, the dosage range, the desired action, expected side effects, adverse effects, how to give the medications, nursing implications, and the classification without error. Why make a medication card? Nurses need to understand about the patient and the medications you give them Drug cards are a good way to learn and remember medications Never give a medication that is unfamiliar or why it is prescribed to YOUR patient Components of a Drug Card Trade name _________________________ Generic name ________________________ Route of administration _________________ Dosage range ________________________ Desired action ________________________ Expected side effects ___________________ (minimum of 3) Adverse effect _________________________ Drug classification ______________________ Nursing Implications ____________________ (minimum of 3) Mr. John Wright DOB: 01 Dec 1960 Patient history: Atrial fibrillation, hypertension, diabetes mellitus type 2, and COPD (chronic obstructive pulmonary disease) Allergies: Penicillin Medications Orders: Metoprolol succinate ER 50 mg PO daily Coumadin 2 mg PO daily Insulin Novolin R Vancomycin 500 mg/100 mL 5% dextrose IVPB (IV piggyback) Albuterol sulfate inhalation (90 mcg/inhalation) Review of Main Points What is the Nursing Process? What are the 9 Rights of Medication Administration? What should the nurse do as soon as they discover a medication error? What are the federal laws regarding medication administration? What is required on prescription to be considered legal? What are high-alert drugs? What is the difference in a generic drug name and a trade name? What is the difference in a side effect and an adverse effect?