Drug Administration 2022-2021 PDF

First year 1st semester Academic year 2022-2021 Fundamental of nursing By Dr Arzak Mohamed Khalifa Medication administration By Dr. Arzak Mohamed Objectives By the end of this lecture the students should be able to: 1.Define drug. 2.Illustrate factors that affec...

First year 1st semester Academic year 2022-2021 Fundamental of nursing By Dr Arzak Mohamed Khalifa Medication administration By Dr. Arzak Mohamed Objectives By the end of this lecture the students should be able to: 1.Define drug. 2.Illustrate factors that affecting drug action 3.Discuss drug order (MAR) or Kardex 4.Explain medication errors 5.Define Standard Medication Rights 6. List Routes for administrating drugs 7.Follow nursing considerations for enteral drug. 8.Follow nursing considerations for Parenteral Medication 9.List nurse role in preventing infection during an Injection Outlines: 1. Definition of drug. 2. Overview of pharmacological concepts. 3. Factors affecting drug action. 4. Drug order. 5. Medication errors 6. Nurse role in management when a drug error occurs 7. Standard medications rights 8. Routes for administering drugs. 9. Enteral medication 10. Parenteral medications 11. Nurse role in preventing infection during an Injection Nursing responsibilities for medication administration 1. Assessment of the patient 2. Preparing the medication to be administered. 3. Accurate dosage calculations. 4. Administration of the medication. 5. Documentation of medications given. 6. Monitoring the patient’s reaction &response. 7. Educating the patient  A medication is a substance or preparation used in diagnose, treat, or prevent disease. A drug is any substance that change normal physiological functions of body, with the potential for affecting health All medicines are drugs but all drugs are not medicines  Purposes of drug administration Preventing illness: (Polio and Tetanus vaccines to prevent illness) Eliminate a disease: (Antibiotics such as penicillin eliminate illness) Reduce Symptoms Related to Illness or Injuries Cold Remedies/suppressants and aspirin reduce symptoms Replace Something the Body is Lacking Insulin &Thyroid Medication Names of Medications: 1. The chemical name: It reads like a chemical formula. (The generic name) "Diazepam (sedation) 2. The brand name, also called the trade name, of a drug this name is owned by the pharmaceutical company. Valium  Overview of Pharmacology Concept Pharmacology is the scientific study of origin, chemistry, effects, and use of drugs. The science is made up of branches: ❑ Pharmacognosy ❑ Pharmacodynamics ❑ Pharmacokinetics ❑ Toxicology Pharmacognosy Pharmacognosy refers to the study of natural drug sources; such as plant, animals, and their products. (Sources of drugs) as Vegetable or Plant Sources: e.g., digitalis and morphine. Animals sources: drugs from animal sources e.g. insulin Pharmacodynamics Pharmacodynamics is the mechanisms by which drugs alter cell physiology and produce biochemical or physiologic changes in the body (mechanism of drug action). Pharmacokinetics Pharmacokinetics is the studies of absorption, distribution, metabolism and excretion of drug i.e. what the body does to the drug. Absorption: Factors that influence drug absorption are : The route, ability of the drug to dissolve Lipid solubility of drug, and gastro Intestinal tract (G.I.T.) motility. Distribution: It means distribution of the drug within the body tissues and organs and finally to its specific site of action after its absorption. Factors that influence drug absorption are:  - The route of administration  - Ability of the drug to dissolve  - Blood flow to the site of administration  - Body surface area  - Lipid solubility of drug, and  - Gastro Intestinal tract (G. I.T.) motility. Metabolism: After a drug reaches its site of action, it becomes metabolized into a less active or inactive form; that is more easily excreted. This process is called biotransformation. Most biotransformation occurs within the liver, although the lungs, kidneys, blood, and intestines also metabolize drugs.  Excretion: The drug exit the body through the kidney, liver, bowel, lung. Toxicology Toxicology: is representing the study of poisons, including the adverse effects of drugs on living organisms.  Adverse Drug Reactions (ADRs) - Type A, Augmented (over dosage toxicity) - Type B, Bizarre or unusual (hypersensitivity) - Type C, Continuous (due to long-term use ( - Type D, Delayed (teratogenesis and carcinogens( - Type E, Ending of use (drug withdrawal) Factors affecting drug action  Body weight  Nutritional factors: (The food in the stomach)  Disease: (liver or excreted by the kidneys).  Environment: (noisy environment)  Developmental Considerations: (older age)  Genetic Factors (white patient may cause unexpected side effects )  Culturally: health beliefs can also affect compliance and response to a drug regimen  Sex: the difference in the distribution of body fat and fluids in men and women Drug order (MAR) or Kardex A prescription is a legal order for preparation and administration of a drug. Components of drug order 1. Patient’s full name 2. Date: The day, month, year, 3. Drug name 4. Dose 5. Route of administration 6. Time and frequency of administration 7. Signature of physician  Physician Prescription Time distribution Drug Dose Frequency Route Twice /day Augmentin 1gm IV 10am 10pm sign 1gm/12hrs  Preparations of drugs  Oral Solids: e.g. tablets, capsules, powder  Topical: e.g. ointments: semisolid and suppositories.  Inhalants: e.g. inhalations  Solutions: e.g. enemas, douches, suspensions, syrup, An aqueous solution in the form of drops or sprays, optic (eye) and otic (ear) solutions.  Medication Errors Why Do Medication Errors Occur? a) Lack of Knowledge or Information :(drug interaction) b) Faulty Communication: Confusion between drugs with similar names. Abbreviations are misunderstood.Poor, or no, documentation. C) Equipment Errors d) Calculation and Measurement Error e) Other: Lighting is inadequate.The nurse is fatigued  Nursing role when a drug error occurs - Check the patient’s condition immediately when the error is noted. - Report the nurse manager and the physician immediately. - Document the error on the patient’s medical record. - Complete an accident reports, it includes the steps taken after the error was recognized. - Discovered errors made by other nurses, these must also be documented Standard Medication Rights(10 rights ) 1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time 6. Right documentation 7. Right Client Education 8. Right to Refuse 9. Right Assessment 10. Right Evaluation  Routes for administrating drugs Route How drug is administered  Oral route ▪ Administrating drug through an ▪ Enteral route enteral tube (NGT) ▪ Sublingual administration ▪ Placing drug under tongue ▪ Buccal administration ▪ Placing drug between cheek and gum  Parenteral route: Injecting drug into ▪ Subcutaneous injection ▪ Subcutaneous tissue ▪ Intramuscular injection ▪ Muscle tissue ▪ Intradermal injection ▪ under epidermis ▪ Intravenous injection ▪ Vein ▪ Intraarterial injection ▪ Artery ▪ Intracardiac injection ▪ Heart tissue ▪ Intraperitoneal injection ▪ Peritoneal cavity ▪ Intraspinal injection ▪ Spinal canal ▪ Intraosseous injection ▪ Bone  Topical route Inserting drug into ▪ Vaginal ▪Vagina administration ▪Rectum ▪ Rectal administration ▪Placing drug into direct contact with ▪ Instillation mucous membrane ▪ Irrigation ▪Flushing mucous membrane with drug in solution ▪ Skin application ▪Applying transdermal patch ▪ Inhalation ▪Having patient inhale drug into lung  CNS ▪ E.g. epidural anesthesia. ▪ Epidural ▪ (Into the cerebrum) direct injection into brain. ▪ Intracerebral ▪ (Into the cerebral ventricles) ▪ Intracerebroventricles administration into the ventricular system of the brain. cancer pain  Nursing guidelines for administering oral route (Enteral/ Oral drug) 1. Prepare the dose as prescribed. 2. Don’t crush sustained release (SR), or enteric coated drugs. 3. Empty the required dose into a drug cup and don’t touch the preparation to prevent contamination. 4. Hold drug cup at eye level and fill to desired level scale. 5. Patients who find difficulty to take liquids from a cup; the drug can be given directly into the mouth using a plastic syringe Administering Sublingual and Buccal Drugs *To give a drug sublingually, ask the client to open the mouth and lift the tongue; place the drug under the client’s tongue. Give instructions:  Keep the medication under the tongue until it dissolves completely to ensure absorption.  Avoid chewing the tablet  Do not smoke before the drug has completely  To give a drug buccally,  instruct the client to open the mouth wide, and place the tablet between the client’s cheek and teeth.  Keep the medication in place until it dissolves  Do not drink liquids for an hour because some tablets take up to an hour to dissolve.  Do not smoke before the drug has completely dissolved  Parenteral Medication Parenteral refers to any route other than gastrointestinal. The effects of parenterally administered drug can develop rapidly depending on the rate of absorption Injection Equipment * Syringes: Syringes are made of plastic. standard size measured in gauges from 13 to 30. * Vials: are closed glasses container with rubber stoppers * Ampules: are glass containers, the tops of which must be broken off to allow insertion of a needle and withdrawal of the drug.  Intradermal injection (ID) - Injections are giving into the dermis. - The intradermal injections are testing for sensitivity (Allergy test) and immunization - A very small amount of fluid (0.1 ml or less) is given using a 1 ml syringe at an angle of 10°- 15o, which will raise a small weal (bleb). - The area should not be massaged after removing the needle. The usual site of injection is lightly pigmented area of the forearm where the reaction can be easily observed; also it can be injected into upper arm, and across the scapula.  The Subcutaneous injection (SC) - The SC route involves the injection of drugs under the skin (below dermis) at an angle 45° or 90° depending on needle length and size of patient. - Absorption is slower and drug action is usually longer with SC than with IV or IM injections. - The SC route is commonly used for few drugs (e.g. insulin, heparin, clexane). Common sites for SC injections are: 1. The outer posterior aspect of upper arms. 2. The abdomen from below the costal margin to the iliac crests. 3. The upper dorsal gluteus areas. 4. Anterior aspect of the thighs. 5. Suprascapular area. Contraindication of SC. Injections: -Areas with skin lesion or bony prominent -Areas with large under lying nerve or muscle - Patients with impaired or abnormal SC tissue (such as areas of burns, inflamed tissue, or scars) - A client with generalized edema or sever peripheral vascular disease.  Special Consideration for SC injection:  Systematically rotate injection sites to prevent lipodystrophy and variable insulin absorption.  Abdomen is the common site to reduce hematoma  Gently bunch the tissue between thumb and forefinger during injection.  After injection, slowly and gently withdraw needle.  Gently wipe the area with the gauze pad. Intramuscular injection (IM)  The IM route involves the injection of drugs into certain muscles at an angle 9O°  Absorption is more rapid than from SC injections because muscle tissue has a greater blood supply.  I.M. injections allow less painful administration of irritating drugs. Sites of IM injection : A.Deltoid muscle (not more 1 ml) B.Dorso gluteus (Gluteus maximus) (not more 5 ml) A.Ventro gluteus (not more 5 ml) B.Vastus lateralis (not more 3 ml) Z-track injection ▪The Z-track method prevents leakage, into the subcutaneous tissue. ▪It’s typically used to administer drugs that irritate and discolor SC tissue, as iron preparation. ▪use in elderly patients who have decreased muscle mass. Contraindications for I.M. are: Impaired coagulation mechanisms. peripheral vascular disease. Edema and shock. After thrombolytic therapy Inflamed, edematous, or irritated sites or at sites that contain scar tissue, or other lesions Complications of IM injection administration: Pain with injection (client reports. Discomfort) Damage to SC or IM tissue Including abscesses ,SC tissue discoloration, hematomas, and muscle contractions Nerve injury (shooting pain down limb temporary or permanent paralysis). Bone injury (pain or bone damage).  Speed shock or rapid absorption of medication (unexpectedly rapid onset of medication action ,may lead to increased HR, decreased level of respiratory rate, decreased level of consciousness and cardiovascular collapse.  Infection of muscle or bone  Abscess. Nurse role in preventing infection during an Injection ▪ Draw medication from ampule quickly. Do not allow it to stand open ▪ Avoid letting needle touch contaminated surface ▪ Avoid touching length of plunger or inner part of barrel. Keep tip of syringe covered with cap or needle.  To prepare skin, wash skin soiled with dirt, drainage, or feces with soap and water and dry. Use friction and a circular motion while cleaning with an antiseptic swab from center of site, and move outward in a 2 inch radius.  The nurse should avoid using the deltoid and dorsogluteal sites in infants and children.  Never recap a syringe just put it in Sharp Container.