Medication Administration Part 1 PDF

D. Filos RN, MSN MEDICATION ADMINISTRATION 10/28/24 D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 Nursing Drug Knowledge  Generic & Trade  Effects Names  Adverse Effects  Classifications  Allergic Reactions...

D. Filos RN, MSN MEDICATION ADMINISTRATION 10/28/24 D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 Nursing Drug Knowledge  Generic & Trade  Effects Names  Adverse Effects  Classifications  Allergic Reactions Mild  Indications Anaphylactic  Pharmakinetics  Metabolism  Tolerance  Excretion  Toxic  Idiosyncratic D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 Drug Dose and Serum Drug Levels  Therapeutic range: concentration of drug in the blood serum that produces the desired effect without causing toxicity  Peak Level: the point when the drug is at its highest  Trough level: the point when the drug is at its lowest concentration, indicating the rate of elimination  Half-life: amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body  Medication Reconciliation  Admission Assessment  Prescribed Medications  PTA Medications  Allergies  Pregnancy and lactation status  Dietary supplements and herbal and “natural” remedies Aging and Drug Response Taylor , P. 828  Decreased gastric motility  Decreased total body water  Decreased lipid content in skin  Decreased liver function  Decreased kidney function  Adverse CNS effects  Altered Peripheral Vascular Tone D. Filos RN, MSN 10/28/24 Critical Thinking  Proper Order  Calculating adult medication dosages  Patients Condition  Equipment Decisions  Documenting medication administration  Patient Teaching D. Filos RN, MSN 10/28/24 Medication Orders  Verbal Orders  Telephone Orders  Standing Orders  PRN Orders  Stat Orders  One time Order D. Filos RN, MSN 10/28/24  Three RIGHTS Checks 1. Patient 1. Removing medication from 2. Medication Med Cart 2. Comparing 3. Dose medication to MAR  Students have 4. Route an additional check: 5. Time instructor checks 6. Reason ALL Meds Assessment 3. Rechecking to 7. EMR/MAR at 8. Documentation bedside prior to 9. Response admission 10. Refuse 10/28/24 D. Filos RN, MSN 11. Educate Frequency of Orders  Daily  BID  TID  QID  ac  pc  HS D. Filos RN, MSN 10/28/24 Check Allergy Bands!! D. Filos RN, MSN 10/28/24 Identifying the Patient  Utilizing 2 patient identifiers  Name  Birthdate  MRN  Comparing with the EMR  Right Time OR When is my medication administration considered LATE?  Our Clinical Site Medication Rules  For Medications given more frequently than Q6 hours (Q1, Q2, Q3, Q4) or rapid short acting insulin (regular, Aspart/Novolog) Administer within 30 minutes before or after the scheduled time  Medications given Q6 hours or less frequently (Q6, Q8, Q12) Administer within 60 minutes before or after scheduled time.  Daily, Weekly or Monthly medications – Administer within 2 hours before or after scheduled time D. Filos RN, MSN 10/28/24 Patient is off the floor at 6am when the dose is due Due at Due atPATIEN Due at T BACK ____________________________________________ 9A TO M FLOOR AT 6am 12 N 10AM 6p GIVE SKIP RESUME Give Give Give D. Filos RN, MSN 10/28/24 Oral Medication Administration  Enteral  Solid PO  Liquid Feeding Tubes  Scored sublingual  SR,XL,CR and buccal  Enteric Coated routes D. Filos RN, MSN 10/28/24  For Oral Medications  Brown syringes mean oral dose only D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 Topical Medications  Lotions, creams, ointments and medicated powders  Trans-dermal patches  Eye Drops  Nose Drops/Mists  Ear Drops  Rectal – suppositories  Vaginal – creams + suppositories D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 SAFE INJECTIONS Parenteral Medications  Intradermal  TB tests  Subcutaneous administration  Insulin administration  Heparin  Intramuscular administration  Deltoid site  Ventral Gluteal  Vastus Lateralis sites Needles  Length  Gauge  Needleless Systems  Safety Guards  Sharps Containers D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 lntradermal Sub Cutaneous  DRUG SPECIFIC SYRINGES  ¼ - ½ INCH  3/8 -5/8 INCH  25G, 27G  25G – 30G  LESS THAN 0.5  1 mL Maximum Volume mL  45 – 90 degree Angle  Angle 5-15  To Pinch or Not to Pinch degrees  No Aspiration and No Massage of sites  No Aspiration  Don’t Forget to Rotate and No Massage Sites of sites D. Filos RN, MSN 10/28/24 Intradermal D. Filos RN, MSN 10/28/24 Sub Cutaneous Sites D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 Intra-Muscular  5/8 Inch – 1.5 Inch Needle  20G – 25 G  Know Your Sites  Up to 3 mL Volumes in large muscles  Gentle pressure NOT Massage  What is the Z-track method?  Never recap used needles  No Aspiration D. Filos RN, MSN 10/28/24 Information from Dr. Linda Diggle, Immunization Nurse Specialist and internationally known expert in injection procedures & technique What is the evidence for the aspiration technique during SC and IM medication Administration D. Filos RN, MSN 10/28/24  History & Facts about Aspiration The practice of aspiration of blood during injections is a tradition that has been taught in nursing for the past 40 years The Center for Nursing History Collection (16) This precautionary technique is performed to ensure that a low flow blood vessel or artery has not been penetrated  Results: Key Summary of the Evidence There is no reported evidence that aspiration with or without blood return confirms needle placement eliminates the possibility of an intramuscular injection into a non-subcutaneous blood vessel Recommendations for Consideration  Aspiration is not indicated for SC injections  Aspiration is not indicated for IM injections of vaccines and immunizations  Aspiration may be indicated for IM injections of large molecule medications, such as penicillin Organizations which state aspiration is not necessary for immunizations & vaccines are:  Centers for Disease Control (CDC)  Advisory Committee on Immunization Practices (ACIP)  Department of Health Services (DHS)  American Academy of Family Physicians (AAFP)  U.K. Department of Health (DoH)  World Health Organization (WHO) D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 D. Filos RN, MSN 10/28/24 Younger Nurses Are More Likely to Follow the Latest Recommendations on IM Injections AJN D. Filos RN, MSN 10/28/24 Reconstituting Medications D. Filos RN, MSN 10/28/24 What volume is needed for the dose?  The nurse has an order to administer 500 mg of Cefazolin.  The vial of medication in powder form states there are 500 mg per vial.  The powder must be reconstituted before it can be administered. The reconstitution instructions on the label state to add 2 mL of sterile water to the vial to reconstitute the powder into a liquid form for injection.  The label states that after the powder is reconstituted with the 2 mL of diluent, the concentration of fluid will be 225 mg/mL. D. Filos RN, MSN 10/28/24  A vial of Doxorubicin reads 36 mg per vial  Instructions say to reconstitute each 12mg with 2.5mL of NS. How many mL of NS will be needed to reconstitute the vial of the recommended concentration? D. Filos RN, MSN 10/28/24  Instructions on a 2.5g vial of Chlorothiazide reads to reconstitute with 20mL of sterile water. This will provide a concentration of _____ mg/mL D. Filos RN, MSN 10/28/24 Never recap, bend or break a used needle – straight to the sharps container D. Filos RN, MSN 10/28/24 Controlled Substances  Locked  Narcotic Counts  Report any Discrepancies  Record Partial Doses D. Filos RN, MSN 10/28/24 Stryker Cactus Smart Sink Medication Disposal System D. Filos RN, MSN 10/28/24 What We Need To Document  Electronic Charting  Drugs Given: Sites and parameters  Doses Missed: Explanation of why  Refused Medications  Incident Reports for Medication Errors (SHARE)  Patient Education/Teaching D. Filos RN, MSN 10/28/24 Medication Errors  Check patient’s condition immediately; observe for adverse effects.  Obtain a set of VS  Notify nurse manager and primary care provider.  Complete form used for reporting errors, as dictated by the facility policy. These forms are not mentioned in the patient chart.