Medication Administration - Cairo University

Medication Administration Dr. Manal Mohamed Mostafa Prof, Medical Surgical Nursing Cairo University  Medication Administration  Intended learning outcomes(ILOs) At the end of this lecture the student will be able to: Define medication administration Identify the common abb...

Medication Administration Dr. Manal Mohamed Mostafa Prof, Medical Surgical Nursing Cairo University  Medication Administration  Intended learning outcomes(ILOs) At the end of this lecture the student will be able to: Define medication administration Identify the common abbreviations associated with medication administration List the ten rights of medication administration Mention at least three advantages and disadvantages of each route Make decision about appropriateness of the administration route Practice the right technique in administering medication by following the ten rights  Introduction Administering drugs is one of the most important nursing responsibilities, and to ensure safe and effective drug therapy for the patient the nurse need to be familiar with the indications, dosage, and intended effects of the prescribed drugs.  Definitions Medication It is a substance administered for the diagnosis, treatment, or relief of a symptom or for the prevention of disease and used interchangeably with the word drug. Medication administration The way or the manner by which the medication is given to the patient.  Concepts of basic pharmacology Drug/ medication: A drug is any substance that modifies body functions when taken into the body. A medication is a drug administered for therapeutic purposes. Chemical name: A precise formula of the actual chemical compound that is the drug or medication. This could be a simple or highly complex scientific inscription.  Concepts of basic pharmacology Generic name: A simpler version of the chemical name but universally used among drug manufacturers to describe a particular chemical formula. Brand name / trade name: A copyrighted name assigned to a generic drug by its manufacturer. Also referred to as proprietary name, is selected by the drug company that sells.  Pharmacokinetics processes Pharmacokinetics is the study of the movement of drug molecules in the body (i.e., what the body does to the drug). Specific processes are: Absorption, Distribution, Metabolism, and Excretion.  processes Absorption: is the process by which a drug is transferred from its site of entry into the body to the bloodstream. Distribution: is the process by which the medication is delivered to the target cells and tissues. After a drug has been absorbed into the bloodstream, it is distributed throughout the body. The drug accumulates in specific tissues for its action.  Factors affecting distribution Body size: an increase in the percentage of body fat may cause a longer duration of drug action because of slower distribution throughout the body. The less a client weight, the greater the concentration of a drug in tissues and the more powerful the drugs effects. 2. Circulatory dynamics: drugs pass more easily from interstitial to intravascular spaces than between body compartments.  Factors affecting distribution(cont.) The concentration of a drug a specific site depend on: - the number of blood vessels in tissue. - the degree of local vasodilatation or vasoconstriction. - the rate of blood flow to a tissue site. 3. Protein binding: the degree to which drugs in the blood stream to the protein albumin affects drug distribution. When drug molecules are bound to albumin they cannot exert any pharmacological activity  processes Metabolism:or biotransformation, is the breakdown of the drug to an inactive form. The liver is the primary site for drug metabolism. Various processes and enzymes are involved in metabolism. Physiologic changes associated with aging or the presence of liver disease may complicate the process.  processes Excretion:After the drug is broken down to an inactive form, excretion of the drug from the body occurs. Most drugs are excreted by the kidneys. The lungs are the primary route for the excretion of gaseous substances, such as inhalation anesthetics. Many drugs are excreted through the intestines. The sweat, salivary, and mammary glands are also routes of drug excretion.  Factors influencing drug action 1. Genetic differences: it determines whether naturally occurring enzymes are present. Enzyme deficiencies or metabolic disturbances can alter the way the body handles the medication. 2. Physiological variables: A- sex: hormonal difference between males and females alter the metabolism of certain drugs. B- age: infants lack many of the enzymes necessary for normal drug metabolism.  i-e: infants and children require dosages lower than those adults can tolerate.  Factors influencing drug action (cont.) The elderly experienced physiologic changes associated with aging process, including decreases in gastric motility, acid production and blood flow, which affect drug absorption. Liver function declines with advancing age and changes in hepatic enzymes involved in drug metabolism. C- nutritional status: if the client’s nutritional status is poor cell function for biotransformation cannot occur. d. pathology: (disease) the presence of disease can affect the action of the drug. E.g. the liver is the primary organ for drug breakdown. Pathological conditions involving the liver may slow down the process of metabolism.  Factors influencing drug action (cont.) 3. Environmental conditions: Exposure to heat and cold can affect responses to drugs. E.g.: hypertensive clients receive vasodilators to control blood pressure. In hot weather it may be necessary to reduce vasodilators dosages because the temperature adds to the medications effects. In cold weather vis versa. Exposure to ionizing radiation creates a similar effect by altering the rate of enzyme activity.  Factors influencing drug action (cont.) 4. Psychological factors: Exposure to severe physical and emotional stress triggers a hormonal response that eventually may interfere with drug metabolism. Anger, and hostility may result in adverse reactions to medications. 5. Time of administration: - The presence of food in the stomach delays the absorption of orally administered medication. - same medications should be given with food to prevent gastric irritation.  Types of drug action A: therapeutic effects: ⚫ Is the desired effect of the medication, it is the reason the drug - was administered. - is the intended or predicted physiological response that a - drug causes. B. adverse drug effects: (side effects) - Predictably a drug will cause unintended secondary effects. - Side effects may be harmless or injurious. There are several known adverse drug effects  Types of drug action C.Toxic effects: It develops after prolonged intake of high doses of medication, or use of drugs intended for external application. e.g. morphine (a narcotic analgesic) reliever pain by depressing the central nervous system, however toxic levels of morphine cause severe respiratory depression and death. D. Iatrogenic disease: Caused unintentionally by drug therapy  Types of drug action E.Allergic reaction: It is another unpredictable response to drug. It occurs in an individual who has been previously exposed to the drug and has developed antibodies. i.e. initial dose cause an immunological response the drug acts as an antigen causes antibodies to be produced repeated administration develops an allergic response. Allergic reaction may be mild or severe, ranging from minor to serious  Types of drug action E.Allergic reaction: Mild allergic reaction: (minor) Skin rash, urticaria, fever, diarrhea, nausea, vomiting. Severe allergic reaction(called an anaphylactic reaction): A life threatening immediate reaction: Respiratory distress, sudden severe bronchospasm, edema of pharynx and larynx, severe wheezing, shortness of breath and cardiovascular collapse.  Types of drug action F. Drug tolerance: When the body becomes accustomed to a particular drug over a period of time. An increase in dosage may be needed to cause a therapeutic effect. G. Accumulative effect: Occurs when the body cannot metabolize and excrete one dose of a drug before anther dose is administered. 6. Idiosyncratic effect: Is any abnormal (or unpredictable) response to a drug that may over response, or response different from the expected outcome.  Principles of Drug Administration Three Checks of medication administration ❑ Checking the medication with the medication administration record (MAR) when removing it from its stored location. ❑ Checking the medication when preparing it. ❑ Checking the medication before administering it to the patient.  Five “Rights” of Accurate Medication Administration ❑ Right medication (Drug) ❑Right dose ❑ Right time ❑ Right route ❑Right client  Ten “Rights” of Accurate Medication Administration ❑ Right medication (Drug) ❑Right dose ❑ Right time ❑ Right route ❑ Right client ❑ Right documentation ❑ Right client education ❑ Right to refuse ❑ Right assessment ❑ Right evaluation  Essential components of the Medication Order The medication order consists of seven parts: Patient's name Date and time the order is written Name of drug to be administered Dosage of the drug Route by which the drug is to be administered Frequency of administration of the drug Signature of person writing the order  Nursing Responsibilities for Administering Drugs Ways to prevent drug administration errors: Assessment of the patient and clear understanding of why the patient is receiving a particular medication If the handwriting in the order is not clear, ask the physician for clarification. Question administration of multiple tablets or vials for single dose. Concentrate when preparing and administering the medication.  Nursing Responsibilities for Administering Drugs Read drug labels carefully and be aware of drugs with similar names. Never rush or hurry when preparing medications. If interrupted, start the double-check over for the five rights. Take the Medication Administration Record (MAR) to the bedside to double-check the patient's name. Use sterile technique in preparing and administering injections. Do not leave any prepared medications at the patient's bedside.  Nursing Responsibilities for Administering Drugs Accurate dosage calculations. Educating the patient regarding his or her medications and medication regimen. When a new or unfamiliar drug is ordered , consult resource. Educate yourself.Continue to increase your pharmacology knowledge.  General rules for drug administration Prepare medication for one patient at a time. Check each medication order against the original physician's order. Prepare medication card and check rights. Prepare needed supplies and equipment. Read the label on the drug container; notes the name, strength, supplies dose, expiration date, and clarity of the solution. Wash hands and put on clean gloves.  General rules for drug administration cont. ▪ Identify the patient; identify yourself if indicated. ▪ Explain the procedure to the patient. ▪ Check for drug allergies. ▪ Do not give a drug when signs and symptoms of toxicity are present. Notify the physician and record that the drug was omitted and why. ▪ Prepare and give drugs in well lighted areas as free of interruptions and distractions as possible. ▪ Keep the patient's privacy.  General rules for drug administration cont. Assist the patient to comfortable position. Document medication: dosage, route, site, time, and signature. Evaluate the patient's response to the medication within an appropriate time frame. Return to observe the patient for signs of a local or systemic reaction. Routes of administration  1-Topical (dermatomucosal) Route Topical drugs are applied directly to the skin surface and they include: Skin medications Optic(eye) medications Otic(ear) medications Handheld oropharyngeal inhalers Nasal medications Vaginal medications Rectal medications  Optic medications ❑Used to treat local conditions of the eye and surrounding structure ❑Available in the form of irrigation, drops, and ointments  Eye Drop Administration Use a medication dropper to place the prescribed dosage on the conjunctival sac. Applying eye ointment  Nasal drug administration ❑Used for local drug administration ❑Drops or sprays often used for their local effect which is to shrink swollen mucous membranes  Otic Administration ❑ Used to treat local conditions of the ear and auditory canal ❑ Includes eardrops and irrigations ❑Manually open the ear canal and administer the appropriate dose. Handheld Oropharyngeal Inhalers  Vaginal drugs ❑ Used to treat local vaginal infections, and to relieve pain and itching ❑ Inserted in suppositories, creams, jellies, or foam Rectal drugs ❑ Used for either local or systemic administration ❑ Normally in suppository form ❑ Slowest rate of absorption  Guidelines for Nursing: Inserting a Rectal Suppository Use a glove for protection. Have the patient lie on either side, preferably the left side with upper leg drawn up toward chest. The descending colon is on the left side; this is a more anatomically correct position. Assess the patient's rectal area. Lubricate the suppository and fingertips to reduce irritation on intestinal mucosa while inserting the suppository.  Guidelines for Nursing: Inserting a Rectal Suppository cont. Separate the buttocks and then have the patient relax by breathing through the mouth while the suppository is inserted. Introduce the suppository well beyond the internal sphincter (4 inches for adults ). Avoid embedding the suppository in the fecal mass. Correct placement when there is stool in the rectum is between the stool and the rectal mucosa.  Guidelines for Nursing: Inserting a Rectal Suppository cont. Be sure the patient understands that he or she is to retain the suppository, usually for 30 to 45 minutes after insertion. Encourage the patient to walk about 15-30 min ( this often helps promote peristalsis).  Guidelines for Nursing Care: Applying Transdermal Patches Wear gloves when applying or removing patches. Hand washing is also a necessity. Remove the old patch before applying the new one. Dispose of old patches carefully. Keep out of the reach of children. Remove the patch from its protective covering and then remove the clear plastic covering without touching the adhesive.  Guidelines for Nursing Care: Applying Transdermal Patches Apply the patch and use the palm to press firmly for about 10 seconds. Rotate application sites. Apply the patch at the same time of the day and write the date and time on the patch. Document application on the MAR. Monitor the patient's response carefully. Be alert for adverse effects specific to the medication applied.  Guidelines for Nursing Care: Applying Transdermal Patches Check for dislodgment of the patch if the patient is active. Assess for any skin irritation. If necessary, remove the patch, wash the area carefully with soap and water, and allow skin to air dry.  2-Enteral route The delivery of any medication that is absorbed through the gastrointestinal tract(GIT) Enteral administration includes: Oral Nasogastric tube(NGT) Buccal Sublingual(SL) Rectal  Forms of oral drugs Capsules Tablets Pills Enteric coated capsules and tablets(EC) Suspensions Syrups  Gastric Tube Administration Gastric tubes provide access directly to the GI system.  General Principles of Oral Administration Note whether to administer medication with food or on empty stomach. Have patient sit upright when not contraindicated. Place the medication into the patient’s mouth. Allow self-administration: assist when needed. Follow administration with cup of water and ensure that the patient has swallowed the medication.  General Principles of Oral Administration Sublingual Medication Administration Place the pill or direct spray between the underside of the tongue and the floor of the oral cavity. Buccal Medication Administration Place the medication between the patient’s cheek and gum. Sublingual Buccal Medication  Adminstring oral medication Equipment Preparation: Medication administration record (MAR), Form of medication "tab, cap, syrup", Disposable gloves, medication cup, Glass of Water, juice, or preferred liquid, Medication tray, Paper towel.  Adminstring oral medication Tablets or capsules: Pour from bottle into bottle cap until you have correct dosage. Transfer to the medication cup. Liquid: - Remove bottle cap and place it upside down on the countertop. - Holding cup at eye level, pour liquid to desired level. - Pour with label facing up (i.e., against the palm of your hand) - Wipe neck of bottle before replacing cap. Administrating oral medication  Some patients object to the taste of certain medications The following techniques help disguise(‫)تمويه‬or mask the objectionable taste crush a medication or add it to food so that the patient can swallow it. Some drugs cannot be crushed (e.g., enteric-coated and sustained- release capsules). Check with the pharmacist or a pharmacology reference when uncertain about crushing a medication. Allow the patient to suck on a small piece of ice for a few minutes before taking the medication. The ice numbs the taste buds, and the objectionable taste is less discernible.  Some patients object to the taste of certain medications Store oily medications in the refrigerator. Cold oil is less aromatic than oil at room temperature. Place the medication in a syringe (without needle), and place the syringe well back on the tongue, being careful not to trigger the patient's gag reflex. Offer oral hygiene immediately after giving the medication. Give the medication with generous amounts of water or other liquids, if permitted, to dilute the taste.  3-Parenteral administration Intradermal injection Subcutaneous injection Intramuscular injection Intravenous access Intraosseous infusion  Intradermal (ID) Injection Injections typically used to diagnose tuberculosis, identify allergens, and administer local anesthetics. Insertion of the needle into the skin.  Subcutaneous Injection (sub-q, SC, SQ) Insertion of the needle into the subcutaneous tissue just below the skin between the dermis and the muscle as insulin and heparin  Intramuscular(IM) Injection -Insertion of the needle into a muscle -Used to promote rapid drug absorption and to provide an alternate route when the drug is irritating the subcutaneous tissue.  Intravenous Administration (I.V.) Involves injection of drugs directly into bloodstream Administered through established IV line or direct injection into the vein (in emergencies) Used for intermittent or continuous infusions  Types of medication orders A standing order / Scheduled is one that carried out as specified until it is canceled by anther order. The physician specifies that a certain order is to be carried out for a stated number of drugs or times. After the stated period has passed the order is canceled automatically. As needed (p.r.n) (on as-needed basis).the client receives medication when it is requested or is needed (post-operative).  Types of medication orders ❑A single order ( those that should be administered one- time medications).is carried out only once at a time specified by the physician(pre-operative)given once and usually at specific time. A stat order: is also single order but one that is carried out at once (given once and immediately). (those that should be administered immediately and only once as antihistamine for drug reaction).  Formulas for computing drug dosages formula that can be used to calculate drug dosages is as follows: Dose on Hand (D) = Dose Desired (X) Quantity on hand (H) Quantity desired (V) D = desired dose (dose ordered, often in milligrams) H= on-hand or available dose (dose on the drug label, often in mg/tablet, capsule, or milliliter) X= unknown (number of tablets) V= unit (one tablet, here)  Formulas for computing drug dosages Another formula that can be used to calculate drug dosages is as follows: Dose Desired (X) = Dose on Hand (D) x Quantity desired (v) Quantity on hand (H)  Formulas for computing drug dosages Example: Amoxicillin, 625 mg PO, is ordered. It is supplied as a liquid preparation containing 250 mg in 5ml. how much does the nurse administer. 250mg = 625mg 5mL x mL X= 625mg x 5mL = 12.5ml 250 mg  Appreviations Routes of adminis Drug dosage: Times of administration: meaning abb meaning abb meaning abb intradermal ID by per before meals a.c. intramuscula IM sufficient qs two times a day b.i.d. r IV quantity with c intravenous IVPB suppository supp discontinue DC intravenous suspension susp hourly hrly piggyback OD tablet Tab at bedtime hs. right eye OS every day Od left eye OU capsule cap after meals pc both eyes p.c. gram g as needed prn after meals PO drop gt every q by mouth SC/SQ drops gtt every day, daily qd subcutaneous SL milligram mg every 2 hours q2h sublingual cubic cc four times a day q.i.d centimeter every other day qod  Medication Administration Record Patient’s Name:--------------- Age:--------------- Section: ------------------------------------------------ Medication’s name:----------------------------------- Time:---------------------------------------------------- Date:---------------------------------------------------- Route:--------------------------------------------------- Signature:---------------------------------------------- Checked By:-------------------------------------------  Nursing Responsibilities for Administering Drugs Ways to prevent drug administration errors: Assessment: of the patient and clear understanding of why the patient is receiving a particular medication Concentrate when preparing: and administering the medication. Never rush or hurry: when preparing medications. If interrupted, start the double- check over for the five rights.  Nursing Responsibilities for Administering Drugs Ways to prevent drug administration errors: Read drug labels carefully: and be aware of drugs with similar names. Accurate dosage calculations. Take the MAR to the bedside to double-check the patient's name. Use sterile technique in preparing and administering injections. Do not leave any prepared medications at the patient's bedside.  Nursing Responsibilities for Administering Drugs Ways to prevent drug administration errors: Ask the physician for clarification:If the handwriting in the order is not clear. Question administration: of multiple tablets or vials for single dose. Question: abrupt and excessive increases in dosages  Nursing Responsibilities for Administering Drugs Ways to prevent drug administration errors: ▪ Educating the patient: regarding his or her medications and medication regimen. ▪ Consult resource:When a new or unfamiliar drug is ordered. ▪ Educate yourself. Continue to increase your pharmacology knowledge. Child Abuse