Medication Administration.pdf

(Review of Pharmacology) ● Pharmacokinetics: the effect the body has on a drug ○ ADME ■ Absorption = a drug is transferred from its site of entry into the body to the bloodstream ● Drugs given orally take the longest to be absorbed ● Liquid solutions, injections, and IV are the fastest ● Medications...

(Review of Pharmacology) ● Pharmacokinetics: the effect the body has on a drug ○ ADME ■ Absorption = a drug is transferred from its site of entry into the body to the bloodstream ● Drugs given orally take the longest to be absorbed ● Liquid solutions, injections, and IV are the fastest ● Medications applied to the skin have a local effect ● Bioavailability – the amount of the drug that reaches the bloodstream ● Lipid soluble drugs can be absorbed easily ● Increases with blood flow ● Most absorption occurs in the small intestine (duodenum) ■ Distribution = after the drug has been injected or absorbed into the bloodstream, it is transported throughout the body to where they take action ● Dependent on: ○ Blood circulation ○ Protein binding ○ Selective permeability of blood (affects pregnant women) ■ Metabolism = the change of an active drug from its original form to a new form; liver is primary site ● Oral drugs move to the liver by the portal vein (first pass) ● Reduces the bioavailability of oral medication ■ Excretion = removing the drug from the body; kidneys excrete most drugs through urine ● Pharmacodynamics: how the drugs affect the body ○ Drugs combine with an enzyme to achieve desired effects ● Adverse drug reactions (ADRs): harmful effects that lead to injury; must be documented ○ Ex. morphine dropping the blood pressure & requires intervention & discontinuation of the medication ○ Look for black box warnings !!! ○ Side effects – mild and predictable ■ Ex. a side effect of morphine is constipation ○ Allergic effects – rash, fever, diarrhea, nausea, vomiting ■ Anaphylactic reaction → life threatening, respiratory distress, cardiovascular collapse ○ Drug tolerance – body becomes accustomed to the effects of a drug over time ■ Requires larger doses for desired effect Bryanna Kanning Concepts Peer Tutor 2023 ● ● ● ● ○ Toxic effects – risk for permanent damage or death ■ Occurs when a drug is taken more frequently than it is excreted ■ Older adults are at risk due to impaired hepatic metabolism Drug interactions ○ Additive effect – drugs with similar action; results in an increase in the overall effect ■ Ex. antihistamine with pain medication = additional sedation ○ Synergistic effect – drugs with different sites; results in greater effects when taken together ■ Alcohol and barbiturates → increased CNS depression ○ Antagonistic effect – combined drugs alter the overall sum effect; effect is less than that of each drug alone ■ Displacement (antidotes) – to reverse the effect of something ○ Interference – one drug interferes with another; leads to the buildup of a medication and can result in toxicity ○ Dietary supplements and herbal/natural remedies can lead to drug interaction ■ Ex. grapefruit juice with “statins” = muscle aches Factors affecting drug action ○ Developmental considerations ■ Infants & fetus – small body weight, reduced body water, immaturity of organs and blood brain barrier ■ Older people – aging process, decreased liver function ○ Patient’s body weight ○ Biological sex ○ Genetic and cultural factors ○ Physiological factors ○ Environment ○ Timing of medication administration ■ Presence of food in the stomach can slow down absorption ● However, some drugs should be taken with food to prevent gastric irritation Teratogenic: drugs that are known to have the potential to cause developmental defects in the embryo or fetus and are definitely contraindicated ○ Cocaine, alcohol, isotretinoin ○ Drugs can cross into breast milk ○ Children’s medication dose is much smaller than adults (usually based on weight) Therapeutic range: concentration of a drug in the blood serum that produces the desired effect without causing toxicity ○ Can be measured with blood draws after medication has been absorbed ○ Peak level – highest concentration, absorption is complete Bryanna Kanning Concepts Peer Tutor 2023 ■ Drawn 1 hour after drug is administered ○ Trough level – lowest concentration, elimination is complete ■ Drawn 30 minutes before next dose CHAPTER 29: MEDICATIONS *please reference lab comprehensive notes for more information* ● No medication can be given to a patient without a medication order from a licensed practitioner!! (nurses can be held liable and have the right to refuse an order) ○ The medication order MUST include (never guess!): ■ Patient’s name and date of birth ■ 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 ■ Signature of the prescribing provider ○ If anything is missing → you cannot give the medication & you must call the provider ● Dosage calculations ○ Common conversions ■ 1 gram (g) = 1000 milligrams (mg) ■ 1 milligram (mg) = 1000 micrograms (mcg) ■ 30 milliliters (mL) = 1 ounce (oz) ■ 2.2 pounds (lb) = 1 kilogram (kg) ■ 1 teaspoon (tsp) = 5 mL ■ 1 tablespoon (tbsp) = 3 tsp = 15 mL Bryanna Kanning Concepts Peer Tutor 2023 ○ ● Patient safety goals ○ IDENTIFY patient ■ Patient name ■ Date of birth ○ Use medicines safely ■ Properly label medicines ■ Take extra care with patients on anticoagulants ● Increased risk for bleeding!! ■ Give correct information about a patient’s medications ■ Give written information about medications the patient needs to take ■ Educate the patient on bringing an up-to-date list of medicine when going to the doctor ● Rights of Medication Administration Bryanna Kanning Concepts Peer Tutor 2023 ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ (1) right patient (2) right medication (3) right dosage (4) right time (5) right route (6) right documentation (7) right reason (8) right assessment (allergies, complications, ability to swallow) (9) right response from patient (10) right to education (11) right to refuse (assess the reason & address the concern) Nursing considerations ■ Three Checks ● (1) In the med room: read the eMAR and select proper medication ● (2) After retrieving medication: compare medication label with the eMAR ● (3) At bedside: recheck labels after identifying patient and before administration ■ Check for allergies ■ Assess the patient ■ Education ● Drug administration ○ Children → difficulty swallowing tablets and capsules; most medications are available in liquid form ■ Use a dropper for infants or very young children ■ Crush uncoated tablets or empty soft capsules and mix the medication with soft foods ○ Older adults ■ Allow extra time to administer medications ■ May have difficulty swallowing medications; easier to take it in liquid form or crushed ■ Assist in setting up a schedule for at home use ■ Monitor for adverse reactions ■ Teach the name of the drug, not just the color ○ Know what and why BEFORE medication administration ■ Drug → generic and trade name ■ Dose → safe range, abnormal labs, accurate calculations ● Process for drug administration ○ Perform assessments prior to administration Bryanna Kanning Concepts Peer Tutor 2023 ○ Provide effective medication teaching ■ Verify the medication is okay with the patient ○ Position the patient and assist as needed ■ Oral medications → high fowler’s position ○ Never leave the medications at bedside ○ Document medication administration on MAR ■ Always be detailed!!! ○ Medication refusal ■ Assess the reason why & educate ■ For time sensitive medications → encourage patient to take and explain the importance ● Syringe administration ○ Longer needle for IM injection; deeper ○ A larger person requires a longer needle to reach muscle tissue ○ Do not recap needles, use the safety guard and place them in puncture-resistant containers ○ ● Intradermal injection: into the dermis, longest absorption time ○ Used for allergy tests, local anesthesia, tuberculosis ○ Body’s reaction is easily visible ○ 27 gauge 3/8 in, less than 0.5 mL ○ Angle: 5-15 degrees ● Subcutaneous injection: into the adipose tissue, slow and sustained rate of absorption into the capillaries ○ Used for insulin and heparin ■ Insulin → must be double checked by 2 licensed nurses ● Check the order, blood glucose, correct dose, and correct insulin Bryanna Kanning Concepts Peer Tutor 2023 ○ Avoid sites that are bruised, tender, hard, swollen ○ Pinching of the skin is advised for thinner patients ○ 29 gauge 3/8 in, no more than 1 mL ■ Insulin is given in an insulin syringe ○ 45 degree angle for smaller patients; 90 degree angle for larger patients ○ Injections in the abdomen > arms > thighs > gluteal ○ ● Intramuscular injection: into the muscles; slow, sustained release over hours, days, or weeks ○ Fastest rate of absorption due to larger and more blood vessels ■ Good route for irritating medications ○ Used for antibiotics, hormones, vaccines ○ Z track technique prevents leakage of medication into the needle track ○ 20- to 25-gauge needle, up to 3 mL ○ Angle: 90 degrees ○ Locations for IM route ■ Deltoid → fast absorption, less pain ● 25 gauge 1 ½ inch ● ■ Vastus Lateralis → large muscle, easily accessible (common for <2 years) Bryanna Kanning Concepts Peer Tutor 2023 ● 22 gauge 1 ½ inch ● ■ Ventrogluteal → tolerates large amounts, less painful (Z-track method) ● 22 gauge 1 ½ inch ● ● Topical application: applied to the skin or mucous membranes, including eyes, ears, nose, rectum, vagina, and lungs ○ Intended for direct action at a particular site ○ Powder → promote drying and prevent friction of the skin ○ Ointment → prolonged contact of medication with the skin; softens the skin ○ Creams & oils → lubricate and soften skin; prevent drying of skin ○ Lotions → protect and soothe the skin ○ Transdermal patches ● Always record each dose of medication as soon as possible after it is given!! Bryanna Kanning Concepts Peer Tutor 2023