NURS356 Medication Administration PDF

Medication Administration NURS356 Nancy Hannafin Copyright © 2011 Copyright Wolters © 2019 Kluwer Wolters Health All Kluwer | Lippincott Williams & Wilkins...

Medication Administration NURS356 Nancy Hannafin Copyright © 2011 Copyright Wolters © 2019 Kluwer Wolters Health All Kluwer | Lippincott Williams & Wilkins Rights Reserved Objectives Discuss Discuss principles of medication administration, including an understanding of medication orders, dosage calculations, and all safety measures. Obtain Obtain appropriate patient information to establish appropriate medication history Describe Describe principles used to prepare and administer medication via all appropriate routes Use Use nursing process to safety administer medications Develop Develop teaching plan to meet patient medication needs Copyright © 2019 Wolters Kluwer All Rights Reserved Drug Nomenclature  Chemical name: identifies drug’s atomic and molecular structure  Generic name: assigned by the manufacturer that first develops the drug  Official name (monograph): name by which the drug is identified in official publications United States Pharmacopeia (USP) and National Formulary (NF) (typically generic name)  Trade name: brand name copyrighted by the company that sells the drug Copyright © 2019 Wolters Kluwer All Rights Reserved Drug Preparations  Oral o Capsule, pill, tablet, extended release, elixir, suspension, syrup  Topical o Liniment, lotion, ointment, suppository, transdermal patch  Injectable o Vial, ampule, Carpuject Copyright © 2019 Wolters Kluwer All Rights Reserved Drug Classifications  Classified by effect on body system; chemical composition; clinical indication or therapeutic action  Two primary classifications: o Pharmaceutical class  Refers to the mechanism of action (MOA), physiologic effect (PE), and chemical structure (CS) of the drug o Therapeutic class  Refers to the clinical indication for the drug or therapeutic action (e.g., analgesic, antibiotic, or antihypertensive). Copyright © 2019 Wolters Kluwer All Rights Reserved Pharmacokinetics (Effect of Body on Drug)  Absorption: blood flow, body surface area o Affected by route of administration  Distribution: after absorbed into the blood stream o Depends upon, protein binding, adequate circulation, membrane permeability  BBB, placenta  Metabolism: after distribution  Excretion: after distribution Copyright © 2019 Wolters Kluwer All Rights Reserved  Factors Affecting Absorption of Medications Route of administration Lipid solubility (faster absorption) pH (acidic drugs absorption) Blood flow Local conditions at the site of administration Drug dosage Copyright © 2019 Wolters Kluwer All Rights Reserved Pharmacodynamics  Pharmacodynamics is the process by which drugs alter cell physiology and affect the body.  Drugs turn on, turn off, promote, or block responses that are part of the body’s processes.  Drug–receptor interaction occurs when the drug interacts with one or more cellular structures to alter cell function.  Drugs may also combine with other molecules in the body to achieve their effect.  Other drugs act on the cell membrane or alter the cellular environment to achieve their effect. Copyright © 2019 Wolters Kluwer All Rights Reserved Adverse Drug Effects  Side Effects: expected, anticipated, sometimes wanted  Allergic effects: anaphylactic reaction  Drug tolerance: body accustom to drug  Toxic effect: specific symptoms risk of death o Know antidote, Morphine/ Narcan  Drug interactions: antagonistic and synergistic effects o Visteral /Demerol Copyright © 2019 Wolters Kluwer All Rights Reserved Factors Affecting Drug Action  Developmental considerations  Weight  Gender  Genetic and cultural factors  Psychological factors  Pathology  Environment  Timing of administration Copyright © 2019 Wolters Kluwer All Rights Reserved Drug Dose and Serum Drug Levels  Therapeutic range: concentration of drug in the blood serum that produces the desired effect without causing toxicity  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 Copyright © 2019 Wolters Kluwer All Rights Reserved Types of Medication Orders Standing order (routine order): carried out until cancelled by another order PRN order: as needed Single or one-time order Stat order: carried out immediately Copyright © 2019 Wolters Kluwer All Rights Reserved Parts of the Medication Order (prescription)  Patient’s name  Date and time order is written  Name of drug to be administered  Dosage of drug  Route by which drug is to be to be administered  Frequency of administration of the of drug  Signature of person writing who wrote the order Copyright © 2019 Wolters Kluwer All Rights Reserved Figure 33.6 Medication Administration Record Copyright © 2019 Wolters Kluwer All Rights Reserved Three Checks of Medication Administration  Read the label: o When the nurse reaches for the container or unit dose package o After retrieval from the drawer and compared with the eMAR/MAR immediately before pouring from a multidose container o Before giving the unit dose medication to the patient or when replacing the multi-dose container in the drawer or shelf of medication room Copyright © 2019 Wolters Kluwer All Rights Reserved Rights of Medication Administration  Right Patient  Right assessment data  Right medication  Right reason  Right dosage  Right response  Right route  Right to education  Right time  Right to refuse  Right documentation  Six safety rights at time of administration: Right: patient, medication, dose, route time, documentation Copyright © 2019 Wolters Kluwer All Rights Reserved Identifying the Patient  Checking the identification bracelet  Validating the patient’s name (first identifier)  Validating the patient’s identification number, medical record number, and/or birth date (second identifier)  Comparing with the EMAR or MAR  Asking the patient to state his or her name if possible Copyright © 2019 Wolters Kluwer All Rights Reserved Medication Errors  Check patient’s condition immediately; observe for and treat any adverse effects.  Notify nurse manager and primary care provider.  Write description of error and remedial steps taken on medical record.  Complete form used for reporting errors, as dictated by the facility policy. o Special event, event, unusual occurrence report Copyright © 2019 Wolters Kluwer All Rights Reserved Type of Medication Errors  Inappropriate prescribing of the drug  Extra, omitted, or wrong doses  Administration of drug to wrong patient  Administration of drug by wrong route or rate  Failure to give medication within prescribed time  Incorrect preparation of drug  Improper technique when administering drug  Giving drug that has deteriorated Copyright © 2019 Wolters Kluwer All Rights Reserved Oral Medications Solid form: tablets, capsules, pills Liquid form: elixirs, spirits, suspensions, syrups Buccal Advantages / Disadvantages Copyright © 2019 Wolters Kluwer All Rights Reserved Administration of Oral Medications  Oral route: having patient swallow drug  Enteral route: administering drug through an enteral tube  Sublingual administration: placing drug under tongue  Buccal administration: placing drug between tongue and cheek Copyright © 2019 Wolters Kluwer All Rights Reserved Administration of Parenteral Medications Red items within scope of nursing practice  Subcutaneous injection: subcutaneous tissue  Intramuscular injection: muscle tissue  Intradermal injection: corium (under epidermis)  Intravenous injection: vein  Intra-arterial injection: artery  Intracardial injection: heart tissue  Intraperitoneal injection: peritoneal cavity  Intraspinal injection: spinal canal  Intraosseous injection: bone Copyright © 2019 Wolters Kluwer All Rights Reserved Criteria for Choosing Equipment for Injections  Route of administration  Viscosity of the solution  Quantity to be administered  Body size  Type of medication Copyright © 2019 Wolters Kluwer All Rights Reserved Parts of a Needle and Syringe Copyright © 2019 Wolters Kluwer All Rights Reserved Angles of Insertion for Various Injections Copyright © 2019 Wolters Kluwer All Rights Reserved Sites for Intramuscular Injections  Ventrogluteal site  Vastus lateralis site  Deltoid muscle site  Dorsogluteal site is no longer recommended. Copyright © 2019 Wolters Kluwer All Rights Reserved Copyright © 2019 Wolters Kluwer All Rights Reserved Preparing Medications for Injection  Ampules  Vials  Prefilled cartridges or syringes  Mixing medication in one syringe  Mixing insulins in one syringe  Reconstituting powdered medications Copyright © 2019 Wolters Kluwer All Rights Reserved Mixing of Insulin's Copyright © 2019 Wolters Kluwer All Rights Reserved Intradermal Injections  Administered into the dermis, just below the epidermis.  Has the longest absorption time of all parenteral routes.  Used for sensitivity tests and local anesthesia.  Body’s reaction to the substances is easily visible.  Sites commonly used are the inner surface of the forearm and the upper back, under the scapula.  A 1/4″ to 1/2″, 25- or 27-gauge needle is used, and the angle of administration is 5 to 15 degrees.  The dosage given intradermally is small, usually less than 0.5 mL. Copyright © 2019 Wolters Kluwer All Rights Reserved Subcutaneous injections  Administered into the adipose tissue layer just below the epidermis and dermis.  Various sites used: o Outer aspect of the upper arm o Abdomen (from below the costal margin to the iliac crests) o The anterior aspects of the thigh o The upper back o The upper ventral or dorsogluteal area Copyright © 2019 Wolters Kluwer All Rights Reserved Subcutaneous Injection Sites Lateral posterior aspect of upper arms Scapular areas Upper dorsogluteal Lower quadrants of the abdomen ( outside a 2 in. radius of the umbilicus) Anterior thighs Copyright © 2019 Wolters Kluwer All Rights Reserved Subcutaneous Heparin SQ in abdomen, arm or thigh Insert 90º angle Do not aspirate after injection Monitor coagulation levels: APPT or PTT Copyright © 2019 Wolters Kluwer All Rights Reserved Intravenous Administration of Medication  Delivers the drug directly into the bloodstream  Medication has an immediate effect and cannot be recalled, or actions slowed  Route most often used in emergency situations Copyright © 2019 Wolters Kluwer All Rights Reserved Topical Administration of Medications  Skin applications  Eye instillations and irrigations  Ear instillations and irrigations  Nasal instillations  Vaginal applications  Rectal instillations Copyright © 2019 Wolters Kluwer All Rights Reserved Ophthalmic Medications/Eye Instillation Clean eyelid & lashes Don gloves Instruct client to look up Hold dropper 1-2 cm above the lacrimal sac Press on nasolacrimal duct ~ 30 seconds Wait the prescribed time Instilling an eye drop into the lower before administering another conjunctival sac. med(~1 minute) Copyright © 2019 Wolters Kluwer All Rights Reserved  Ear Instillation Side lying position Straighten ear canal o Pull auricle down & back (child) o Upward & outward (adult) o Keep dropper 1cm above ear canal o Apply gentle massage to tragus of ear o Remain on side 2-3 minutes Copyright © 2019 Wolters Kluwer All Rights Reserved  Vaginal Medication Administration Vaginal o Empty bladder o Dorsal recumbent position o Gloves, Use lubricant if needed o Insert cream filled applicator or rounded end of suppository with index finger (3-4 in) o Remain supine for 5-10 minutes Copyright © 2019 Wolters Kluwer All Rights Reserved Rectal Medication Administration Rectal o Glove, H2O soluble lubricant o Sim’s position o Ask client to breath slowly through mouth o Insert rounded end 4 inches (adults) 2 inches (child) less for infant o Client to remain flat for 5 min. to retain suppository Inserting a rectal suppository beyond the internal sphincter and along the rectal wall. Copyright © 2019 Wolters Kluwer All Rights Reserved Respiratory Inhalation Metered-Dose Inhalers An extender spacer attached to a mouthpiece placed in the mouth. Copyright © 2019 Wolters Kluwer All Rights Reserved  Client Assessment History of Allergies Medication History o Length of time on drug o Time of dosing o Side effects Client’s Knowledge Client’s Learning Needs Herbal or other supplements Copyright © 2019 Wolters Kluwer All Rights Reserved Medical Record Documentation  Name of the medication  Dosage  Route and time of administration  Name of person administering medication  Site used for an injection  Intentional or inadvertently omitted drugs  Refused drugs  Medication errors Copyright © 2019 Wolters Kluwer All Rights Reserved Patient Teaching  Review techniques of medication administration.  Remind the patient to take the medication as prescribed for as long as prescribed.  Instruct the patient not to alter dosages without consulting a physician.  Caution the patient not to share medications. Copyright © 2019 Wolters Kluwer All Rights Reserved Question #1 Which type of drug preparation is a medication in a clear liquid containing water, alcohol, sweeteners, and flavor? A. Elixir B. Suspension C. Solution D. Syrup Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #1 Answer: A. Elixir Rationale: An elixir is a medication in a clear liquid containing water, alcohol, sweeteners, and flavor. A suspension contains finely divided, undissolved particles in a liquid medium. A solution is a drug dissolved in another substance. A syrup is medication combined in a water and sugar solution. Copyright © 2019 Wolters Kluwer All Rights Reserved Question #2 Tell whether the following statement is true or false. Only pain medications may be give to patients without a medication order from a licensed practitioner. A. True B. False Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #2 Answer: B. False Rationale: No medications may be give to patients without a medication order from a licensed practitioner. Copyright © 2019 Wolters Kluwer All Rights Reserved Question #3 In which of the following medication supply systems are large quantities of medications kept on the nursing unit making them immediately available to the nurse? A. Individual supply B. Stock supply C. Unit dose system D. Bar-coded medication cart Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #3 Answer: B. Stock supply Rationale: With the stock supply system, large quantities of medications are kept on the nursing unit. The medications are readily available to the nurse, but this eliminates the double-check system by the pharmacy. Copyright © 2019 Wolters Kluwer All Rights Reserved Question #4 Tell whether the following statement is true or false. The recommended intramuscular site for an adult is the vastus lateralis. A. True B. False Copyright © 2019 Wolters Kluwer All Rights Reserved Answer to Question #4 Answer: B. False Rationale: The recommended intramuscular site for an adult is the ventrogluteal or deltoid. Copyright © 2019 Wolters Kluwer All Rights Reserved