Unit 4 medications.pdf

 Unit4 Medications Definitions & terminology Rights Effects Factors affect action Routes Reaction assessment Prescribing Administration Calculation  Definitions Medication: Is a substance administered for...

 Unit4 Medications Definitions & terminology Rights Effects Factors affect action Routes Reaction assessment Prescribing Administration Calculation  Definitions Medication: Is a substance administered for diagnosis, cure, treatment, relief, or prevention of disease. Drug: Has association of obtained substances such as heroin, cocaine Prescription: is the written direction for the preparation and a administration of drug. Generic name: Is given before a drug becomes official. Official name: Is name under which it is listed in one of official publications (e.g., pharmacopoeia). Trademark or brand name: Is the name given by the drug manufacturer. Pharmacology: Is study of effect of drugs on living organisms. Pharmacist: A person licensed to prepare and dispense drugs and to make up prescriptions.  Types of Drug Preparation Aqueous ‫يئام‬solution: One or more drugs dissolved in water. Aerosol spray or foam: A liquid, powder, or foam deposited in a thin layer on the skin by air pressure. Aqueous suspension: One or more drugs finely divided in a liquid such as water. Capsule: A gelatinous container to hold a drug in powder, liquid, or oil form. Cream: A non greasy, semisolid preparation used on the skin. Elixir: A sweetened and aromatic solution of alcohol used as a vehicle for medicinal agents.  Types of Drug Preparation Gel or Jelly: A clear or translucent semisolid that liquefies when applied to the skin. Liniment: An oily liquid used on the skin. Lotion: An soothing liquid that may be a clear solution, suspension, or emulsion used on the skin. Lozenge (troche): A flat, round, or oval preparation that dissolves & releases a drug when held in the mouth. Ointment: A semisolid preparation of one or more drugs used for application to the skin & mucous membranes. Paste: A preparation like an ointment, but thicker and stiffer, that penetrates the skin less than an ointment.  Types of Drug Preparation  Pill: One or more drugs mixed with a cohesive material, in oval, round, or flattened shapes.  Powder: A finely ground drug or drugs; some are used internally, other externally.  Suppository: One or several drugs mixed with a firm base such as gelatin and shaped for insertion into body; base dissolves gradually at body temperature, releasing drug  Syrup: An aqueous solution of sugar often used to disguise unpleasant tasting drugs.  Tablet: A powdered drug compressed into a hard small disc; some are readily broken along a scored line; others are enteric-coated to prevent them from dissolving in the stomach.  Transdermal patch: A semi permeable membrane shaped in the form of a disk or patch that contains a drug to be absorbed through the skin over a lengthy period of time.  Aspects of Nursing Practice Governed by Law The administration of drugs is controlled by law. Under the law, nurses are responsible for their own actions regardless of whether there is a written order. Nurses should question any order that appears unreasonable and refuse to give the medication until the order is clarified.  Aspects of Nursing Practice Governed by Law The use of controlled substances. In hospitals, controlled substances are kept in a locked drawer, cupboard, medication cart, or computer-controlled dispensing system. Agencies have special forms for recording the use of controlled substances. Includes: 1. Name of client, 2. Date and time of administration, 3. Name of drug, dosage, 4. Signature of person who prepared and gives drug. 5. Name of physician who ordered drug  Effects of Drugs Therapeutic effect (desired effect): Is primary effect intended A side effect : Secondary effect that is unintended, are usually predictable and may be either harmless or potentially harmful. Drug toxicity: Harmful effects on an organism or tissue results from: Over dosage, Ingestion of a drug intended for external use, Build up of drug in blood due to impaired metabolism or excretion (cumulative effect). Some toxic effects are apparent immediately; some are not apparent for weeks or months.  Effects of Drugs Drug allergy: Is an immunologic reaction to a drug. Allergic reaction can be mild or severe (Anaphylactic reaction) usually occurs immediately after administration of drug. Drug tolerance: Occurs in a person who has unusually low physiologic activity in response to a drug and who requires increases in dosage to maintain therapeutic effect. Accumulative effect: Is increasing response to repeated doses of drug Occurs when of administration exceeds rate of metabolism or excretion. Idiosyncratic effect: Is unexpected and individual. It is under response or over response to a drug.  Effects of Drugs Drug interaction: Occurs when administration of one drug before, at same time as, or after another drug alters effect of one or both drugs. The effect of one or both drugs may be either increased or decreased Iatrogenic disease: disease caused unintentionally by medical therapy and can be due to drug therapy.  Factors Affecting Medication Action 1- Age: 2- Body weight. 3- Sex-linked differences. 4- Genetic factors: sensitive or may metabolize a drug differently than most people 5- Psychological factors: how one feels and believes a drug what drug can do. 6- Illness and disease. altered drug action circulatory, liver, or kidney dysfunction 7- The time of administration : Orally medications are absorbed more quickly on empty stomach Some medications irritate GI should be given after a meal. 8- Environment. Temperature  Types of Medication Orders 1-Stat order: Medication is to be given immediately and only once (e.g. Demerol 100mg I.M stat). 2-Single order (one-time order): Medication to be given once at a specified time (e.g. Pethidine 100 mg hour before surgery). 3-Standing order: Carried out indefinitely until an order is written to cancel it, or may be carried out for a specified number of days. 4-PRN order, As needed order: Permits nurse to give a medication when, in nurse’s judgment, client requires it.  Essential Parts of A Drug Order(prescription) Full name of the client Date and time the order is written Name of the drug to be administered Dosage of the drug Route of administration Frequency of administration Signature of the person writing the order.  Calculating Dosages (Dose Calculation) There are several formulas that can be used to calculate drug dosages. One formula uses ratios: Dose on hand = Desired dose Quantity on hand Quantity desired (x)  Calculating Dosages e.g. Erythromycin 500 mg is ordered. It is supplied in a liquid form containing 250 mg in 5 ml. To calculate the dosage, the nurse uses the formula: Dose on hand (250 mg) = Desired dose (500 mg) Quantity on hand (5 ml) Quantity desired (x) 250 x = 5 ml X 500 x = 5 ml X 500 = 10 ml (therefore, the dose ordered is 10 ml) 250 mg  Administering Medication Safety Nursing Responsibilities regarding Administering Medications 1-Nurses are responsible for their own actions. They should question any order that consider incorrect. 2-Be knowledgeable about medications they administer. 3- Laws govern uses of Narcotics. Keep Narcotics in a locked place. 4- Use only medications that are in a clearly labeled container. 5- Return liquid medications that are cloudy or have changed color to pharmacy 6- Before administering a medication, identify client correctly using the appropriate means of identification  Nursing Responsibilities regarding Administering Medications 7- Don’t leave medication at bedside, except (e.g. nitroglycerin, cough syrup). 8- If a client vomits after taking an oral medication, report 9-Take special precautions when administering certain medications; for example, have another nurse checks dosages of anticoagulants, insulin, IV preparations. 10- When a medication is omitted for any reason; record fact together with the reason. 11- When a medication error is made; report it immediately to the nurse in charge or doctor.  Process of Administering Medication 1- Identify the client 2- Administer the drug 3- Provide adjunctive interventions as indicated 4- Record the drug administered 5- Evaluate client's response to drug  “Rights” of Drug Administration 1. Right drug 2. Right dose 3. Right time and Frequency 4. Right route 5. Right client 6. Right documentation 7. Right of refusal 8. Right History and Assessment 9. Right Drug-Drug Interaction and Evaluation. 10. Right Education and Information (right to know)  Routes of Administration Orally, Sublingual, Buccal, Rectally, Subcutaneous, Intramuscular Intravenous  Routes of Administration 1- Topical Medications Topical applications are applied to a circumscribed surface area of the body. They affect only the area to which they are applied, and include: 1. Dermatologic preparations or medications 2. Instillations and irrigations a. Dermatologic Preparations or Medications Applied to skin include:  Ointments,  Pastes,  Creams,  Lotions,  Powders,  Sprays  Patches that used transdermal to provide sustained action (e.g., nitroglycerin patches and anti-motion sickness preparation).  b. Instillations and Irrigations Instillations: Is the insertion of a medication into a body cavity cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina. Irrigation (lavage): Is washing out of a body cavity by a stream of water or other fluid.  Ophthalmic Instillations It is medications for the eyes. They are instilled in form of liquids or ointments. Eye drops are packaged in mono-drip plastic containers Ointments are supplied in small tubes. All containers must state that medication is for ophthalmic use. Ophthalmic instillations are used to provide an eye medication (e.g., an antibiotic) Sterile preparations and sterile technique are indicated.  Otic Instillation It is medications for ear Ear drops are used to: 1- Soften earwax 2-To relieve pain 3-Provide local therapy to inflammation and/or infection In child, ear canal straighten by pulling the pinna down and back) In adult, ear canal straighten by pulling the pinna up and back  Nasal Instillations Nasal instillations (nose drops and sprays) usually are instilled to: Shrink swollen mucous membranes Loosen secretions and facilitate drainage Treat infections of the nasal cavity or sinuses.  Rectal Instillation Insertion of medications into the rectum in form of suppositories It is a convenient and safe method of giving certain medications. Advantages include the following: 1- It avoids irritation of upper gastrointestinal 2- When the medication has an objectionable taste or odor. 3- Drug is released at a slow but steady rate. 4- Provide higher blood stream levels (titers) of medications, because venous blood from lower rectum is not transported through the liver.  Respiratory Inhalation Medications administered by inhalation such as bronchodilators It is administered with the use of nebulizers that deliver a fine spray or mist of medications to client. A metered- dose inhaler (MDI) is a handheld nebulizer that can be used by clients to self-administer measured doses of an aerosol medication. Client needs to be instructed about how to use inhalers.  Oral Medication It is used to provide a medication that has systemic effects and/or local effects on gastrointestinal tract. Oral medications could be in the form of tablets and capsules and liquids (syrup and suspension). Sublingual Medication It is placed under tongue, where it dissolves, absorbed into blood vessels in short time The medication should not be swallowed. e.g. Nitroglycerine Buccal Medications: It means apply to cheek. A medication is held in mouth against mucous membranes of cheek until drug dissolves. The drug may act locally on the mucous membranes of mouth Or systemically when it is swallowed in the saliva.  Parenteral Medications It is administered by needle. Intradermal: under the epidermis (into dermis) Intramuscular: into a muscle Subcutaneous (hypodermic): into subcutaneous tissue, just below the skin Intravenous: into a vein.  1- Intradermal (ID) Administration of a drug into dermal layer of the skin beneath epidermis. Only small amount of liquid is used 0.1 ml. It is indicated for allergy, tuberculin tests and administering BCG vaccine. Common sites for intradermal injections are inner lower arm, upper chest and back beneath scapulae Left arm is used for tuberculin tests and right arm is used for all other tests. 1 ml syringe needle is short and fine, gauge is 25, 26 or 27, ¼ to 5/8 inch along  1- Intradermal (ID) Syringe is held at about a 15 degree angle to skin, with level of needle upward. Needle is then inserted through epidermis into dermis, and fluid is injected. Area is not massaged because medication may disperse into tissue or out through needle insertion site It is absorbed slowly through blood capillaries in area.  2- Subcutaneous (SC) Administered S/C (just beneath the skin) e.g. vaccines, pre operative medications, narcotics, insulin and heparin. Common sites for S/C are outer aspect of upper arms and anterior aspect of thighs It is convenient and has good blood circulation, other areas can be used are abdomen, scapular areas of the upper back and upper ventrogluteal and dorsogluteal areas.  2- Subcutaneous (SC) Only small doses (0.5-1 ml) of medication are usually injected via the S/C route. Type of syringe depends on medication to be given. Generally 2 ml syringe is used. If insulin is administered, insulin syringe is used. Generally 25 gauge, 5/8 inch needle is used for adults, and needle is inserted at a 45 degree  3- Intramuscular (IM) Injections into muscle tissue are absorbed more faster than subcutaneous injections because of the greater blood supply to the body muscles. Muscles can take a larger volume of fluid without discomfort Usually a 2-5 ml syringes are needed. Needle is 11/2 inches and 21 or 22 gauge. Selection of safe site located away from large blood vessels, nerves and bones Several body sites can be used for IM injection. Preferred site is Ventrogluteal site. Vastus lateralis is the proffered for children under 7 months of age. Other sites such as Dorosgluteal, Deltoid, and Rectus femoris are used. An Intramuscular needle inserted into the muscle layer Ventrogluteal site for an intramuscular injection The Vastus Lateralis site for an Intramuscular injection One method of establishing the Dorsogluteal site for an Intramuscular Injection D-Deltoid Site. E-Rectus Femoris site. ANGLES FOR INJECTION  4- Intravenous (IV) It enters client’s blood stream directly by a vein, they are appropriate when a rapid effect is required. Methods of Medications by administered I.V : 1-Large volume infusion of I.V fluids 2-Intermittent intravenous infusion 3-Volume controlled infusion (used for children) 4-Intravenous push or bolus (I.V.P) 5-Intermittent injection ports (device)  4- Intravenous (IV) Before adding any medications to any existing intravenous infusion, the nurse must: a) Inspect and palpate intravenous insertion site for signs of infection, infiltration, or a dislocated catheter. b) Inspect surrounding skin for redness, pallor, swelling. c) Palpate surrounding tissues for coldness and presence of edema, which could indicate leakage of the I.V fluid into the tissues. IMPORTANT NEVER, EVER RECAP A USED NEEDLE !!!!  Disadvantages Advantages Route -Inappropriate /contraindicated for clients: -Most common route Oral  with nausea or vomiting, -Most convenient  unconscious -Safe method,  unable to swallow, -Doesn’t break skin  gastric or intestinal suction. barrier  has reduced motility -Doesn’t cause stress - May have unpleasant taste or odor. -Least expensive -Can’t be used before certain diagnostic tests or surgical procedures. -May discolor teeth, harm tooth -May irritate gastric mucosa -Can be aspirated by seriously ill clients -If swallowed, drug may be -Convenient, safe Sublingual inactivated by gastric juice. -Administered for local effect -Drug must remain under tongue -More potent than oral because until dissolved and absorbed. drug directly enters the blood and bypass the liver Same as for sublingual Same as for sublingual Buccal -Dose absorbed is unpredictable. -Drug released at slow, steady Rectal rate -May be messy and may soil -Provides local effect. Topical clothes. -Few side effects -Drug can rapidly enter body through abrasions and cause systemic effect.  -Must involve sterile technique because breaks -Onset of drug action Subcutaneous skin barrier faster than oral -More expensive than oral -Can administer only small volume. -Slower than intramuscular administration -Some drugs can irritate tissues and causing pain. -Can be anxiety-producing. -Breaks skin barrier -Can administer larger Intramuscular -Can be anxiety- volume than subcutaneous producing -Drug is rapidly absorbed -Amount of drug administered -Absorption is slow Intradermal must be small. -Breaks skin barrier -Limited to highly soluble drugs -Rapid effect Intravenous -Rapid distribution inhibited by poor circulation. -Drug intended for -Introduces drug throughout Inhalation localized effect can the respiratory tract. have systemic effect. -Rapid localized relief. -Of use only for -Drug can be administered respiratory system. with unconscious client.