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Chapter 35: Medication Administration


Chapter 35: Medication Administration Bonnie M. Wivell, MS, RN, CNS Introduction Medication is a substance used in the Diagnosis Treatment Cure Relief Prevention of ... – PowerPoint PPT presentation

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Title: Chapter 35: Medication Administration

Chapter 35 Medication Administration
  • Bonnie M. Wivell, MS, RN, CNS

  • Medication is a substance used in the
  • Diagnosis
  • Treatment
  • Cure
  • Relief
  • Prevention of health alterations
  • The nurse is responsible for the following in
    regard to medications
  • Preparation
  • Administration
  • Teaching
  • Evaluating response

Medication Legislation and Standards
  • The role of the U.S. government in regulation of
    the pharmaceutical industry is to protect the
    health of the people by ensuring that medications
    are safe and effective.
  • First law was passed in 1906
  • Pure Food and Drug Act requires all meds to be
    free of impure products
  • Other federal medication laws
  • Control medication sales and distribution
  • Medical testing
  • Naming and labeling
  • Regulate controlled substances

Medication Legislation and Standards Contd.
  • FDA enforces laws, and ensures all meds on the
    market undergo vigorous testing before being sold
    to the public
  • MedWatch program initiated in 1993 by FDA a
    voluntary program that encourages nurses and
    other health care professions to report when a
    medication, product, or medical event causes
    serious harm to a client
  • State laws control substances not regulated by
    the federal government.
  • Local government regulates the use of alcohol and

Medication Legislation and Standards Contd.
  • An institution is concerned primarily with
    preventing poor health outcomes resulting from
    medication use
  • Medication Regulations and Nursing Practice are
    governed by individual state Nurse Practice Acts
  • NPAs have the most influence over nursing
    practice by defining the scope of a nurses
    professional functions and responsibilities
  • NPAs are broad in scope and nature so as not to
    limit the nurses functional ability
  • Health care agencies interpret the NPAs

Controlled Substances
  • Controlled substances (AKA narcotics) are
    carefully controlled through federal and state
  • Violation of the Controlled Substances Act is
    punishable by fines, imprisonment, and loss of
    nurse licensure.
  • See Box 35-1

Patient Safety
  • Patient Safety
  • To err is Human

Clinical Effectiveness of Safe Practices Clinical Effectiveness of Safe Practices
Intervention Results
Physician computer order entry 81 reduction of medication errors
Pharmacist rounding with team 66 reduction of preventable adverse drug events 78 reduction of preventable adverse drug events
Rapid response teams Cardiac arrests decreased by 15
Team training in labor and delivery 50 reduction in adverse outcomes in preterm deliveries
Reconciling medication practices upon hospital discharge 90 reduction in medication errors
Ventilator bundle protocol Ventilator-associated pneumonias decreased by 62
Pharmacological Concepts
  • Drug Names
  • Generic becomes the official name listed in
    publications and is the name generally used
    throughout the drugs use
  • Chemical chemicals that make up drug
  • Brand/Trade the name under which a manufacturer
    markets a med usually short and easy to remember
  • Many companies produce the same med so
    similarities in trade names are often confusing
  • Example
  • Brand Hydrochlorothiazide
  • Trade Esidrix and HydroDiuril

Pharmacological Concepts Contd.
  • Classification
  • The effect of the medication on a body system
  • The symptoms the medication relieves
  • The medications desired effect
  • Some medications are part of more than one class
  • Medication Forms
  • The form of the medication determines its route
    of administration
  • The composition of a medication enhances its
    absorption and metabolism
  • Many meds come in several forms Tablets,
    Capsules, Elixirs, Suppositories

  • Pharmacokinetics the study of how meds enter
    the body, reach their site of action, metabolize,
    and exit the body
  • Absorption passage of med into blood
  • Route of administration
  • Ability of med to dissolve
  • Blood flow to site of administration
  • BSA
  • Lipid solubility of a med

  • After absorption, distribution occurs within the
    body to tissues, organs, and to specific sites of
    action via blood stream.
  • Distribution depends on
  • Circulation limited blood flow can inhibit
  • Membrane permeability
  • Blood brain barrier and Placenta
  • Protein Binding most meds bind to albumin to
    some extent
  • Meds bound to proteins cant do what they are
    supposed to
  • Free or unbound medication is the active form
    of the med
  • Decreased albumin due to disease process ? more
    active medication ? med toxicity

  • Medications are metabolized into a less potent or
    an inactive form.
  • Biotransformation occurs under the influence of
    enzymes that detoxify, degrade, and remove active
  • Most biotransformation occurs in the liver
  • Other sites for metabolism lungs, kidneys,
    blood, intestines

  • Medications are excreted through
  • Kidney
  • Liver
  • Bowel
  • Lungs
  • Exocrine glands

Types of Medication Action
Therapeutic effect Expected or predictable Side effect Predictable and often unavoidable
Adverse effect Unintended, undesirable, and often unpredictable severe response Toxic effect Medication accumulates in the blood stream
Idiosyncratic reaction Over- or under-reaction to a medication Allergic reaction Unpredictable response to a medication
Medication Interactions
  • Occur when one medication modifies the action of
  • A synergistic effect occurs when the combined
    effect of two medications is greater than the
    effect of the medications given separately.
  • Can be beneficial Tylenol and Codeine
  • ETOH and antihistimines, antidepressants, or
    narcotics (all CNS depressants)
  • HTN may be treated with diuretic and vasodilator

Medication Dose Responses
Serum half-life Time for serum medication concentration to be halved Onset Time it takes for a medication to produce a response
Peak Time at which a medication reaches its highest effective concentration Trough Time at which drug is at its lowest amount in the serum
Duration Time medication takes to produce a response Plateau Blood serum concentration is reached and maintained
Routes of Administration
Oral Swallow, Sublingual, Buccal Parenteral ID, Sub-Q, IM, IV
Other Epidural, Intrathecal, Intraosseous, Intraperitoneal, Intrapleural, Intraarterial Topical Skin Transdermal patch Instillation or irrigation
Inhalation Nasal passages, oral passage, ET or trach Intraocular Insertion of disk containing med drops
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Effects of Nutrition on Drugs
Grapefruit Can cause toxicity when taken with cisapride, carbamazepine, diazepam, verapamil, amiodarone, lovastatin
Vitamin K Decrease effectiveness of warfarin
Tyramine (found in cheese, beer, dried sausage, sauerkraut) In combination with MAOI meds (Nardil, Parnate, Marplan) creates increase in epinephrine ? HA, ? P, ? BP ? death
Milk Interferes with absorption of tetracycline antibiotics
Systems of Medication Measurement
  • Requires the ability to compute medication doses
    accurately and correctly
  • Metric system organized in units of 10
  • Apothecaries older than metric
  • Household system least accurate
  • Solution

Nursing Knowledge Base
  • Safe administration is imperative
  • Nursing process provides a framework for
    medication administration
  • Clinical calculations must be handled without
  • Conversions in and between systems
  • Dose calculations
  • Pediatric and elderly calculations
  • ALWAYS double-check calculation and medication
    with a second nurse on high alert meds (insulin,

Prescribers Role
  • Prescriber can be physician, nurse practitioner,
    or physicians assistant.
  • Prescribers must document the diagnosis,
    condition, or need for each medication.
  • Orders can be written, computer generated,
    verbal, or by telephone.
  • DO NOT use abbreviations on pages 701-703 when
    documenting med orders or other information about

Types of Orders in Acute Care Agencies
  • Standing or Routine Medication Orders
  • PRN Orders as needed
  • Single (one-time) Orders
  • STAT Orders within 15 mins
  • Now Orders up to 90 mins to administer
  • Prescriptions taken outside the hospital

Communication of Medication Order
  • Order is written on clients chart
  • By provider or RN receiving TO or VO
  • Order copied to Medication Administration Record
  • MAR contains name, room, bed, drug name, dose,
    route, times, allergies
  • Video

Components of Medication Orders
  • Clients full name
  • Date and time that the order is written
  • Medication name
  • Dose
  • Route
  • Time and frequency of administration
  • PRN orders must have a reason
  • Signature

Medication Administration
  • Pharmacists role
  • Distribution system
  • Medication errors (near miss)
  • Medication Reconciliation
  • Verify
  • Clarify
  • Reconcile
  • Transmit
  • Nurses role

The Six Rights of Medication Administration
  • Right medication
  • Right dose
  • Right patient
  • Right route
  • Right time
  • Right documentation
  • Right to refuse

Where Do Drugs Come From in the Hospital?
  • Pyxis/Omnicell
  • Machine on the nursing unit where a stock supply
    of meds are stored
  • Commonly used meds
  • Narcotics
  • Packaged in the pharmacy and delivered to the
    nursing unit
  • Unit dose system drugs are packaged individually
  • Liquids can be unit dose or bottles
  • Medication in bottles will be measured in
    Milliliters, teaspoons, ounces, etc.

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Potential Medication Error
Critical Thinking
  • Knowledge understand why you are giving a med
    if you dont know, look it up
  • Experience skills become more refined
  • Attitudes take adequate time to prepare and
  • Standards ensure safe practice
  • 6 Rights

The Nursing Process and Med Administration
  • Assessment
  • Medical history
  • Allergies
  • Medication data
  • Diet history
  • Clients perceptual or coordination problems
  • Clients current condition
  • Clients attitude about medication use
  • Clients knowledge and understanding of
    medication therapy
  • Clients learning needs

Nursing Diagnosis
  • Anxiety
  • Ineffective health maintenance
  • Health-seeking behaviors
  • Deficient knowledge (medications)
  • Noncompliance (medications)
  • Disturbed visual sensory perception
  • Impaired swallowing
  • Effective therapeutic regimen management
  • Ineffective therapeutic regimen management

  • Minimize distractions or interruptions when
    preparing and administering meds
  • This will limit errors
  • Prioritize care when administering meds
  • Collaboration
  • Prescriber
  • Pharmacist
  • Case manager/social worker

  • Health promotion
  • Client and family teaching
  • Acute care
  • Receiving med orders (write it down and read it
  • Correct transcription and communication of orders
  • Accurate dose calculation and measurement
  • Correct administration
  • Recording med administration
  • NEVER chart a med before administering it
  • Restorative care med administration varies
    across care settings

Special Considerations
  • Infants and children
  • Vary in age, weight, surface area and the ability
    to absorb, metabolize, and excrete meds
  • Lower doses special calculations
  • Alternative forms, such as liquids or elixirs
    Psychological prep
  • Older adults
  • Simplify
  • Assess swallowing
  • Some have greater sensitivity
  • Polypharmacy

  • You must monitor a clients response to meds on
    an on-going basis
  • The goal of safe and effective med administration
    involves the clients response to therapy and
    ability to assume responsibility for self-care
  • You will evaluate the effectiveness of nursing
    interventions when you assess whether the client
    has met goals/outcomes

  • Will cover actual administration and other issues
    surrounding administration during tomorrows