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Medication%20Administration

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Title: Medication%20Administration


1
Medication Administration
2
Define selected terms related to the
administration of medications.
3
Medication
  • Substance administered for the diagnosis,
    treatment, or relief of a symptom or for the
    prevention of diseases
  • Used interchangeably with the word drug
  • Drug also has the connotation of an illegally
    obtained substance

4
Prescription
  • Written directions for the preparation and
    administration of a drug

5
Generic name of a drug
  • Name given before a drug becomes officially
    approved as a medication

6
Official name of a drug
  • Name under which it is listed in one of the
    official publications

7
Chemical name of a drug
  • Name by which a chemist knows the drug

8
Trade or brand name
  • Name given by the drug manufacturer
  • Usually short and easy to remember

9
Pharmacology
  • Study of the effect of drugs on living organisms

10
Pharmacy
  • Art of preparing, compounding, and dispensing
    drugs
  • Also refers to the place where drugs are prepared

11
Describe legal aspects of administering
medications.
12
Legal Aspects of Administering Medications
  • Nursing practice acts
  • Responsibility for actions
  • Question any order that appears unreasonable
  • Refuse to give the medication until the order is
    clarified

13
  • Controlled Substances
  • Kept under lock
  • Special inventory forms
  • Documentation requirements
  • Counts of controlled substances
  • Procedures for discarding

14
  • Nurses need to know how nursing practice acts in
    their areas define and limit their functions and
    be able to recognize the limits of their own
    knowledge and skills. Under the law, nurses are
    responsible for their own actions regardless of
    whether there is a written order. Therefore,
    nurses should question any order that appears
    unreasonable and refuse to give the medication
    until the order is clarified.

15
  • Another aspect of nursing practice governed by
    law is the use of controlled substances.
    Controlled substances are kept under lock.
    Special inventory (list of items) forms are used
    for recording the use of these substances

16
  • The information usually required on these forms
    include the name of the client, date and time of
    administration, name of the drug, dosage, and
    signature of the person who prepares and gives
    the drug. The name of the primary care provider
    who ordered the drug may also be listed.

17
  • A verifying signature of another RN may be
    required by the agency when a drug is
    administered. Careful inventory control is
    maintained. When a portion or all of a controlled
    substance is discarded, the nurse must ask
    another nurse to witness the discarding. In most
    agencies, counts of controlled substances are
    taken at the end of each shift and the count
    total should tally with the total at the end of
    the last shift minus the number used.

18
Identify physiologic factors and individual
variables affecting medication action.
19
Factors Affecting Medication Action
  • Developmental
  • Gender
  • Cultural, ethnic, and genetic
  • Diet
  • Environment
  • Psychologic
  • Illness and disease
  • Time of administration

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  • Medication action may be affected by
    developmental factors, gender, culture,
    ethnicity, genetics, diet, environment,
    psychologic factors, illness and disease, and
    time of administration.

22
  • The nurse needs to be aware of developmental
    factors. Pregnant women must be careful about
    taking medications, especially in the first
    trimester, because of the possible adverse
    effects on the fetus. Infants usually require
    smaller doses because of their body size and the
    immaturity of their organs.

23
  • Older adults have different responses to
    medications due to physiologic changes that
    accompany aging and because they may be
    prescribed multiple drugs and incompatibilities
    may occur.

24
  • Gender differences in medication action are
    chiefly related to the distribution of body fat
    and fluid and hormonal differences. In addition,
    most research studies on medications have been
    done on men.
  • In addition to gender, a clients response to
    drugs is also influenced by genetic variations
    such as size and body composition
    (pharmacogenetics).

25
  • Ethnopharmacology is the study of the effects of
    ethnicity on response to prescribed medications.
    Cultural factors and practices (values and
    beliefs) can also affect a drugs action for
    example, an herbal remedy may speed up or slow
    down the metabolism of certain drugs (see
    Culturally Competent Care).

26
  • The diet may contain nutrients that can interact
    with medications and increase or decrease action.
  • It is important to consider the effects of a drug
    in the context of the clients personality,
    milieu (surroundings ), and environmental
    conditions (e.g., temperature, noise).

27
  • Psychologic factors, such as a clients
    expectations about what a drug can do, can affect
    the response to the medication.
  • Illness and disease can affect how a client
    responds to a medication. For example, aspirin
    can reduce body temperature of a feverish client
    but has no effect on body temperature of a client
    without a fever.

28
  • Time of administration is important because
    medications are absorbed more quickly if the
    stomach is empty however, some medications
    irritate the gastrointestinal tract and are given
    after a meal.

29
Routes of Medication Administration
  • Oral (PO)
  • Sublingual (SL)
  • Buccal
  • Parenteral
  • Subcutaneous (SC)
  • Intramuscular (IM)
  • Intradermal (ID)

30
  • Intravenous (IV)
  • Intra-arterial (IA)
  • Intracardiac (IC)
  • Intraosseous (IO)
  • Intrathecal (intraspinal) (IT) (IS)
  • Epidural (ED)
  • Intra-articular

31
Topical
  • Dermatological
  • Instillations and irrigations
  • Inhalation
  • Ophthalmic, otic, nasal, rectal, and vaginal

32
  • Routes of medication administration include oral,
    sublingual, buccal, parenteral, and topical.
  • In oral administration the drug is swallowed. It
    is the most common, least expensive, and most
    convenient route for most clients

33
  • In sublingual administration a drug is placed
    under the tongue, where it dissolves.

34
  • Buccal means pertaining to the cheek. In buccal
    administration a medication is held in the mouth
    against the mucous membranes of the cheek until
    the drug dissolves.

35
  • Some common routes for parenteral administration
    include subcutaneous (hypodermic), into the
    subcutaneous tissue just below the skin
    intramuscular, into the muscle intradermal,
    under the epidermis (into the dermis)

36
  • intravenous, into a vein
  • intra-arterial, into an artery
  • intracardiac, into the heart muscle
    intraosseous, into the bone
  • intrathecal or intraspinal, into the spinal
    canal
  • epidural, into the epidural space and
    intra-articular, into a joint.

37
  • Topical applications are those applied to a
    circumscribed surface area of the body. Routes
    for topical applications include dermatologic,
    applied to the skin instillations and
    irrigations, applied into body cavities or
    orifices such as the urinary bladder, eyes, ears,
    nose, rectum, or vagina

38
  • ophthalmic, otic, nasal, rectal, and vaginal
    topical preparations and inhalations,
    administered into the respiratory system by a
    nebulizer or positive pressure breathing
    apparatus.

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40
Parts of a Medication Order
  • Full name of the client
  • Date and time the order written
  • Name of drug to be administered
  • Dosage
  • Frequency of administration
  • Route of administration
  • Signature of person writing the order

41
Types of Medication Orders and Examples
  • Stat order
  • Demerol 100 mg IM stat
  • Single order
  • Seconal 100 mg hs before surgery
  • Standing order
  • Multivitamin 1 capsule po daily
  • Demerol 100 mg IM q 4 h x 5 days
  • prn order
  • Amphojel 15 mL prn

42
  • A stat order indicates that the medication is to
    be given immediately and only once (e.g., Demerol
    100 mg IM stat).
  • The single order or one-time order is for
    medication to be given once at a specified time
    (e.g., Seconal 100 mg hs before surgery).

43
  • The standing order may or may not have a
    termination date, may be carried out indefinitely
    (e.g., multiple vitamins daily) until an order is
    written to cancel it, or may be carried out for a
    specified number of days (e.g., Demerol 100 mg IM
    q4h 5 days).
  • A prn order or as-needed order permits the nurse
    to give a medication when, in the nurses
    judgment, the client requires it (e.g., Amphojel
    15 mL prn).

44
State systems of measurement that are used in the
administration of medications.
45
Systems of Measurement
  • Metric
  • Apothecary
  • Household

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47
List six essential steps to follow when
administering medication.
48
Six Essential Steps for Administering Medications
  • Identify the client
  • Inform the client
  • Administer the drug
  • Provide adjunctive interventions as indicated
  • Record the drug administered
  • Evaluate the clients response to the drug

49
  • 1. When administering any drug, regardless of the
    route of administration, the nurse must identify
    the client, inform the client, administer the
    drug, provide adjunctive interventions as
    indicated, record the drug administered, and
    evaluate the clients response to the drug.

50
  • The nurse must use at least two client
    identifiers whenever administering medications.
    Acceptable identifiers may be the persons name,
    an assigned identification number, a telephone
    number, a photograph, or another personal
    identifier.

51
  • If the client is unfamiliar with the medication,
    the nurse should explain the intended action as
    well as any side effects or adverse reactions
    that might occur. It is also very important to
    listen to the client.

52
  • Before administering the drug, the nurse should
    read the medication administration record (MAR)
    carefully and perform three checks with the
    labeled medication (See Box 353). In addition
    the ten rights of medication administration
    must be observed

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  • The nurse should provide adjunctive interventions
    as indicated. Clients may require physical
    assistance in assuming positions for parenteral
    medications or may need guidance about measures
    to enhance drug effectiveness and prevent
    complications.

55
  • The nurse must record the drug administered,
    following agency regulations.

56
  • In order to evaluate the clients response to
    the drug, the nurse should know the kinds of
    behavior that reflect the action or lack of
    action of the drug and its untoward effects (both
    minor and major) for each medication the client
    is receiving.
  • The nurse may also report the clients response
    directly to the nurse manager and primary care
    provider.

57
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

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59
Describe physiologic changes in older adults
that alter medication administration and
effectiveness
  • .
  • Elder Considerations
  • Altered memory
  • Decreased visual acuity
  • Decrease in renal function

60
  • Less complete and slower absorption from the
    gastrointestinal tract
  • Increased proportion of fat to lean body mass
  • Decreased liver function
  • Decreased organ sensitivity
  • Altered quality of organ responsiveness
  • Decrease in manual dexterity

61
  • Physiologic changes in older adults that alter
    medication administration and effectiveness
    include altered memory decreased visual acuity
    decreased renal function, resulting in slower
    elimination of drugs and higher drug
    concentration in the bloodstream for longer
    periods less complete and slower absorption from
    the gastrointestinal tract

62
  • increased proportion of fat to lean body mass,
    which facilitates retention of fat-soluble drugs
    and increases the potential for toxicity
    decreased liver function, which hinders
    biotransformation of drugs

63
  • decreased organ sensitivity, which means that the
    response to the same drug concentration in the
    vicinity (surrounding region) of the target
    organ is less in older people than in the young
    altered quality of organ responsiveness,
    resulting in adverse effects becoming pronounced
    before therapeutic effects are achieved

64
  • and decreased manual dexterity due to arthritis
    and/or decreased flexibility .

65
Outline steps required to administer oral
medications safely.
  • Prior to administering oral medications, the
    nurse should assess for allergies to medications
    ,the clients ability to swallow the medication

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  • presence of vomiting or diarrhea specific drug
    action, side effects, interactions, and adverse
    reactions the clients knowledge of and learning
    needs about the medication and determine if
    assessment data influences administration of the
    medications.

68
  • In preparation for administering the medication,
    the nurse should know the reason why the client
    is receiving the medication, the drug
    classification, contraindications, usual dosage
    range, side effects, and nursing considerations
    for administering and evaluating the intended
    outcomes for the medication. The nurse should
    check the MAR, verify the clients ability to
    take medication orally, and organize the supplies.

69
  • Outline steps required for nasogastric and
    gastrostomy tube medication administration.
  • Nasogastric/Gastrostomy Tube Medication
    Administration
  • Check with the pharmacist for a liquid form
  • Check to see if medication may be crushed
  • Crush a tablet into a fine powder and dissolve in
    at least 30 mL of warm water

70
  • Open capsules and mix the contents with water
    only with the pharmacists advice
  • Do not administer whole or undissolved
    medications
  • Assess tube placement
  • Aspirate stomach contents and measure the
    residual volume

71
  • Nasogastric/Gastrostomy Tube Medication
    Administration
  • Remove the plunger from the syringe and connect
    the syringe to a pinched or kinked tube
  • Put 15 to 30 mL (5 to 10 mL for children) of
    water into the syringe barrel to flush the tube
    before administering the first medication

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  • Pour liquid or dissolved medication into the
    syringe barrel and allow to flow by gravity into
    the enteral tube
  • Administer each medication separately and flush
    with at least 15 to 30 mL water between each
    medication

74
  • When you have finished administering all
    medications, flush with another 15 to 30 mL (5 to
    10 mL for children) of warm water to clear the
    tube
  • If the tube is connected to suction, disconnect
    the suction and keep the tube clamped to enhance
    absorption

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Medication Administration
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