medication management

1. MEDICATION
ADMINISTRATION
JYOTI
MSC(N) 1ST YR

2. MEDICINE
Medicine may be defined as a substance used to promote
health , to prevent, to diagnose , to alleviate or cure
diseases. The safe and accurate administration of
medication is one of the major responsibility of a nurse

3. Mechanism of drug action
Mechanisms
of action
Absorption
Distribution
Metabolism
Excretion

4. Adverse effect:
Undesirable effect other than the intended therapeutic
effect are known as adverse effect.
Allergic effect:
An allergic effect is an immune system response that
occur when body interprets the drug administration is
foreign substance and form antibody against the drug,
manifested by rashes, urticaria, fever, diarrhea, nausea,
and vomiting and the most serious allergic effect is called
an anaphylactic reaction.

5. Drug tolerance:
It occurs when the body become accustomed to the effect of a
particular drug over a period of time.
Toxic effect:
Toxic effect are specific group of symptoms related to drug
therapy that carry risk for permanent damage for death, toxicity
can occur from cumulative effect.
Idiosyncratic effect:
it is unusual or peculiar response to a drug that may
manifest itself by over response, under response for even
the opposite of the expected response. Idosyncratic effect
are the though to be result of genetic enzymes deficiency
that leads to be an abnormal mechanism of drug break
down

6. Drug interaction:
Drug interaction occur when one drug is affected in some
way by another drug, a food or another substance that is
taken at the same time.
example alcohol and barbiturates when taken together
create unbeneficial synergistic effect with potential
significantly increase center nervous system depression.

7. Factor
affecting
drug
interaction
Development
consideration
Weight
Gender
Genetic and
cultural
factor:
Psychological
factor
Timing of
drugs
Environment
Pathology:

8. CALCULATION OF DRUG
P1 V1 = P2 V2
P1= available concentration
V1= requires volume of drug
P2= advised concentration
V2= total volume

10. Essentials of medication order
 Patients full name.
 Date and time.
 Drug name.
 Dosage.
 Route of administration.
 Time and frequency of administration.
 Signature of physician of medication is one of the major
responsibility of a nurse

11. Types of Medication Orders
 STAT order: needed immediately
 Single order: given only once
 PRN order: given as needed
 Routine orders: given within 2 hours of being written
and carried out on schedule
 Standing order: written in advance carried out under
specific circumstances.

12. Commonly used abbreviation

13. Basic principles (Safety) in medication
administration
3 checks and 8 Rights
• obtaining the container
• removing the med
• replacing the container
– Right patient
– Right dose
– Right drug
– Right route
– Right time
– Right Frequency
– Right Documentation
– Right to refuse

14. Route of drug administration

15. Oral Route:
Advantages:
 Convenient - can be self- administered, pain free, easy to take
 Absorption - takes place along the whole length of the GI tract
 Cheap - compared to most other parenteral routes.
Disadvantages:
 Less amount of drug reaches the target tissue.
 Some of the drug is destroyed by gastric juices e.g. adrenaline,
insulin, oxytocin
 Absorption has to take place which is slow, so is not preferred
during emergency.
 It might cause gastric irritation
 It might be objectionable in taste.
 It might cause discoloration of teeth e.g. iron causes staining,

16. Sublingual Route
Advantages:
 Rapid absorption takes place.
 Drug is dissolved easily
 Drug enters the blood directly
 Spitting out of the drug removes its effect
Disadvantages:
 unpalatable & bitter drugs
 irritation of oral mucosa
 large quantities not given
 few drugs are absorbed
 Person may swallow the drug
 Might be unpleasant in taste.

17. Rectal Route
Advantages:
 This route is preferred in unconscious or uncooperative
patients.
 This route avoids nausea or vomiting
 Drug cannot be destroyed by enzymes.
 This route is preferred if drug is irritant.
Disadvantages:
 This route is generally not acceptable by the patients.

18. Parenteral administration
Purposes:
 To get rapid and systemic effect of the drug
 To provide needed effect when the patient unconscious,
unable to swallow due to neurological or surgical
alterations.
 To give nourishment when it cannot taken by mouth

19. Types of parental administration
 Intra muscular
 Intra venous
 Intra-arterial
 Intra-cardiac
 Intra-thecal
 Intra-osseous- into bone marrow
 Intra-epidural
 Intra-peritoneal
 Intra-articular
 Intra-dermal (Intracutaneous)
 Subcutaneous route (Hypodermic)

21. Site for Sub-cutaneous and intra-muscular

23. Other method of parental administration
 Intra-arterial route:This method is used for
chemotherapy in cases of malignant tumors and in
angiography.
 Intra-cardiac route:- Injection can be applied to the left
ventricle in case of cardiac arrest.
 Intra-thecal route: Intra-thecal route involves the
subarachnoid space. Injection may be applied for the lumbar
puncture, for spinal anesthesia and for diagnostic purposes
 Intra-articular route: Intra-articular route involves
injection into the joint cavity. Corticosteroids may be injected
by this route in acute arthritis

24. Nursing responsibility in administration of
medication
While preparing the drugs:
Read the physician’s orders before preparing the drug. No
medicine should be prepared without the doctors orders. Verbal
orders are carried out only in emergency.
Check medicine card against the physician’s orders. Be sure the
medicine is copied correctly on the medicine card and in the
nurse’s record.
Avoid conversation during the preparation of medicine.
Calculate the drug dosage accurately if doubt consult other
Supervisor or physician.
Give medication only from clearly labeled container.
Read the label of the medicine and compare it with the medicine
card thrice:-
Before the medicine container taken from the shelf-
Before pouring the drugs
Before replacing the container in shelf- Check the expiry
date of the drugs along with the 3 checks

25.  Make sure the medicine glasses are clean and dry before
the medicine is taken
 When taking tablets and capsules do not touch them
with hand. Drop the tablets from the container to its lid
and then in to the medicine cup to be taken to the bedside
 Once the medicine is poured out of bottle , it should not
be poured back in the bottle to prevent contamination of
whole medicine.
 Do not use the medicine differ in color , taste, odour and
consistency.
 Prepare the drug just before the time of administration of
medicine. Never leave the medicine tray without proper
identification.

26. Before administering the drugs:
 Ask if patient has taken medication before
 Ask for patient allergies
 Review concomitant medicines, herbs and foods
 Review lab values
 Know right medications , dose, patient, route, time,
and reason.
 Explain to patient, medication’s name , purpose and
potential adverse effects.

27. During Administration:
 Identify the patient correctly.
 Give the drugs one by one
 Stay with the patient until he has taken the medicine
completely
 Always give the medicine prepared by yourself.
 Do not leave the medicine with the patient.
 Medication errors must be reported according to the
policy of the hospital

28. after administration
 Observe for changes in clinical status, adverse reactions
and allergic reactions.
 When present, involve the family in monitoring the
patient.
 Monitor for acute changes in clinical status, patient’s
subjective and objective response.
 Adverse reactions and allergic reactions
 If adverse reaction are present follow the hospital policy
and procedure of reporting adverse reaction of drugs .

29. Medication safety guidelines
 Medications are not given without physician’s written
orders.
 Do not administer a drug about which any doubt exists,
check further with the physician.
 Labels must be clear if not return to pharmacy.
 A nurse not to pour medication to one bottle to another,
not to put a medicine back into bottle,
 Nurses are not authorized to re-label medication bottles,
Medication which loses its label or which lacks a legible
label shall be return to the pharmacy.
 Nurse who administer the medications are responsible for
their own action.
 Be knowledgeable about the medication that you
administer

30.  Keep the Narcotics in locked place. Narcotics are to be
checked by every shift, and the narcotic cabinet must be
locked
 Return liquid that are cloudy in color to the pharmacy
 The nurse who prepares the drug administers it. Only the
nurse prepares the drug knows what the drug is.
 If the client vomits after taking the medication, report this
to the nurse in-charge or physician.
 Preoperative medications are usually discontinued during
the postoperative period unless ordered to be continued.
 When a medication is omitted for any reason, record the
fact together with the reason.

31.  When the medication error is made, report it
immediately to the nurse in-charge or physician.
 Prepare medications for one patient at a time.
 Do not label the medicine by patient room number or
bed number .
 Chart carefully
 Chart if any nursing action done before administering(
apical heart rate, B.P, )
 Check for the expected effect(therapeutic) of the drug.
Did side effects or adverse effects occur perform
indicated nursing actions . Record observations.