Chapter 23: Administering Medications
Legal Considerations   <ul><li>U.S. Drug Legislation </li></ul><ul><ul><li>Sets official drug standards </li></ul></ul><ul...
Medication Systems <ul><li>Stock Supply </li></ul><ul><li>Bulk quantity </li></ul><ul><li>Central location </li></ul><ul><...
<ul><li>Automated Dispenser </li></ul><ul><li>Password-accessible locked cart </li></ul><ul><li>Computerized tracking </li...
Pharmacological Considerations <ul><li>Pharmacokinetics </li></ul><ul><li>What happens to the drug in the body </li></ul><...
Pharmacokinetics <ul><li>Four processes </li></ul><ul><li>Absorption </li></ul><ul><li>Distribution </li></ul><ul><li>Meta...
Absorption <ul><li>Movement of drug into the bloodstream </li></ul><ul><li>Factors affecting absorption </li></ul><ul><ul>...
Distribution <ul><li>Drug transport to tissues and organs </li></ul><ul><li>Factors affecting distribution </li></ul><ul><...
Metabolism <ul><li>Biotransformation: chemical conversion of drug </li></ul><ul><li>Factors affecting metabolism </li></ul...
Excretion <ul><li>Elimination of the drug </li></ul><ul><li>Factors affecting excretion </li></ul><ul><ul><li>Organ functi...
<ul><li>ClickerCheck </li></ul><ul><li>The client has been on a low-protein diet. This will most likely affect which pharm...
<ul><li>Correct answer:  C </li></ul><ul><li>A low-protein diet may lead to an inadequate level of plasma proteins, which ...
Concepts Related to Pharmacokinetics <ul><li>Time until onset and peak </li></ul><ul><li>Therapeutic range </li></ul><ul><...
Pharmacodynamics: Effects of Drugs <ul><li>Primary Effects </li></ul><ul><li>Therapeutic effects </li></ul><ul><li>Predict...
Pharmacodynamics: Effects of Drugs   (Cont’d)  <ul><li>Secondary Effects </li></ul><ul><li>Unintended </li></ul><ul><li>No...
Pharmacodynamics: Effects of Drugs   (Cont’d) <ul><li>Types of Secondary Effects </li></ul><ul><li>Side effects </li></ul>...
Drug Interactions <ul><li>Antagonistic </li></ul><ul><li>Synergistic </li></ul><ul><li>Incompatibilities </li></ul>
Nursing Considerations: The Medication Order <ul><li>Types of Medication Orders </li></ul><ul><li>Written order </li></ul>...
Nursing Considerations: The Medication Order  (Cont’d) <ul><li>Communication of Orders </li></ul><ul><li>Handwritten  </li...
<ul><li>ClickerCheck </li></ul><ul><li>The primary provider has written a medication prescription. The nurse is having dif...
<ul><li>Correct answer:  D </li></ul><ul><li>All other answers increase the risk of a medication error. </li></ul>
Components of the Medication Order/Prescription <ul><li>Client’s full name (some locales require address) </li></ul><ul><l...
Nursing Considerations: Medication Administration Safety <ul><li>Three Checks </li></ul><ul><li>Before you pour </li></ul>...
Nursing Considerations: Medication Administration Safety  (Cont’d) <ul><li>Six Rights </li></ul><ul><li>Right drug </li></...
Routes of Administration  <ul><ul><li>Tablets, pills, capsules </li></ul></ul><ul><ul><li>Liquids </li></ul></ul><ul><ul><...
Overview of Medication Administration, by Routes <ul><ul><li>Lotions, creams, ointments </li></ul></ul><ul><ul><li>Transde...
Routes of Administration <ul><li>Respiratory Inhalations </li></ul><ul><li>Use concept of nebulization </li></ul><ul><li>A...
Routes of Administration  (Cont’d) <ul><li>Parenteral Medications </li></ul><ul><li>Intradermal </li></ul><ul><li>Transder...
Parenteral Medication Administration <ul><li>Equipment Preparation </li></ul><ul><li>Syringe/needle (size, gauge) </li></u...
Parenteral Medication Administration  (Cont’d) <ul><li>Safety Issues </li></ul><ul><li>Use sharps containers </li></ul><ul...
Parenteral Medication Administration  (Cont’d) <ul><li>Use the correct site </li></ul><ul><ul><li>Wrong site could mean wr...
Parenteral Medication Administration  (Cont’d) <ul><li>Intravenous Medications </li></ul><ul><li>IV push </li></ul><ul><li...
<ul><li>ClickerCheck </li></ul><ul><li>When administering a drug via a parenteral routes, the drug would be absorbed faste...
<ul><li>Correct answer:  B, false </li></ul><ul><li>Absorption refers to the “movement” of the drug from the site of admin...
Avoiding Medication Errors <ul><li>Arrive to work well rested and undistracted. </li></ul><ul><li>Use the six rights. </li...
Avoiding Medication Errors  (Cont’d) <ul><li>Clarify unfamiliar drug names and dosages or illegible orders. </li></ul><ul>...
What Should I Do If I Commit a Medication Error? <ul><li>Immediately assess the patient’s vital signs and physical status....
Critical Thinking <ul><li>You have checked the medication record (MAR) for Margaret Marks (“Meet Your Patients,” in Volume...
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Ch23

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Ch23

  1. 1. Chapter 23: Administering Medications
  2. 2. Legal Considerations <ul><li>U.S. Drug Legislation </li></ul><ul><ul><li>Sets official drug standards </li></ul></ul><ul><ul><li>Defines prescription drugs </li></ul></ul><ul><ul><li>Regulates controlled substances </li></ul></ul><ul><ul><li>Improves safety </li></ul></ul><ul><ul><li>Requires proof of efficacy </li></ul></ul><ul><li>Nurse Practice Acts </li></ul><ul><ul><li>Identify nursing responsibilities for administration and client monitoring </li></ul></ul>
  3. 3. Medication Systems <ul><li>Stock Supply </li></ul><ul><li>Bulk quantity </li></ul><ul><li>Central location </li></ul><ul><li>Not client-specific </li></ul><ul><li>Unit Dose </li></ul><ul><li>Individually packaged </li></ul><ul><li>Client-specific drawers </li></ul><ul><li>24-hour supply </li></ul>
  4. 4. <ul><li>Automated Dispenser </li></ul><ul><li>Password-accessible locked cart </li></ul><ul><li>Computerized tracking </li></ul><ul><li>Can combine stock and unit doses </li></ul><ul><li>Self-Administration </li></ul><ul><li>Individual containers </li></ul><ul><li>Kept at client’s bedside </li></ul>Medication Systems (Cont’d)
  5. 5. Pharmacological Considerations <ul><li>Pharmacokinetics </li></ul><ul><li>What happens to the drug in the body </li></ul><ul><li>Pharmacodynamics </li></ul><ul><li>How the drug affects the body </li></ul>
  6. 6. Pharmacokinetics <ul><li>Four processes </li></ul><ul><li>Absorption </li></ul><ul><li>Distribution </li></ul><ul><li>Metabolism </li></ul><ul><li>Excretion </li></ul>
  7. 7. Absorption <ul><li>Movement of drug into the bloodstream </li></ul><ul><li>Factors affecting absorption </li></ul><ul><ul><li>Route of administration </li></ul></ul><ul><ul><li>Drug solubility </li></ul></ul><ul><ul><li>pH/ionization </li></ul></ul><ul><ul><li>Blood flow </li></ul></ul>
  8. 8. Distribution <ul><li>Drug transport to tissues and organs </li></ul><ul><li>Factors affecting distribution </li></ul><ul><ul><li>Local blood flow </li></ul></ul><ul><ul><li>Membrane permeability </li></ul></ul><ul><ul><li>Protein-binding capacity </li></ul></ul>
  9. 9. Metabolism <ul><li>Biotransformation: chemical conversion of drug </li></ul><ul><li>Factors affecting metabolism </li></ul><ul><ul><li>Liver function </li></ul></ul><ul><ul><li>Health/disease status </li></ul></ul><ul><ul><li>First-pass effect </li></ul></ul>
  10. 10. Excretion <ul><li>Elimination of the drug </li></ul><ul><li>Factors affecting excretion </li></ul><ul><ul><li>Organ function, especially the kidneys, liver, and lungs </li></ul></ul><ul><ul><li>Exocrine glands </li></ul></ul>
  11. 11. <ul><li>ClickerCheck </li></ul><ul><li>The client has been on a low-protein diet. This will most likely affect which pharmacokinetic process? </li></ul><ul><li>a. Absorption </li></ul><ul><li>b. Excretion </li></ul><ul><li>c. Distribution </li></ul><ul><li>d. Metabolism </li></ul>
  12. 12. <ul><li>Correct answer: C </li></ul><ul><li>A low-protein diet may lead to an inadequate level of plasma proteins, which will affect availability of “free” drug. </li></ul>
  13. 13. Concepts Related to Pharmacokinetics <ul><li>Time until onset and peak </li></ul><ul><li>Therapeutic range </li></ul><ul><ul><li>Peak level </li></ul></ul><ul><ul><li>Trough level </li></ul></ul><ul><ul><li>Therapeutic level </li></ul></ul><ul><li>Half-life </li></ul><ul><li>Concentration of active drug </li></ul>
  14. 14. Pharmacodynamics: Effects of Drugs <ul><li>Primary Effects </li></ul><ul><li>Therapeutic effects </li></ul><ul><li>Predicted </li></ul><ul><li>Intended </li></ul><ul><li>Desired </li></ul><ul><li>Why the drug was prescribed </li></ul>
  15. 15. Pharmacodynamics: Effects of Drugs (Cont’d) <ul><li>Secondary Effects </li></ul><ul><li>Unintended </li></ul><ul><li>Nontherapeutic </li></ul><ul><li>Can be </li></ul><ul><ul><li>Predictable </li></ul></ul><ul><ul><li>Harmless </li></ul></ul><ul><ul><li>Harmful </li></ul></ul>
  16. 16. Pharmacodynamics: Effects of Drugs (Cont’d) <ul><li>Types of Secondary Effects </li></ul><ul><li>Side effects </li></ul><ul><li>Adverse reactions </li></ul><ul><li>Toxic reactions </li></ul><ul><li>Allergic reactions </li></ul><ul><li>Idiosyncratic reactions </li></ul><ul><li>Cumulative effect </li></ul>
  17. 17. Drug Interactions <ul><li>Antagonistic </li></ul><ul><li>Synergistic </li></ul><ul><li>Incompatibilities </li></ul>
  18. 18. Nursing Considerations: The Medication Order <ul><li>Types of Medication Orders </li></ul><ul><li>Written order </li></ul><ul><li>Automatic “stop” date </li></ul><ul><li>STAT order </li></ul><ul><li>Standing order </li></ul><ul><li>PRN order </li></ul>
  19. 19. Nursing Considerations: The Medication Order (Cont’d) <ul><li>Communication of Orders </li></ul><ul><li>Handwritten </li></ul><ul><li>Preprinted </li></ul><ul><li>Orally </li></ul><ul><li>Telephone </li></ul>
  20. 20. <ul><li>ClickerCheck </li></ul><ul><li>The primary provider has written a medication prescription. The nurse is having difficulty deciphering what has been written. The best strategy to clarify the information is </li></ul><ul><li>a. Ask the patient what medication the provider prescribed. </li></ul><ul><li>b. Call the pharmacist and ask her to read the </li></ul><ul><li>prescription. </li></ul><ul><li>c. Ask the nurse who knows the provider’s handwriting to read the prescription. </li></ul><ul><li>d. Call the provider and ask him to clarify the prescription. </li></ul>
  21. 21. <ul><li>Correct answer: D </li></ul><ul><li>All other answers increase the risk of a medication error. </li></ul>
  22. 22. Components of the Medication Order/Prescription <ul><li>Client’s full name (some locales require address) </li></ul><ul><li>Date and time </li></ul><ul><li>Name of medication </li></ul><ul><li>Dosage size, frequency, number of doses </li></ul><ul><li>Route of administration </li></ul><ul><li>Printed name and signature of prescriber, including relevant credentials and legal registration number </li></ul>
  23. 23. Nursing Considerations: Medication Administration Safety <ul><li>Three Checks </li></ul><ul><li>Before you pour </li></ul><ul><ul><li>Check the medication label against the MAR </li></ul></ul><ul><li>After you pour </li></ul><ul><ul><li>Verify the label against the MAR </li></ul></ul><ul><li>At the bedside </li></ul><ul><ul><li>Check the medication again </li></ul></ul>
  24. 24. Nursing Considerations: Medication Administration Safety (Cont’d) <ul><li>Six Rights </li></ul><ul><li>Right drug </li></ul><ul><li>Right client </li></ul><ul><li>Right dose </li></ul><ul><li>Right time </li></ul><ul><li>Right route </li></ul><ul><li>Right documentation </li></ul><ul><li>Other Rights </li></ul><ul><li>Right reason </li></ul><ul><li>Right to know </li></ul><ul><li>Right to refuse </li></ul>
  25. 25. Routes of Administration <ul><ul><li>Tablets, pills, capsules </li></ul></ul><ul><ul><li>Liquids </li></ul></ul><ul><ul><li>Buccal </li></ul></ul><ul><ul><li>Sublingual </li></ul></ul><ul><ul><li>Enteral medications </li></ul></ul><ul><li>Oral Medications </li></ul><ul><li>Most commonly used route </li></ul><ul><li>Includes </li></ul>
  26. 26. Overview of Medication Administration, by Routes <ul><ul><li>Lotions, creams, ointments </li></ul></ul><ul><ul><li>Transdermal patches </li></ul></ul><ul><ul><li>Eye and ear </li></ul></ul><ul><ul><li>Nasal </li></ul></ul><ul><ul><li>Vaginal </li></ul></ul><ul><ul><li>Rectal </li></ul></ul><ul><li>Topical Medications </li></ul><ul><li>Applied directly to body surface/body cavities </li></ul><ul><li>Local (and sometimes systemic) effects </li></ul>
  27. 27. Routes of Administration <ul><li>Respiratory Inhalations </li></ul><ul><li>Use concept of nebulization </li></ul><ul><li>Absorption via alveoli and blood supply </li></ul><ul><ul><li>Atomizers </li></ul></ul><ul><ul><li>Aerosol </li></ul></ul><ul><ul><li>Metered dose inhaler </li></ul></ul>
  28. 28. Routes of Administration (Cont’d) <ul><li>Parenteral Medications </li></ul><ul><li>Intradermal </li></ul><ul><li>Transdermal </li></ul><ul><li>Subcutaneous </li></ul><ul><li>Intramuscular </li></ul><ul><li>Intravenous </li></ul>
  29. 29. Parenteral Medication Administration <ul><li>Equipment Preparation </li></ul><ul><li>Syringe/needle (size, gauge) </li></ul><ul><li>Medication Preparation </li></ul><ul><li>Vials and ampules </li></ul><ul><li>Reconstituting from powder </li></ul><ul><li>Two medications in one syringe </li></ul>
  30. 30. Parenteral Medication Administration (Cont’d) <ul><li>Safety Issues </li></ul><ul><li>Use sharps containers </li></ul><ul><li>Avoid recapping a dirty needle </li></ul>
  31. 31. Parenteral Medication Administration (Cont’d) <ul><li>Use the correct site </li></ul><ul><ul><li>Wrong site could mean wrong route </li></ul></ul><ul><li>Be familiar with the technique required for the medication (e.g., heparin, insulin) </li></ul>
  32. 32. Parenteral Medication Administration (Cont’d) <ul><li>Intravenous Medications </li></ul><ul><li>IV push </li></ul><ul><li>IV piggyback </li></ul><ul><li>Medicated drips </li></ul>
  33. 33. <ul><li>ClickerCheck </li></ul><ul><li>When administering a drug via a parenteral routes, the drug would be absorbed fastest if given per the IM route. </li></ul><ul><li>a. True </li></ul><ul><li>b. False </li></ul>
  34. 34. <ul><li>Correct answer: B, false </li></ul><ul><li>Absorption refers to the “movement” of the drug from the site of administration into the blood stream. Therefore, the intravenous, parenteral route leads to “instant” absorption. </li></ul>
  35. 35. Avoiding Medication Errors <ul><li>Arrive to work well rested and undistracted. </li></ul><ul><li>Use the six rights. </li></ul><ul><li>Calculate doses carefully; double-check with a second RN. </li></ul><ul><li>Watch for drugs with similar names. </li></ul><ul><li>Watch for clients with the same last names. </li></ul>
  36. 36. Avoiding Medication Errors (Cont’d) <ul><li>Clarify unfamiliar drug names and dosages or illegible orders. </li></ul><ul><li>Avoid abbreviations. </li></ul><ul><li>Know and use your resources. </li></ul><ul><li>Keep up with changes in medication orders. </li></ul>
  37. 37. What Should I Do If I Commit a Medication Error? <ul><li>Immediately assess the patient’s vital signs and physical status. </li></ul><ul><li>Report findings to the primary care provider. </li></ul><ul><li>Notify the nurse manager of your unit and report the event surrounding the event. Check with your institution for agency-specific policy regarding incident reporting. </li></ul>
  38. 38. Critical Thinking <ul><li>You have checked the medication record (MAR) for Margaret Marks (“Meet Your Patients,” in Volume 1) and prepared her next dose of antibiotic for intravenous administration. The MAR also indicates that she is receiving morphine for pain and that her last dose was given 1 hour ago. When you enter the room, you find her apparently sleeping. You are not able to awaken her to verify her identity. What do you suspect is happening, and how should you respond? </li></ul>

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