The document summarizes key points about administering medications including: - Legal and regulatory considerations for prescribing and administering drugs - Different systems for storing and distributing medications like unit dosing and automated dispensers - Pharmacokinetic processes like absorption, distribution, metabolism, and excretion that determine what happens to drugs in the body - Factors that influence these processes and the effects of drugs - Components of medication orders and important considerations for safe administration like the rights, routes, equipment, and avoiding errors

1. Chapter 23: Administering Medications

2. Legal Considerations U.S. Drug Legislation Sets official drug standards Defines prescription drugs Regulates controlled substances Improves safety Requires proof of efficacy Nurse Practice Acts Identify nursing responsibilities for administration and client monitoring

3. Medication Systems Stock Supply Bulk quantity Central location Not client-specific Unit Dose Individually packaged Client-specific drawers 24-hour supply

4. Automated Dispenser Password-accessible locked cart Computerized tracking Can combine stock and unit doses Self-Administration Individual containers Kept at client’s bedside Medication Systems (Cont’d)

5. Pharmacological Considerations Pharmacokinetics What happens to the drug in the body Pharmacodynamics How the drug affects the body

6. Pharmacokinetics Four processes Absorption Distribution Metabolism Excretion

7. Absorption Movement of drug into the bloodstream Factors affecting absorption Route of administration Drug solubility pH/ionization Blood flow

8. Distribution Drug transport to tissues and organs Factors affecting distribution Local blood flow Membrane permeability Protein-binding capacity

9. Metabolism Biotransformation: chemical conversion of drug Factors affecting metabolism Liver function Health/disease status First-pass effect

10. Excretion Elimination of the drug Factors affecting excretion Organ function, especially the kidneys, liver, and lungs Exocrine glands

11. ClickerCheck The client has been on a low-protein diet. This will most likely affect which pharmacokinetic process? a. Absorption b. Excretion c. Distribution d. Metabolism

12. Correct answer: C A low-protein diet may lead to an inadequate level of plasma proteins, which will affect availability of “free” drug.

13. Concepts Related to Pharmacokinetics Time until onset and peak Therapeutic range Peak level Trough level Therapeutic level Half-life Concentration of active drug

14. Pharmacodynamics: Effects of Drugs Primary Effects Therapeutic effects Predicted Intended Desired Why the drug was prescribed

15. Pharmacodynamics: Effects of Drugs (Cont’d) Secondary Effects Unintended Nontherapeutic Can be Predictable Harmless Harmful

16. Pharmacodynamics: Effects of Drugs (Cont’d) Types of Secondary Effects Side effects Adverse reactions Toxic reactions Allergic reactions Idiosyncratic reactions Cumulative effect

17. Drug Interactions Antagonistic Synergistic Incompatibilities

18. Nursing Considerations: The Medication Order Types of Medication Orders Written order Automatic “stop” date STAT order Standing order PRN order

19. Nursing Considerations: The Medication Order (Cont’d) Communication of Orders Handwritten Preprinted Orally Telephone

20. ClickerCheck 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 a. Ask the patient what medication the provider prescribed. b. Call the pharmacist and ask her to read the prescription. c. Ask the nurse who knows the provider’s handwriting to read the prescription. d. Call the provider and ask him to clarify the prescription.

21. Correct answer: D All other answers increase the risk of a medication error.

22. Components of the Medication Order/Prescription Client’s full name (some locales require address) Date and time Name of medication Dosage size, frequency, number of doses Route of administration Printed name and signature of prescriber, including relevant credentials and legal registration number

23. Nursing Considerations: Medication Administration Safety Three Checks Before you pour Check the medication label against the MAR After you pour Verify the label against the MAR At the bedside Check the medication again

24. Nursing Considerations: Medication Administration Safety (Cont’d) Six Rights Right drug Right client Right dose Right time Right route Right documentation Other Rights Right reason Right to know Right to refuse

25. Routes of Administration Tablets, pills, capsules Liquids Buccal Sublingual Enteral medications Oral Medications Most commonly used route Includes

26. Overview of Medication Administration, by Routes Lotions, creams, ointments Transdermal patches Eye and ear Nasal Vaginal Rectal Topical Medications Applied directly to body surface/body cavities Local (and sometimes systemic) effects

27. Routes of Administration Respiratory Inhalations Use concept of nebulization Absorption via alveoli and blood supply Atomizers Aerosol Metered dose inhaler

28. Routes of Administration (Cont’d) Parenteral Medications Intradermal Transdermal Subcutaneous Intramuscular Intravenous

29. Parenteral Medication Administration Equipment Preparation Syringe/needle (size, gauge) Medication Preparation Vials and ampules Reconstituting from powder Two medications in one syringe

30. Parenteral Medication Administration (Cont’d) Safety Issues Use sharps containers Avoid recapping a dirty needle

31. Parenteral Medication Administration (Cont’d) Use the correct site Wrong site could mean wrong route Be familiar with the technique required for the medication (e.g., heparin, insulin)

32. Parenteral Medication Administration (Cont’d) Intravenous Medications IV push IV piggyback Medicated drips

33. ClickerCheck When administering a drug via a parenteral routes, the drug would be absorbed fastest if given per the IM route. a. True b. False

34. Correct answer: B, false 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.

35. Avoiding Medication Errors Arrive to work well rested and undistracted. Use the six rights. Calculate doses carefully; double-check with a second RN. Watch for drugs with similar names. Watch for clients with the same last names.

36. Avoiding Medication Errors (Cont’d) Clarify unfamiliar drug names and dosages or illegible orders. Avoid abbreviations. Know and use your resources. Keep up with changes in medication orders.

37. What Should I Do If I Commit a Medication Error? Immediately assess the patient’s vital signs and physical status. Report findings to the primary care provider. 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.

38. Critical Thinking 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?