Med Admin 1 & 2

Nurse Responsibilities

Interpret orders, prepare/administer meds, teach patient, document, evaluate response.

What medication task can student nurses NOT do?

Transcribe orders or take verbal/telephone orders.

3 Medication Names

Chemical, generic, trade/brand.

Chemical name

Describes molecular structure of the drug.

Generic name

Official drug name used in references like CPS.

Trade/Brand name

Manufacturer’s name for the medication.

Drug classification

Describes what the drug does and its effect on the body.

Example of multiple drug classifications

Aspirin = analgesic, antipyretic, anti-inflammatory.

Types of drug preparations

Tablet, capsule, liquid, patch, cream, etc.

Critical rule for drug preparations

Always administer medication in prescribed form.

Pharmacokinetics

What the body does to the drug.

4 parts of pharmacokinetics (ADME)

Absorption, distribution, metabolism, excretion.

Absorption

Movement of drug from entry site into bloodstream.

First-pass effect

Oral drug metabolized before reaching circulation.

Bioavailability

Amount of drug reaching target cells.

Distribution

Movement of drug through bloodstream to tissues.

Albumin and drugs

Only unbound drugs are active.

Who is at risk for low albumin toxicity?

Older adults, liver disease, malnutrition.

Metabolism

Breakdown of medication into inactive form mainly in liver.

Risk with poor liver function

Drug accumulation and toxicity.

Excretion

Drug leaves body through kidneys, lungs, skin, bowel, mammary glands.

Main organ for excretion

Kidneys.

Half-life

Time for 50% of drug to be eliminated.

Therapeutic effect

Desired effect of medication.

Side effect

Predictable unintended effect.

Adverse effect

Severe harmful effect requiring drug stoppage.

Toxic effect

Harm from accumulation, overdose, or impaired metabolism.

Idiosyncratic reaction

Unpredictable drug reaction.

Allergic reaction

Immune response to medication.

Signs of allergic reaction

Rash, hives, itching, rhinitis.

Anaphylaxis

Life-threatening allergic reaction causing bronchoconstriction and circulatory collapse.

Nursing action for anaphylaxis

Stop drug, notify prescriber, initiate protocol.

Medication interaction

One drug alters another drug’s effect.

Polypharmacy

Use of multiple medications.

Who is most affected by polypharmacy?

Older adults.

Synergistic effect

Combined drugs produce greater effect together.

Example of synergistic effect

Alcohol + CNS depressants.

Why is grapefruit juice dangerous with statins?

Blocks CYP3A4 causing toxic drug levels.

Medication response goal

Maintain constant therapeutic blood level.

Onset

Time when drug effect begins.

Peak

Highest drug concentration.

Trough

Lowest drug concentration.

Duration

Length of time drug effect lasts.

Medication order

Legal written direction by prescriber.

Routine order

Ongoing medication order.

Stat order

Immediate one-time order.

Single order

One-time scheduled order.

Standing order

Condition-based order.

PRN order

As-needed order requiring nursing judgment.

7 required parts of a medication order

Patient name, date/time, drug, dose, frequency, route, prescriber signature.

Medication reconciliation

Creating accurate medication list during admission, transfer, discharge.

Purpose of medication reconciliation

Prevent errors and polypharmacy.

Nurse’s role in medication administration

Know drug, assess safety, administer correctly, monitor, document, report reactions.

10 Rights of medication administration

Right client, medication, dose, route, time, documentation, reason, refuse, education, evaluation.

Right client

Use 2 identifiers like name and DOB.

Right dose

Usually no more than 3 tablets.

Right time

Give within ±30 minutes depending on policy.

Right documentation

Never sign before giving medication.

Right to refuse

Patient can refuse medication.

What should nurse do if patient refuses medication?

Ask why, educate, notify prescriber, document.

Client education must include

Reason, action, side effects, precautions.

Right evaluation

Assess effectiveness, side effects, adverse reactions, interactions.

3 Checks of medication administration

First check, second check, third check.

First check

When removing medication from drawer.

Second check

After preparation.

Third check

Before returning or administering medication.

During all 3 checks verify

Right client, medication, dose, route, time.

Also check during 3 checks

Allergies, expiry, transcription.

3 A’s at bedside

Allergies, assessment, armband.

Medication administration considerations

Keep meds packaged until bedside, never leave unattended, stay until swallowed.

Best patient position for oral meds

Upright to prevent aspiration.

Oral medication route

Most common and easiest route with slower onset.

Contraindications for oral meds

Nausea/vomiting, GI obstruction, gastric suction, unconsciousness, decreased LOC, increased RR.

Medications that should NOT be crushed

Enteric-coated, sustained-release, sublingual/buccal meds.

Liquid medication measuring under 10 mL

Use oral syringe.

Liquid medication measuring 10 mL or more

Use medication cup.

How to pour liquid meds

Label facing palm and measure at meniscus.

Scored tablets

Only tablets that may be safely split.

Important oral med rule

Avoid mixing medications together.

Best fluid for medications

Water.

Safe medication disposal for needles

Yellow sharps container.

Safe medication disposal for medications/vials

Blue pharmaceutical container.

Federal medication regulation agency

Health Products and Food Branch (HPFB).

HPFB responsibilities

Assesses safety, approves drugs, licenses production sites, inspections, recalls.

Food and Drug Act regulates

Drug composition, strength, purity, packaging, labeling, storage.

Products covered by Food and Drug Act

Drugs, herbs, natural health products.

Provincial regulatory body in Manitoba

College of Registered Nurses of Manitoba (CRNM).

CRNM role

Sets standards for safe medication practice.

Examples of CRNM standards

Entry-level competencies, scope of practice, RN authorized prescriber.

Negligence

Failure to meet standard of care.

Example of negligence

Not checking patient identification.

Site-level medication policies

Hospital policies that follow federal and provincial standards.

Examples of site-level policies

Auto-stop antibiotics and high-risk med restrictions.

Legal aspect of medication administration

Nurse is responsible even if order came from provider.

What unsafe orders should nurses question?

Incomplete or unsafe orders.

Can medication administration be delegated?

No.

Standards of practice responsibilities

Interpret orders, reconcile meds, administer, monitor, report errors.

Safety culture

Focuses on reducing system errors and interruptions.

Examples of interruption reduction

“Do not disturb” zones and medication prep areas.

Medication error

Preventable event causing inappropriate therapy or harm.