NUR215 Medication Administration

What is Pharmacokinetics?

How medications enter the body (absorption), reach their site of action (distribution), are metabolized (metabolism), and exit the body (excretion).

What are five (5) factors that influence absorption?

(1) Route of administration,

(2) Blood flow to the site of administration,

(3) Body surface area,

(4) Lipid solubility,

(5) Client-specific factors.

What are five (5) factors that influence distribution?

(1) Physical/chemical properties of the medication,

(2) Physiology of the person taking the medication,

(3) Circulation,

(4) Membrane permeability,

(5) Protein binding.

What are two (2) factors that influence metabolism?

(1) Genetics and (2) Age.

True or False?

Medications are excreted through the kidneys, skin, bowel, lungs, liver, and exocrine glands.

True.

True or False?

Chemical makeup of the medication determines the organ of excretion.

True.

What are the six (6) types of medication actions (effects)?

(1) Therapeutic effect,

(2) Adverse effect,

(3) Side effect,

(4) Toxic effect,

(5) Idiosyncratic reaction,

(6) Allergic reaction.

What is a therapeutic effect?

Expected/predicted response.

What is an adverse effect?

Unintended/undesirable/unpredicted response.

What is a toxic effect?

Accumulation of medication in the bloodstream.

What is an idiosyncratic reaction?

Unpredictable; Over or under-reaction/different than normal.

What is an allergic reaction?

Unpredictable response to a medication.

True or False?

Drug to drug interactions are when one medication modifies the action of another.

True.

True or False?

Drug-food interactions are the effects of nutrients are pharmacokinetics.

True.

What are six (6) factors that influence medication actions?

(1) Weight, (2) Sex, (3) Genetics, (4) Culture, (5) Pregnancy status, and (6) Age.

What is polypharmacy?

Use of multiple medications.

What is the risk for polypharmacy? Who is at risk?

Adverse drug interactions; older adults with chronic conditions.

What information makes a medication order/prescription from a provider complete (7)?

(1) Patient's full name,
(2) Date/time the order was written/entered into the computer,

(3) Medication name,

(4) Dosage,

(5) Route,

(6) Time/frequency,

(7) Provider signature.

Discuss the nurses' role in medication administration ~ (6-7😏):

(1) Determine if medications ordered are correct,

(2) Assess client's ability to self-administer,

(3) Determine medication timing,

(4) Administer medication correctly,

(5) Closely monitor side effects,

(6) Provide patient education,

(7) DO NOT delegate to AP.

What is a medication error?

Any avoidable event that could result in incorrect use or client injury when a medication is with a nurse, provider, or client.

How do medication errors occur (6)?

(1) Failing to follow the rights of medication administration,

(2) Incomplete or inaccurate client assessment,

(3) Using inappropriate techniques,

(4) Ineligible/incomplete provider prescriptions,

(5) Interruptions,

(6) Overriding AMDS.

True or False?

Nurses are the last line of defense in medication administration.

True.

True or False?

Always report medication administration errors.

True.

How can nurse’s prevent medication errors from occurring:

7 rights

• Right Patient: Check 2 identifiers (Name/DOB).

• Right Drug: Check label 3 times against the MAR.

• Right Dose: Verify calculations; check strength.

• Right Route: Confirm (PO, IV, IM, etc.) and site.

• Right Time: Administer within the allowed window.

• Right Reason: Confirm the drug matches the diagnosis.

• Right Documentation: Record immediately after giving

(1) TACTIS:

T: Therapeutic effect (what does the medication do?)

A: Action (how does the medication work in the body?)

C: Contraindications (when to NOT give the medication)

T: Toxic effects (too much medication in system)

I: Interventions (what will the nurse do BEFORE/DURING/AFTER?)

S: Safe dose

What are the six (6) rights of medication administration?

(1) Right medication,

(2) Right dose,

(3) Right client,

(4) Right route,

(5) Right time,

(6) Right documentation.

True or False?

Check rights of medication administration 3x

True.

When do you check rights of medication administration (3)?

(1) Removing medication from ADMS,

(2) Taking the medication out of packaging and compare to EMAR,

(3) At bedside and compare to EMAR.

What is medication reconciliation?

Maintaining an accurate and up-to-date list of client's medications.

When is medication reconciliation performed (3)?

(1) Upon admission,

(2) Upon transition of care,

(3) Discharge.

What are four (4) technological advances in medication administration?

(1) AMDS,

(2) Barcode scanning,

(3) EMAR,

(4) Computerized order entry.

What are the three (3) largest categories of medication administration?

(1) Enteral, (2) Parenteral, and (3) Topical.

What is the safest and most convenient route of medication administration?

Oral route.

True or False?

Oral medications have a slower onset of action and more prolonged effect.

True.

True or False?

When giving a sublingual medication, instruct the patient to NOT (1) swallow, (2) chew, or (3) drink.

True.

True or False?

When giving a buccal medication, instruct the patient to alternate cheeks each dose, and NOT (1) swallow, (2) chew, or (3) drink.

True.

Which route of medication administration is for client's with NG and PEG tubes?

Enteral medication administration.

True or False?

For enteral medication administration, liquids are preferable to prevent clogging of NG or PEG tube.

True.

True or False?

For enteral medication administration, crush medications and mix with warm water.

True.

What is clogged tubing? Misconnected tubing?

When NG or PEG tube is clogged; Feeding tube connected to IV.

Which route of medication administration are applied locally to skin.

Topical.

What are seven (7) examples of a topical medication?

(1) Transdermal patch,

(2) Ophthalmic,

(3) Otic,

(4) Nasal,

(5) Intravaginal,

(6) Rectal,

(7) Inhalation medications.

True or False?

Always clean skin, use gloves when administering a transdermal patch.

True.

What do you document in regard to transdermal patch administration?

Document patch or medication location/removal on the EMAR.

True or False?

AVOID CORNEA when administering ophthalmic medications.

True.

True or False?

AVOID TOUCHING the eye or eyelid with the dropper.

True.

True or False?

ONLY apply the medication to the affected eye.

True.

True or False?

Never share eye medications.

True.

When are otic medications used?

Local infection/inflammation.

At what temperature are otic medications administered?

Room temperature.

True or False?

AVOID TOUCHING the ear with the dropper.

True.

True or False?

Check for eardrum rupture before administering otic medications.

True.

True or False?

Never occlude the ear canal.

True.

What is the most commonly administered form of nasal intallation?

Decongestant spray.

What is a potential risk of decongestant spray?

Rebound effect, congestion worsens.

True or False?

When giving a suppository, use a gloved hand.

True.

What type of topical medication is bullet-shaped?

Rectal suppositories.

True or False?

Rectal suppositories are rounded to prevent trauma.

True.

True or False?

Rectal suppositories may require an enema before administration.

True.

What shape do inhalation medications take?

Small droplets.

True or False?

Inhaled medications are inhaled through the trachea to the lungs.

True.

True or False?

Inhaled medications are used ton treat respiratory conditions.

True.

What are the four (4) parenteral medication routes?

(1) Intradermal,

(2) Subcutaneous,

(3) Intramuscular,

(4) Intravenous.

Which parenteral medication route is most commonly used for skin testing such as TB?

Intradermal.

Are intradermal injections slow or fast absorption?

Slow absorption from dermis.

What is the angle of insertion for intradermal injections?

5-10 degrees.

True or False?

A small "bleb" (or wheal) will form post-injection.

True.

Which parenteral medication route is placed in loose connective tissue under the dermis?

Subcutaneous.

True or False?

Subcutaneous absorption is SLOWER than IM injections.

True.

What is the angle of insertion for subcutaneous injections?

45-90 degrees based on client's weight.

True or False?

Insulin is most commonly given via subcutaneous injection.

True.

Which parenteral medication route is absorbed faster than subcutaneous injections?

Intramuscular.

True or False?

There are many risks with Im injections.

True.

What is the angle of insertion for intramuscular injections?

90 degrees.

What are four (4) sites for intramuscular injections?

(1) Deltoid,

(2) Vastus Lateralis,

(3) Ventral gluteal site,

(4) Dorsal gluteal site.

Which parenteral medication route is absorbed the quickest?

Intravenous.

What are three (3) examples of IV injections?

(1) Continuous fluids, (2) Piggybacks, and (3) IV push.