Chapter 21 Medications review

Therapeutic Range :

the concentration of a drug in the blood serum that produces the desired effect without causing toxicity

Trough Life :

The point when the drug is at its lowest concentration

Half-Life :

time it takes for the amount of the drug’s active substance in your body to reduce by half

Unit dose system :

involves the pharmacy or manufacturer repackaging and relabeling an individual patient dose

Automated medication-dispensing system :

a machine containing medications such as routine medications, PRN meds, controlled drugs, and emergency medications. Machine acts like an automated bank machine.

Self-Administered supply :

system supplies each patient with the prescribed doses and quantities for a given period

Barcode medication Administration :

this system uses a lightweight handheld laser scanner, a laptop computer attached to a medication cart, and barcodes

Components of a med order :

• Medication Name - use generic/trade name → EHR may automatically enter “tall man lettering”

• Medication Dosage - amount & frequency of the dose

•  Route of Administration - orally, intravenously, and intramuscularly

•  Purpose Of Medication - indication for the use of the medication

•  Signature - date & time the prescription was written and signed by the prescribing

  provider

Routine/Standing orders:

order that is carried out for a specified number of days (ex: antibiotic) or until another order cancels it

PRN Orders :

doesn’t indicate a specific time period for administration of a medication, given as needed

Standing protocols :

written for medications to be administered in specific situations with criteria for administration outlined clearly for patients on a specific unit

Ex: standing protocol for a nurse working on a cardiac unit to administer a certain heart medication if the patient develops an irregular rhythm

One Time Orders :

written for a medication that will be given only once

Ex: pre-op med to help calm the patient before surgery

Stat Orders :

single order for a medication to be given immediately

Ex: furosemide 20 mg IV stat for fluid volume excess

Verbal Orders :

when a order is given in a situation where the provider and the nurse are physically present in the same room, only accepted in emergencies

Ex: Cardiopulmonary resuscitation or other lifesaving interventions

Telephone Orders :

discussion via telephone due to the provider not being available to write and sign the order

Fax Orders :

communicating via fax with provider

6 Rights of Medication Administration:

right patient, medication, dose, route, time, documentation

Prevent Medication errors :

• Inappropriate prescribing of the drug

• Extra, omitted, or wrong doses

• Administration of drug to wrong patient

• Administration of drug by wrong route or rate

• Failure to give medication within prescribed time

• Incorrect preparation of drug

• Improper technique when administering drug

• Giving drug that has deteriorated

What to do when a medication error has occurred?

• Check patient’s condition immediately observe for adverse effects

• Notify nurse manager and primary care provider

•  Write description of error and remedial steps taken on medical record

• Complete form used for reporting errors, as dictated by the facility policy

• Special event, event, unusual occurrence report

• Nurses are legally responsible for the drug s they administer therefore it is

  important to question any drug order suspected to be in error

• All involved in the process share the responsibility for a safe medication system

Medical History : Reconcile the names and doses of all patient medications

• OTC, prescribed, and non prescribed medications

•  Allergies

•  Prior to administering any medication to a patient, be aware of the patient’s medical

  diagnosis and general medical history

•  Drug or Alcohol abuse

Patient who has used opiates or alcohol frequently may require higher doses of sedatives or opiates to obtain the desired effect

Nonprescription Medications :

medications that can be purchased without a providers order

• SOLD OTC - FDA controls over the safety, effectiveness, and advertising of these drugs

•  Patient’s should be educated to discuss all desired nonprescription medications with the provider or nurse due to the possibility of interfering with prescribed medications or diagnostic testing.

  Examples:

  ●Hypercrium perforatum (St. John’s wort) used for mild depression

• Echinacea (coneflower) mild antibiotic

• Ginkgo Biloba (Maidenhair tree) used to increase blood circulation

11 Rights of Medication Administration

#1: Right Patient #2: Right Medication #3: Right Dose #4: Right Route #5: Right Time #6: Right Documentation #7: Right To Refuse #8: Right Education #9: Right Reason #10: Right Assessment

#11: Right Evaluation

Subcutaneous injection :

Subcutaneous tissue

Intramuscular injection :

Muscle tissue

Intradermal injection :

Corium (under epidermis)

Intravenous injection :

Vein

Intra-arterial injection :

artery

Intracardial injection :

Heart tissue

Intraperitoneal injection :

Peritoneal cavity

Intrasprinal injection :

Spinal canal

Intraosseous injection :

Bone

Intradermal Injections: purpose

used for sensitivity tests and local anesthesia

Intradermal Injections: location

administered into the dermis, just below the epidermis

Intradermal Injections: Angle administered

5-15 degrees

Intradermal Injections: absorption

Has the LONGEST absorption time of all parenteral routes

Intradermal Injections: reaction

Body’s reaction to the substances is easily visible

Intradermal Injections: sites

the inner surface of the forearm and the upper back, under the scapula

Intradermal Injections: needle

A 1⁄4” to 1⁄2”, 25 or 27 gauge needle is used and the angle of administration is 5 to 15 degrees

Intradermal Injections: dosage

The dosage given intradermally is small, usually less than 0.5mL

Subcutaneous injections: location

administered into the adipose tissue layer just below the epidermis and dermis

Subcutaneous injections: Angle administered

45 or 90 degrees

Subcutaneous injections: Sites

• Outer aspect of the upper arm

• Abdomen (from below the costal margin to the iliac crests)

• The anterior aspects of the thigh

• The upper back

• The upper ventral or dorsogluteal area

Intramuscular injections: Angle administered

90 degrees

Intramuscular injections: sites

ventrogluteal site, vastus lateralis site, deltoid muscle site, dorsogluteal site is no longer recommended

Intravenous Administration of Medication :

•  Delivers the drug directly into the bloodstream

• Medication has an immediate effect and cannot be recalled or actions slowed

•  Route most often used in emergency situations

Syringe size

• Small gauge (26 to 28 gauge), short (0.5 to 0.625inch) needle

•  Standard syringes are supplied in 3- ,5-, or 10-mL sizes

Needle size

Needle sizes 18-, 21-, 22-, 23-, or 25- gauge needles (26- to 30-)

Mixing Insulin

Medications are mixed in a syringe by first injecting appropriate amounts of air into each vial, then drawing up one medication into the syringe, and expelling any air, unneeded volume of medication. → The ordered volume of the second medication is then slowly added to the syringe containing the first medication. If the medication is added rapidly, too much of the second medication may be drawn up. If this occurs, the syringe and medications must be discarded.

Criteria for choosing equipment

Route of administration

Viscosity of the solution

Quantity to be administered

 Body size

 Type of medication

Reconstituting Medications

• Remove the caps from the both the medication and diluent vials, and clean the tops of the both vials with an alcohol wipe

•  Draw up the diluent into the syringe, and inject it into the medication vial

   Hold the medication vial and mix the medication and diluent until the medication has

  dissolved.

•  Draw the reconstituted medication into a syringe, and remove air and unneeded

  medication from the syringe.

•  Administer the medication as directed

Mixing Medications

•  #1: Withdraw enough air equal to the total amount of insulin

•  #2: Inject the air into the NPH without touching the insulin

•  #3: Inject remaining air into the regular insulin then withdraw the regular dosage

•  #4: Withdraw the NPH dosage

Equipment disposal

Purpose: To decrease risk of needlestick injuries and exposure to a patient’s blood

 Process: After administering an injection, activate an active design safety needle, if used, and then immediately place the syringe and needle in a sharps container

Heparin or Enoxaparin Administration (HIGH ALERT DRUG)

used to help prevent deep vein thrombosis (blood clots in the legs) and subsequent pulmonary embolism (blood clots in the lungs) bc subcutaneous injections of heparin frequently cause bruising

**Check the dose with an RN before administering to the patient

Insulin Administration

Administer subcutaneous using a 26- to 30- gauge needle to regulate an individual’s blood glucose levels
Intermediate insulin are sometimes as a basal insulin

Nutritional insulin:

given with meals to manage the carbohydrate in the food

Correctional Insulin :

insulin given on an as needed basis to manage elevations in the

blood glucose level

Documentation Of Medication Administration

#1: Name of the medication

#2: Dosage
#3: Route & Time of the Administration

#4: Name of person administering medication

#5: Site used for an injection

#6: Intentional or inadvertently omitted drugs #8: Medication errors
#7: Refused drugs

Older Adult Considerations:

• Swallowing difficulty

•  Physical condition which can influence choice of IM sites

•  Visual deficits

•  Increased risk for drug toxicity

•  Save or share meds due to limited income

•  Potential increased in side effects can lead to increased risk of falls/injury

Patient Teaching

• Review techniques of medication administrationj.

  ●  Remind the patient to take the medication as prescribed for the entire duration

  ●  Instruct the patient not to alter dosages without consulting a physician

● Caution the patient not to share medications

What should we consider about medication volume for IM injections?

Larger volumes of medication can be administered via IM injection compared to subcutaneous injections.

What equipment is used for IM injections?

3-mL syringe,
20-25 gauge,
1-3 inch needle

What is the injection technique used for IM injections?

Z-Track Method: Used for irritating medications to prevent tracking into subcutaneous tissue; involves displacing the skin before injection.

What are the common complications of IM injections?

Pain & discomfort.

Tissue damage.

Nerve or bone injury.

Infection.

What are the key safety points to remember for IM injections?

Use appropriate sites and techniques to minimize complications.

Assess muscle mass to determine the correct injection volume.

Rotate injection sites and maintain a record of used sites.

Ensure medications are appropriate for IM administration before proceeding.