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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.
