Chapter 31 Medication Administration

Federal, state, and local regulations

These regulations affect medication practices and must be adhered to by healthcare providers.

NPAs

State nursing practice acts the protect the patients.

Medication names

Can be classified into generic, brand, and chemical names, each serving a specific purpose in prescribing and administration.

Medication Classification

Refers to the categorization of medications based on their effects, therapeutic uses, and chemical characteristics, which helps guide prescribing and administration.

Medication Forms

Refers to the physical forms in which medications are available, such as tablets, capsules, liquids, and injections, each designed for specific routes of administration.

Absorption

The process by which a drug enters the bloodstream after administration, influencing its onset of action and effectiveness.

Distribution

The dispersion of a drug throughout the body fluids and tissues after absorption, which affects the drug's concentration at the site of action.

Metabloism

The biochemical process by which the body transforms and breaks down medications, often occurring in the liver, influencing their efficacy and elimination.

Excertion

The process by which drugs and their metabolites are eliminated from the body, primarily through the kidneys, affecting drug duration and effectiveness.

Pharmacokinetics

The study of how drugs move through the body, including absorption, distribution, metabolism, and excretion.

Therapeutic effects

Intended outcomes of medication administration.

Adverse Effects

Undesirable effects that occur as a result of medication.

Side Effects

Secondary effects of a medication that may occur alongside the intended therapeutic effects, often mild and temporary.

Idiosyncratic Reaction

An unusual, unexpected response to a medication that is specific to an individual, often not related to the drug's pharmacological action.

Allergic Reactions

Hypersensitive responses to a medication, which can range from mild symptoms like rashes to severe reactions such as anaphylaxis.

Minimun Effective Concentration

The lowest concentration of a drug in the body that produces the desired therapeutic effect without causing toxicity.

Therapeutic range

The concentration range of a drug in the bloodstream that achieves the desired effect without toxicity.

Biological Half-Life

The time required for the concentration of a drug in the body to be reduced by half.

The 4 Parenteral Routes

Medication administration are intravenous, intramuscular, subcutaneous, and intradermal.

Inhalation

A route of administration where medication is delivered through the respiratory system.

Intraocular route

A method of delivering medication directly into the eye using a device like a contact lens or a disc.

Critical Thinking in Medication Administration

Involves the Eleven Rights to ensure safe and effective medication delivery.

Types of Orders in acute care agencies

Standing orders/Routine Orders, prn order, single order, stat orders, now orders and prescriptions.

Medication Errors

Preventable events that may cause harm due to medication administration failures. Can be caused by abbreviations.

When the medication error first occurs the nurse should

Assess the patient and notify the healthcare provider immediately, then prepare an incident report.

Needlestick Safety and Prevention Act

A regulation to help prevent injuries during medication administration.

Pharmacist's Role

Dispenses medications, advises, and helps prevent medication errors.

Pediatric Doses

Doses often calculated based on weight for children.

Eleven Rights

1. Right patient

2. Right Medication

3. Right route

4. Right does

5. Right time

6. Right reason

7. Right assessment

8. Right Education

9. Right to refuse

10. Right Documentation

11. Right Evaluation

Oral Administration

Refers to medication given by mouth, including various forms like pills and liquids. There is sublingual and buccal administration to (buccal is check and sublingual is under the tongue)

Intravenous Administration

A method of delivering medication directly into the bloodstream.

Minimum Effective Concentration

The lowest concentration of a medication that produces the desired effect.

Household Measurements

Less precise measurement system often used for patient education.

Nursing Process in Medication Administration

Systematic approach involving assessment, diagnosis, planning, implementation, and evaluation.

Injection Sites

Specific body areas where different types of injections are administered.

Topical Applications

Refers to medications applied directly to the skin or mucous membranes.

Assessment

The first step in the nursing process, which involves gathering comprehensive information about the patient's health status and medication needs.

Analysis and nursing diagnosis

Impaired health maintenance, lack of knowledge, non-adherence, adverse medication interaction and complex medication regimen

Breath-actuated metered-does inhalers (BAIs)

Inhalers that release medication automatically when the patient inhales, allowing for more coordinated delivery of the medication into the lungs.

Dry Powder Inhalers (DPIs)

Powder medication the is then inhaled and then turn into an aerosol .

Preparing an injection from an ampule

Snap off ampule neck, aspirate medication into syringe using filter needle, replace filter needle with an appropriate size needle or needless device. Then administer the injection

Preparing an injection from a vial

If dry, use solvent or diluent as needed, inject air into vial, label multi-dose vials after mixing and refrigerate remaining doses if needed.

Mixing medication from vial and an ampule

Prepare medication from the vial first, then use the same syringe and filter needle to withdraw medication from the ampule

Mixing medication from two vials

Do not contaminate one medication with another, ensure that the final does is accurate, maintain aseptic technique.

Topical Medical Applications

1. Skin application: lotions, pastes and ointments having systemic/ local effect

2. Nasal Instillation: Medication via sprays drop or tampons

3. Eye Instillation

4. Ear Instillation

5. Vaginal Instillation

6. Rectal Instillation

Pressurized metered-does inhalers (pMDIs)

Devices used to deliver medication directly to the lungs in a specific dose, often used for asthma or chronic obstructive pulmonary disease (COPD) management.

Subcutaneous Injections

The stomach, the thighs, the back of arm and the upper but, needle should be 5/8 inchs and should go in at 45 degrees

Intramuscular Injection

Should be done at ventrogluteal, vastus lateralis and deltoid, the angle of insertion is 90 degrees.

Ventrogluteal site

Gluteus medius, preferred and safest site for all adults, children and infants. There are two methods the V and G.

Vastus Lateralis

Used for adults and children, use middle third of muscle for injection and often used for infants toddlers and children receiving biologicals.

Deltoid

Not well developed in many adults, proximity to nerves and artery create potential for injury, volume less than 2 mL, site is three fingers widths below the acromion process.

Intradermal Injection

Angle for this is 5-15 degrees and is primarily used for skin testing sites.