med admin

• right client

• right medication

• right dose

• right route

• right time of delivery

• right documentation

what are the 6 rights of medication administration?

Verify the client’s identity using two client identifiers

what is RIGHT CLIENT?

Confirm the name and form of the medication is correct.

what is RIGHT MEDICATION?

Check the medication you have against the order in the medical record

what is RIGHT DOSE?

Confirm the route (IV, IM, SC, etc.).

what is RIGHT ROUTE OF ADMINISTRATION?

Confirm time drug is to be given and the last time the drug was administered

what is RIGHT TIME OF DELIVERY?

Document the time the drug was given and any pertinent remarks.

what is RIGHT DOCUMENTATION?

right to refuse

Client has the right to refuse the medication.

right assessment

Confirm that the medication is appropriate for the client’s condition.

right education

Provide adequate education addressing what medication the client is taking, expected benefits, and side effects.

right response/evaluation

Observe the client’s response to the drug.

• check MAR or medication information device upon removal of drug from dispenser

• check drug upon preparation

• check drug prior to administration

what are some additional safety strategies for medication administration?

medication error

Any preventable event that may cause inappropriate medication use or jeopardize patient safety

1. assess pt condition

2. notify provider

3. when pt stable, file an incident report

4. report near misses and incidents that cause no harm

nursing steps for when a medication error occurs

reconcile medications

the formal process of comparing a patient's current medication regimen against new orders or transition points to prevent mistakes like omissions, duplications, or dangerous interactions

Medication Reconciliation

what needs to be performed anytime the care of the client is transferred from one health care professional to another?

generic name

the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. Pharmacopeia

trade/brand/proprietary name

This is the name under which a manufacturer markets the medication.

pharmacological classifications

• Effect of medication on body system

• Symptoms the medication relieves

• Medication’s desired effect

Pharmacodynamics

the study of how a drug works, its relationship to drug concentrations, and how the body responds.

Peak plasma level

is when a drug is at its highest concentration, not necessarily at its most therapeutic level.

Trough serum levels

the lowest level of concentration of a medication that correlates to the rate of elimination.

Black Box Warning (BBW)

issued on medications that may produce lethal and iatrogenic results.

Serious Adverse Drug Event (ADE)

• A life-threatening reaction that requires medical intervention to prevent death or permanent disability, or congenital anomaly.

• Must be reported to the FDA to improve safety outcomes, revising drug labels and warnings, and, when needed, to withdraw drugs from the market.

anaphylaxis

a severe, life-threatening reaction resulting from histamine release producing dyspnea, hypotension, and tachycardia.

fatal drug reactions

• anaphylaxis

• stevens-johnsons syndrome(SJS)

Stevens-Johnson Syndrome (SJS)

• potentially fatal drug reaction that develops 1-14 days following drug administration.

• manifested by respiratory distress, fever, chills, a diffuse fine rash, and then blisters.

Allergic or hypersensitivity reaction

• develops when the body perceives a foreign substance (medication) as an allergen, producing antibodies to counteract the allergen.

• The adverse reaction produces histamine in response to tissue injury.

medication interactions

One medication modifies the action of another

medications tolerance

More medication is required to achieve the same therapeutic effect

medication dependence

• Physical

• Psychological

Pharmacokinetics

is the study of the absorption, metabolism, distribution, and excretion of drugs in the human body.

dissolution of a medication

is dependent upon its initial state and route of administration.

oral or enteral

what is the slowest medication administration route?

distribution

the process of drug delivery to the target organ or tissues that occurs before metabolism and excretion.

metabolism/biotransformation

the process of converting a medication to a form that is easily excreted from the body.

liver

Most drugs are metabolized by

mesenteric vein and portal vein into the liver

Oral medications pass from the small intestine to the hepatic circulation via the

first-pass effect

excretion

is the process of removing drugs from the body.

kidneys

the primary organ responsible for drug excretion.

drug toxicity

develops when the body is unable to metabolize and excrete a drug.

skin, lungs, exocrine glands, and intestines

excrete medications to a lesser extent.

Teratogenesis

drug known to cause fetal defects; Pregnancy risks

• Standing orders or routine medication orders

• PRN orders

• Single (one-time) orders

• STAT orders

• Now orders

• Prescriptions

Types of Medication Orders

STAT within 15-30min and Now within 60-90min

difference between STAT order and now order?

• Client’s name

• Date/time order written

• Drug name (generic)

• Dosage

• Route of administration

• Frequency

• Indication for use

• Provider’s signature

A complete medication order should contain the following information

Insulin, opiates, narcotics, intravenous heparin, and injectable potassium chloride

what are some high alert medications?

high alert medications

drugs that are associated with an increased risk of causing considerable client harm when they are administered in error.

double checks with two nurses

what strategy should be used when administering high alert drugs?

• enteral

• topical

• parenteral

routes of drug administration

enteral

administered directly into the gastrointestinal (GI) tract

topical

applied directly to the skin, mucous membranes of the eyes, nose, respiratory tract, vagina, rectum, and urinary tract

parenteral

• administered by injection using a needle and syringe or a catheter

  • Intradermal

    Subcutaneous

    Intramuscular

    Intravenous

    
    

Intracardiac and intraarticular

drug Routes usually limited to physicians

other routes of drug administration

Epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, and intraarterial

Time-critical medications

when administered either 30 minutes before or after the scheduled administration time can cause harm to client or substandard pharmacological effect.

Non-time critical medications

medications that can be administered between one and two hours early or late without causing harm or substandard pharmacological effects to the client.

insulin

• hormone used to treat diabetes.

• administered by injection because the GI tract breaks down and destroys an oral form.

100-unit

what syringe should be used for insulin injection?

Rapid-, short-, intermediate-, and long-acting

Insulin is classified by rate of action:

onset, peak, and duration

what should the nurse know for each of your patients’ ordered insulin doses.

rapid acting insulin

• onset 15 minutes.

• Peak 1-2 hours.

• Make sure they eat within 15 minutes

short acting insulin

• Onset 30-60 minutes.

• Peak 2-5 hours.

• Often used in sliding scale protocols.

intermediate acting insulin

• Onset 1-2 hours.

• Peak 4-8 hours.

• White opaque or cloudy solution.

• Can combine with regular insulin.

• Confusion

• Irritability

• Tremor

• Sweating

signs of hypoglycemia

glucagon

Treatment for hypoglycemia

• Impaired Health Maintenance

• Lack of Knowledge (Medication)

• Nonadherence (Medication Regimen)

• Adverse Medication Interaction

• Complex Medication Regimen (Polypharmacy)

Nursing problems that may apply during medication administration

Intradermal

shallow medication delivery method administered directly into the dermis layer of the skin, positioned just beneath the epidermis

Inner foreman

Upper back

Hairless, lesion free

Intradermal location sites

1ml

Intradermal syringe size

25-27 gauge

Intradermal needle size

1/4-5/8

Intradermal needle length

0.01-0.1ml

Intradermal injection range

5-15*

Intradermal needle angle

*Bevel up

*Insert 1/8 below surface

*Cover with alcohol pad

*Do not massage or bandaid

*Read in 48-72 hours

Intradermal administration requirements

Subcutaneous injection

the injection is given in the fatty tissue, just under the skin.

*Outer posterior upper arm

*Abdomen (avoid 2 inch from

umbilicus)

*Anterior aspect of thigh

*Lower back

*Scapula

Subcutaneous injection site

Tb

whats a common type of Intradermal injection?

*TB syringe

for less than

1ml

*1ml-3ml

Subcutaneous syringe size

25-31g

Subcutaneous needle size

3/16-5/8

Subcutaneous needle length

0.3-1ml

NO MORE THAN 1.5ml

Subcutaneous injection amount

45-90*

Subcutaneous injection angle

*Rotate sites

*Discuss home disposal

*Do not aspirate with insulin

or lovenox

*Leave nitrous bubble in

lovenox

*Hold upside down to alter

dose

Subcutaneous administration requirements

Deltoid

Ventrogluteal

Vastus lateralis

Types of intramuscular injection

2 person confirmation

What is required PRIOR to giving a subcutaneous injection?

up to 2ml

Deltoid injection amount

Muscle of upper arm

Deltoid injection site

*Relax arm, place pinky on

acromion process (knobby

part)- injection is between 3-4

fingers

*3-5 cm below acromion

process

Deltoid injection strategy

1-5ml

(usually 3ml)

Deltoid syringe size

21-25 gauge

Deltoid needle size

Adult 1-1.5

Child 1/2-1

Deltoid needle length

Up to 2ml for adults

Deltoid injection amount

90

Deltoid injection angle

*Gate theory

*Always aspirate

*Keep alcohol pad close

*Have bandaid ready

Deltoid administration requirements

*R hand on L hip, pace palm on

greater trochanter

*Point thumb to groin

*Point index finger to anterior

superior iliac spine

*Extend middle finger along

iliac crest toward buttocks

*Injection site in triangle

Ventrogluteal injection strategy

1-5ml

Ventrogluteal syringe size

21-25g

18g viscus

Ventrogluteal needle size

1-1.5

Child 1/2-1

Ventrogluteal needle length