Chp 21 Medication Administration

Components of medication order

• Client’s full name

• Date & time of prescription

• Name of medication (generic or brand)

  • TALL man letters

• Strength & dosage of medication

• Route of administration

• Time & frequency of administration

  • Exact times or number of time per day

• Purpose

  • “PRN for pain rate 4-7/10”

• Quantity to dispense & number of refills

  • discarched/outpatient

• Signature of prescribing providers

• Type of order:

  • Routine or standing

  • PRN

  • One-time 

  • STAT

• Telephone order

  • Only if necessary

  • Read back info

• Verbal orders

  • Emergency only

  • Read back info

Pharmacokinetics

• Process by which drug moves through the body & is eventually eliminated, includes actions of:

  • Absorption: medication enters bloodstream

  • Distribution: medication is delivered to target cells

  • Metabolism: medication chemically changed

  • Excretion: medication removal from the body

• adverse effects: harmful/dangerous side effect, requires intervention

• Side effects: minor adverse effects, predictable/expected

Rights of medication administration

1. right client

2. right medication

3. right dose

4. right time

5. right route

6. right documentation

• additional rights:

  • right education

  • right to refuse

  • right assessment

  • right evaluation

Initial assessment

• Medication history

  • Medication reconciliation

  • Routine, OTC, supplements/herbs

• Allergies & intolerances

• Medical history

  • Informs of possible drug metabolizing/eliminating issues

  • Prescribed medications

  • Pregnant or lactating

    • Teratogenic drugs

Prior to administering

• Check MAR

• Check allergies

• Check diet & fluid orders

• NPO & meds

  • Patients w/ diabetes

  • BP meds, digoxin, antiseizure, thyroid

• Patient data

  • Lab values, VS

    • Coagulation levels (PT/INR)

    • Liver function tests (LFTs) – AST/ALT/ALP

    • Renal function tests – BUN, Creatinine, GFR

    • Electrolytes – potassium levels

  • physical assessment

    • cognition/neuro status

    • lung/cardaic

    • GI motility

    • Urine output

    • Muscle mass

    • IV access

After administering

• Evaluate for therapeutic effect, adverse effects, of side effects

• document

Improving patient knowledge

• Planning

  • Identify client outcome of medication administration

    • Assess current knowledge if any, determine health literacy

  • Prioritize...administer critical medications first or know which medication need to be given prior to treatment

  • Patient will be able to:

    • State the purpose

    • Describe dosage, route, & timing

    • Identify side effcts & adverse effects & when to call a provider

    • Demonstrate safe-administration if possible

• IMPLEMENTATION

  • Avoid distractions during medication preparation

  • Prepare medications for one patient at a time

  • Check labels for medication name/concentration & measure doses accurately.

  • Follow medication administration rights

  • Do not give medications prepared by someone else

  • Use verbal rx only for emergencies and follow facility protocol for telephone prescriptions.

    • Nursing students CANNOT accept verbal or telephone orders

Evaluating medication effectiveness & documentation

• Response to medication & document

  • Document after medication administration

• Recognize adverse events & document/report them

• Notify provider/charge nurse of errors & implement corrective measure immediately

• Immediately assess the client following a medication error and notify the provider and nursing supervisors or charge nurse

• Incident report – w/in 24 hours of incident

Oral medications

• (PO – per os) are designed to be swallowed

  • Some medication can also be administered via feeding tube

    • Flush with minimum of 20-45mL of water or per policy

    • If not crushed properly can clog tube

  • Considerations: NPO or cannot swallow water/fluids or is nauseated/vomiting

  • Suction may be held 30 minutes after medication to allow for drug absorption

  • Swish and spit or swish and swallow medication

    • Give after other oral medications

  • Measure liquid oral medications with calibrated medicine cups/syringes

Sublingual route

• Rapid absorption

• Bypass first-pass metabolism

• Place under tongue and allow to dissolve

Buccal route

• Place medication on side of mouth (between gum and inner lining of cheek). 

• Opioids, antiemetics, neuroleptics, anxiolytics & sedatives

Lotions, creams & ointments

• Wear gloves or sterile swab when applying

  • Uses: Treat a skin or wound infection, symptoms of skin disorder to treats skin disease

Transdermal

• Absorbed through the skin

• Patches

  • Note date/time and initials on new patch

Ophthalmic

• Treats eye irritation, infections or glaucoma

  • Avoid touching the patient's eye or eye lid with tip of tube/dropper when applying

Otic

• Treats external ear infection or soften/remove ear wax

  • Using hot or cold otic solutions can cause vertigo, nausea & pain

Nasal

• Treat nasal congestion

  • Rebound nasal congestion (inflammation of the nasal mucosa causes worsening of the congestion, commonly occurs if a patient uses decongestant nasal sprays too frequently or for several days.)

Inhalers

• Induce anesthesia during surgery

• Treat respiratory disorders 

  • Via mechanical ventilator, handheld nebulizer, MDI

    • Bronchodilators

      • Assess before & after treatment

        • Think symptoms before & after treatment

Rectal medications

• Small cylindrical waxy base type medication

  • Laxatives, antiemetic suppository

    • Clean technique & patient in side-lying position

    • Lubricate suppository

  • Liquid medication via enema

    • Removal potassium

Vaginal medications

• Forms: foams, jellies, liquids, creams, tablets or suppositories

• Contraception

• Treat bacterial or yeast infection

• Induce labor (prostaglandin suppositories)

Parenteral

• Given by injection or infusion

  • IM, IV, subcutaneous, instar-spinal, intra-articular space, intradermal

    • Absorbed quicker = acts quicker

    • Assess muscle mass in older adults

• Needle diameter size -> Small gauge (diameter) = bigger number

  • 24-gauge needle – smaller diameter size

  • 18-gauge needle – larger diameter size

  • Filter needles -> used to trap any rubber/glass that could be drawn up with medication in vial/ampule

• May use needles system to draw up medications