Medication Administration PDF

what is the study of how a drug works, its relationship to drug concentrations, and how the body responds?

pharmacodynamics

what is it referred to as when a drug is at tis highest concentrations?

peak levels

what is it referred to as when a drug is at its lowest level of concentration AND correlates to the rate of elimination?

trough levels

what is the goal of medication admin?

therapeutic levels

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

an allergic or hypersensativiy reaction

what is produced in an adverse reaction in response to tissue injury?

histamines

what is a severe, life-threatening reaction resulting from histamine release that produces dyspnea, hypotension, and tachycardia?

anaphylaxis

what is a potentially fatal drug reaction that develops 1-14 days following drug administration?

Stevens-Johnson Syndrome (SJS)

what are the manifestations of SJS (Stevens-Johnson Syndrome)?

respiratory distress, fever, chills, a diffuse fine rash, and then blisters

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

pharmacokinetics

what portion of pharmacokinetics is described:

drug enters the body

absorption

what portion of pharmacokinetics is described:

drug moves through the body

distribution

what portion of pharmacokinetics is described:

drug is changed in the body

metabolism

what portion of pharmacokinetics is described:

drug is removed from the body

excretion

what is the process of removing drugs from the body?

excretion

what is the primary organ responsible for drug excretion?

kidneys

what, other than the kidneys, are responsible for excretion?

skin, lungs, exocrine glands, and intestines

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

drug toxicity

what is a life threatening reaction that requires medical intervention to prevent death or permanent disability, or congenital anomaly?

Serious Adverse Drug Event (ADE)

what does trough level tell us?

how much the drug has been eliminated

how do you ananlyze peak and trough levels?

regularly scheduled lab results

what has to happen when a Serious Adverse Drug Event (ADE) occurs?

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

what is issued on medication that may produce lethal and iatrogenic results?

Black Box Warning (BBW)

what are medications categorized as that are known to cause fetal defects?

teratogenic

what is important to remember with anaphylaxis & SJS?

it can affect several body systems all at one time

what is the result of Stevens-Johnson Syndrome (SJS)?

their skin is sloughing off — there’s epidermal tissue on organs

what type of drug interaction is being described:

• anytime a patient is taking more than one medication

• may make a drug more potent or less potent

drug to drug

what are some examples of drug to drug interactions?

• polypharmacy (5+ meds)

• warfarin(anticoagulant — blood thinner) taken concurrent with ciprofloxacin(antibiotic), which causes increased effec of warfarin

in simple terms, what is pharmacokinetics?

the movement of drugs through our body

what type of drug interaction is being described:

you should assess the pt for ANY OTC or herbal supplements when completing medication reconciliation

drug to herbal supplements

what type of drug interaction is being described:

• can delay or enhance absorption of the medication

• affects metabolism and/or excretion thereby potentially causing drug toxicity

drug to food

what is an example of drug to food interactions?

medications that should be taken on an empty stomach — levothyroxine ;; fruit juices (grape interferes with statins(increases effectiveness) and immunosuppressants — warfarin, their vit K consumption has to be consistent )

why is it termed a “black box warning”?

because it will literally be outlined in a BLACK BOX

what is a big black box medication and why?

thalidomide — was OG used to treat morning sickness and caused serious and life threatening abnormalities (VERY teratogenic) ; antidepressants

what are some patient factors that affect medication effects?

weight, gender, age, culture & genetics

why does gender affect the effects of medications?

because males and females have different fat/muscle distribution

why does age affect the effects of medications?

• older adults have a harder time absorbing, metabolizing, and excreting meds due to changes in their GI tract, liver, and kidneys

• older pops usually a higher amt of fat vs muscle so meds can be stored longer in the fatty tissue which decreases the levels in the blood plasma

why does culture affect the effects of medications?

• alternative/complementary therapies

• food preferences

• herbal remedies

• genetic phenotypes may predispose to higher risk of certain diseases

what involves reviewing the client’s current medications, then addressing omissions and duplications?

medication reconciliation

what does medication reconciliation ensure?

continuity of care

what information should a complete medication order include (LIST MENTALLY)?

• client name

• date/time order written

• drug name (generic)

• dosage

• route

• frequency (for prn medications)

• indications for use

• provider’s signature

what would you do if a medication order was ambiguous?

you MUST seek clarification— do not ever assume. this type of order is unacceptable

what are the 7 rights of medication administration (ANSWER MENTALLY)?

1. right pt

2. right medication

3. right dose

4. right route of administration

5. right time of delivery

6. right reason

7. right assessment/documentation

how do you ensure the “right pt” is accomplished in the 7 rights of medication administration?

by verifying the pt’s identity using 2 client identifiers

how do you ensure the “right medication” is accomplished in the 7 rights of medication administration?

confirm the name and form of the medication is correct

how do you ensure the “right dose” is accomplished in the 7 rights of medication administration?

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

how do you ensure the “right route of administration” is accomplished in the 7 rights of medication administration?

by confirming the route (IV, IM, SC, etc.)

what is important to ask a pt when doing medication reconciliation?

WHY they’re taking a med

when do you accomplish medication reconciliation?

during general survey of admission and before discharge — ensuring updates happen every time anything changes

how do you ensure the “right time of delivery” is accomplished in the 7 rights of medication administration?

by confirming the time the drug is to be given and the last time the drug was administered

what does PRN mean?

as needed for

what does a STAT order mean?

within 30 min of ordering

what does an ASAP order mean?

within 30 min-hour of the order

how do you ensure the “right assessment/documentation” is accomplished in the 7 rights of medication administration?

by documenting the time the drug was given and any pertinent remarks

what are some additional rights that every pt has in relation to medical administration?

• right to refuse

• right to education

• right to response/evaluation

what does a “right to refuse” mean for a pt?

that the client has the right to refuse medication

what does a “right to education” mean for a pt?

that each pt deserved adequate education addressing what medication the client is taking, expected benefits, and side effects

what does a “right response/evaluation” mean for a pt?

that they deserve to have their response to a drug observed

what must be completed ?

the 3 medication checks that are additional safety strategies for medication administration

what are the 3 medication checks that you must complete with each administration?

1. med-MAR (Medication Administration Record)-dispensing device

2. prepared med-MAR (ensuring it’s prepared correctly for the correct pt at the correct time)

3. med-MAR-patient (checking pt id)

this is NOT meant to be efficient, it’s meant to be SAFE

what type of medications that, when administered either 30 minutes before or after the scheduled administration, can cause harm to the client or substandard pharmacological effect?

time-critical medications

what type of medications are defined as medications that can be administered between one and 2 hours early or late without causing harm or substandard pharmacological effects to the client?

non-time critical medications

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

high-alert meds

what are some examples of high alert meds?

insulin (low volume of med that has a high risk of error), opiates, narcotics, intravenous heparin (anticoag), injectable potassium and chloride

what is a strategy to reduce the risk of harm for high-alert meds?

double checks

how do you accomplish double-checks?

with 2 nurses verifying identical info before these drugs are administered

what route of drug admin is being described:

is administered into the GI tract

enteral

what route of drug admin is being described:

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

topical

what route of drug admin is being described:

administered by injection using a needle and syringe or catheter

parenteral

what medication type is being described:

• cost effective, convenient

• slower onset of action

• not appropraite for unconscious clients or clients w excessive vomiting and/or diarrhea

oral medications

what medication type is being described:

• rapid onset

• bypasses first-pass effect

• may cause irritation

• not appropriate for children

sublingual (SL) medications

what medication type is being described:

• instruct pt to place medication btwn cheek and gums until it dissolves

• rapid onset of action

• bypasses first pass effect

• decreased effect if swallowed

• client may report nausea if the medication has an undesirable taste

buccal

why is oral meds a slower onset?

because your GI has to dissolve, then process, then it gets to your bloodstream

what medication type is being described:

• can be administered to children, unconscious clients, or clients who are unable to swallow

• increased concentration achieved quickly

• NOT preferred by clients

rectal (PR)

what should you ensure before administering rectal (PR) meds?

that the rectum is empty of stool

what should you educate your patient on for rectal (PR) meds?

that they should refrain from passing stool for a minimum of 20 minutes once the suppository has been given

what is the “first pass affect”?

when you take an oral med and the stomach has to break it down / pass it

what are some conteraindications for rectal (PR) meds?

recent rectal surgery, rectal bleeding, pts at a risk for bleeding (aa low platelet count)

what medication type is being described:

• rapid onset

• can be used by unconscious, noncompliant, or clients unable to tolerate oral medication

• risk doe infection

• high cost

• risk for injury

intravenous (IV)

since IV meds put the pt at risk for injury, what would you do at a nurse?

assess the pt before and after administration

what medication type is being described:

• fast absorption compared to oral route

• soluble suspension substances can be given

• painful

• risk for injury

intramuscular (IM)

why do pts dislike buccal and sublingual meds?

because they sometimes taste very bad

what type of injury does IM med route put the pt at risk for?

nerve damage

what is the maximum volume for SQ med admin?

1.5 mL

what medication type is being described:

• varied absorption rates

• specific needle angle is very important

• ensure sites are rotated

subQ

when would rectal meds be given?

if pt couldn’t swallow

what angle should you insert the needle at for SQ med admin?

45-90 degree angle

what needle gauge range should you use for subQ?

25-30 gauge

what medication type is being described:

• administered between the dermal and epidermal layers using a hypodermic needle

intradermal

for intradermal med admin, what indicates that proper technique was accomplished?

the bleb

what angle should an intradermal injection be given?

5-15 degree

what are some examples for intradermal injections?

TB skin testing, allergy testing

what medication type is being described:

• effects can last for multiple days

• dosing varies due to client factors

• generally applied to the upper torso, chest, upper arms, or back, or behind the ears

transdermal

what are different intravenous injuries?

phlebitis & infiltration

what is phlebitis?

inflammation of the vein from an IV — an intravenous injury — will feel very warm because it’s activating the immune system

what is infiltration?

when infusing, and it collects in the surrounding tissue — it’s not going into the vascular system; usually causes pain and the site it cold to touch ; medication can be absorbed still, but not in the same way

what would you do if a pt was showing signs of infiltration?

stop the IV and then assess the pt with what that IV in mind (what was in that IV push)

what medication type is being described:

administered to the ear

otic

what can cause IV infiltartion?

weak veins, movement of needle, poor insertion, many factors at once

what should you ensure abt the medication when administering otically?

that the medication is at room temperature