Module 9: Concepts of Medication Administration Part I

metric system

-most logically organized

-never use a trailing zero, but always use a leading zero in front of the decimal point

household system

-most familiar to individuals

-disadvantage of inaccuracy

solutions

solid dissolved in fluid, concentration is expressed as:

-units of mass/units of volume (g/L, mg/mL)

-percentage (10% solution)

-proportions (1/1000)

chemical medication name

provides the exact description of medication's composition

generic medication name

listed in the U.S. Pharmacopeia

trade medication name

brand or proprietary name. This is the name under which a manufacturer markets the medication.

effect of medication on body system; symptoms the medication relieves; medication's desired effect

What are three ways medications are classified?

medication forms

Solid, liquid, other oral forms; topical, parenteral; forms for instillation into body cavities

absorption, distribution, metabolism, excretion

What are the four factors of pharmacokinetics?

absorption

passage of medication molecules into the blood from the site of administration

factors that influence absorption

- Route of administration

- Ability of the medication to dissolve

- Blood flow to the site of administration

- Body surface area

- Lipid solubility

distribution

-circulation

-membrane permeability

-protein binding

metabolism

biotransformation occurs under the influence of enzymes that detoxify, break down, and remove active chemicals

excretion

medications exit the body through various routes

therapeutic effect

Type of Medication Action: expected or predicted physiological response

adverse effect

Type of Medication Action: unintended, undesirable, often unpredictable

includes side effect, toxic effect, idiosyncratic reaction, and allergic reaction

side effect

Type of Medication Action: predictable, unavoidable secondary effect

toxic effect

Type of Medication Action: accumulation of medication in the bloodstream

idiosyncratic reaction

Type of Medication Action: overreaction or under-reaction or different reaction from normal

allergic reaction

Type of Medication Action: unpredictable response to a medication; can be mild or severe (anaphylactic)

medication interactions

one medication modifies the action of another

medication tolerance

more medication is required to achieve the same therapeutic effect

medication dependence

Physical or psychological reliance on a medication

medication timing

therapeutic range, peak, trough, half-life, plateau, time-critical medication, patient teaching

oral routes

-swallow or tube (pills, liquid)

-sublingual administration

-buccal administration

topical routes

skin and mucous membranes

inhalation routes

A route of drug administration through the respiratory system where the large surface area and high vascularity cause a rapid response.

parenteral routes

ID, SUBQ, IM, IV

miscellaneous routes

epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, intraarterial

medication safety checks

1. Before you pour or remove the medication from the drawer.

Check the medication label against the MAR.

2. After your pour or remove the medication.

Verify the label against the MAR.

3. At the bedside before administering.

Check the medication again.

Verify at the bedside w/the MAR and use at least 2 identifiers.

medication errors

any preventable event that may cause inappropriate medication use or jeopardizes patient safety

common incidents victim to medication errors

chronic lower respiratory diseases, accidents, stroke, Alzheimer's disease, DM

A. Assess

B. HCP

C. incident report

D. reconcile

Nurse's Role in Medication Errors

Determine effect on patient and intervene to offset any adverse effects of the error.

1. (A) the patient's condition.

2. Notify the (B).

3. Prepare and file an (C)

-Report near misses and incidents that cause no harm

-During transitions in care, (D) medications

medication, dose, patient, route, time, documentation

Identify the six rights of medication administration.

Medication Safety Check Considerations

-check 3x

-check expiration date

-always clarify unclear medications

-open meds in front of patient

-advise them what you're administering as you go

Nursing Assessment Before, During, and Following Administration of Medication

history, allergies, medications, diet history, perceptual/coordination problems, current condition (BP, LOC), attitude about medication use, learning needs

medication prescribers

Physicians, nurse practitioners, physician's assistants

medication orders

written, verbal, telephone

medication abbreviations

-can cause errors; use cation

-know prohibited and error-prone abbreviations

types of orders in acute care agencies

Standing or routine

PRN

Single (one-time)

STAT

Now

Prescriptions

standing medication orders

A set of prewritten orders that a nurse can use to administer treatments and meds and is usually written by a specific practitioner, which allows nurses to administer certain meds; can be used until cancellation or expiration of treatment plan

PRN orders

Similar to standing orders, except that orders of this type are executed according to the patient's needs.

single (one-time) orders

medication to be given once at a specified time

STAT orders

given immediately in an emergency

now orders

- 90 minutes to give medication

- 1 time order

Nurse's Role In Medication Administration

Determines medications ordered are correct

-use clinical judgment; if medication dose & route prescribed are safe for patient

-understand purpose, dosage, route of administration, SE

-contact HCP for clarification if prescription is difficult to read, missing required information, contains prohibited/unfamiliar abbreviations

Nurse's Role In Medication Administration

-assesses patient's ability to self-administer

-determines medication timing

-administers medications correctly

-closely monitors effects

-provides patient teaching

-doesn't delegate medication administration to AP

Medication Administration: Nursing Assessment

Through the patient's eyes

-consider pt's preferences & values

-assess patient experiences

History

-allergies

-medication

-diet history

-perceptual or coordination problems

Miscellaneous

-patient's current condition

-patient's attitude about medication use

-factors affecting adherence to medication therapy

-patient's learning needs

Medication Administration: Nursing Diagnosis

-impaired health maintenance

-lack of knowledge

-nonadherence (medication regimen)

-adverse medication interaction

-complex medication regimen (polypharmacy)

Medication Administration: Nursing Planning

-organize care activities

-goals and outcomes

-setting priorities

-teamwork and collaboration

Medication Administration: Nursing Implementation

-health promotion

Patient and family caregiver teaching

-acute care

receiving, transcribing, communicating medication orders

accurate dose calculation and measurement

-special considerations

infants & children

older adults

Medication Administration: Nursing Evaluation

-partner w/your patients

ensure patients understand and can safely administer their medications

-evaluate outcomes

use knowledge of desired effect and common side effects of each medication to compare expected outcomes w/actual findings

more sensitive, potent

Lifespan Considerations in Medication Administration: Aging

Drug-receptor Interaction: brain receptors become ____, making psychoactive drugs very ____.

1. shrinks

2. decline

3. prolonging

Lifespan Considerations in Medication Administration: Aging

Metabolism:

-Liver mass (1)

-hepatic blood flow and enzyme activity (2).

-metabolism drops to one-half the rate of young adults

-enzymes lose ability to process some drugs, thus (3) drug half-life

1. slow

2. capacity

Lifespan Considerations in Medication Administration: Aging

Absorption: Gastric emptying rate and GI motility (1). Absorption (2) of cells and active transport mechanism decline.

1. less stable

Lifespan Considerations in Medication Administration: Aging

Circulation:

-Vascular nerve control is less (1).

e.g. antihypertensives drop BP too low

1. decline

2. lengthen

3. longer

Lifespan Considerations in Medication Administration: Aging

Excretion

-In kidneys, renal blood flow, GFR, renal tubular secretion and reabsorption, and number of functional nephrons (1).

-blood flow and waste removal slow

-age-related changes (2) half-life for renally excreted drugs

e.g. antidiabetic drugs stay in the body (3)

1. declines

2. water-soluble

3. plasma protein

4. free drug

Lifespan Considerations in Medication Administration: Aging

Distribution

-Lean body mass falls; adipose stores increase

-TBW (1), raising the concentration of (2) drugs, like digoxin

-(3) diminishes, reducing sites available for protein-bound drugs and raising blood levels of (4)

oral administration

-Easiest and most desirable route.

-Food sometimes affects absorption.

-time or delayed-release, enteric-coated medications: do not crush

Consider

-NPO status

-inability to swallow safely

-persisten N/V

-gastric suction

-decreased LOC

sublingual and buccal

rapid absorption of medications because they bypass the digestive system and also allow medications to enter the bloodstream without being partially metabolized by the liver

enteral tube administration

special precautions when administering medications to patients w/enteral or small-bore feeding tubes

-follow tubing connection standards

-verify tube is compatible w/medication absorption

-use liquid medications when possible

-flush b/w medications

1. cannot

GI Tube

-many, but not all, PO medications can be given through GI tube

-liquid form of a medication should be given whenever available

-enteric-coated, time-release, sublingual, buccal, and other medications w/special coatings (1) be administered through GI tube

-any medication given through GI tube requires a prescription specifically stating GI route

A. clean

B. abdomen, hips, and thighs

C. breast/waistline

D. heat

Estrogen Patch

1. Using a soft-tip or felt-tip marker, write the date, time, and initials on the new patch.

2. Put on (A) gloves.

3. Select a clean, dry site away from previous site and free of hair. Avoid site where skin is oily, burned, cut or irritated.

4. Estrogen patches are commonly applied to the flat areas of the (B).

They should never be applied on/near the (C).

5. Explain that the patient shouldn't apply (D) or ointment over patch.

chest, back, abdomen, anterior thigh

Name four sites to apply nitroglycerin ointment.

Don't apply on hairy surfaces or over scar tissue; don't massage ointment into skin.

Name two considerations for nitroglycerin ointment.

Considerations for Oral Medications

-medications that require a pre-assessment (BP, HR) should be placed in a separate medication cup

-give each crushed medication separately

-administer tablets or capsules w/patient in sitting or side-lying position

-if liquid medication is less than 10 mL --> oral syringe

-give sublingual and buccal medications last

enteric-coated, long-acting, sustained-release, sublingual

Which medications shouldn't you crush?

1. existing

2. disposable, clean gloves

3. label

4. location

5. removal

Topical Administration

-When applying a transdermal patch, ask the patient whether he or she has an (1) patch

-Wear (2) when removing and applying transdermal patches

-If the dressing or patch is difficult to see (e.g., clear), apply a noticeable (3) to the patch

-Document patch or medication (4) on the MAR

-Document patch or medication (5) on the MAR

lotions, creams, oils, ointments, patches, powders, and aerosol sprays

nasal instillation

Methods

-Spray

-Drops

-Nasal Tampons (severe nosebleeds)

Decongestant spray or drops most common

-Caution patients to avoid the rebound effect

-Serious systemic effects also develop if excess decongestant solution is swallowed, especially in children

1. cornea

2. eye/eyelid

3. affected

4. conjunctival sac

Eye Instillation

Administration involves placing the medication in the patient’s eye using correct technique for the medication form

Instillation: eye drops, ointments, irrigations, and disks

-Avoid the cornea

-Avoid touching (2) with droppers or tubes

-Use only on the (3) eye

-Never share eye medications

Intraocular instillation

-Disk resembles a contact lens

-Teach patients how to insert and remove the disk from (4)

1. room temperature

2. sterile

3. drainage

4. occlude

5. down & back

6. up & back

7. side-lying position

8. cerumen

Ear Instillation

Eardrops: topical preparations, usually in the form of drops

-Instill eardrops at (1)

-Use (2) solutions.

-Check with the provider if patient has ear (3)

-Never (4) the ear canal.

-Children <3 years: pull pinna (5)

-Adults: pull pinna (6)

-If medication is ordered for both ears, ask patient to stay in (7) position for a few minutes.

Irrigation

Remove (8) that cannot be removed with wax softeners

vaginal installation

Suppositories, foam, jellies, or cream; stay in position for 10 mins

rectal instillation

-Thinner and more bullet-shaped than vaginal suppositories

-Rounded end prevents anal trauma during insertion

-Contain medications that exert local effects

-A small cleansing enema may be required before inserting a suppository (liquid)

-Left side laying sims position with right leg flexed or dorsal recumbent position. Stay in position for 5 minutes

inhalation administration

includes small volume nebulizer, pressurized metered-dose inhalers, breath-actuated metered-dose inhalers, and dry powder inhalers

pressurized metered-dose inhalers (pMDIs)

-Require hand strength and hand-breath coordination

-May be used with a spacer

Breath-actuated metered-dose inhalers (BAIs)

Release depends on strength of patient's breath on inspiration

dry powder inhalers (DPIs)

-Activated by patient's breath

-Deliver more medication to the lungs