medication administration

NUR 310

Define chemical drug classification

Provides the exact description of the med’s composition

Define the generic drug classification

The manufacturer who first develops the drug assigns the name,and is then listed in the US pharmacopeia

Define the trade drug classification

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

Define onset

The time is takes for a med to produce a response

Define peak

The time at which a med reaches its highest effective concentration

Define the duration of drug action

the time that it takes for a med to produce its greatest effect

Define the therapeutic level

This occurs between the minimum effective concentration and the toxic concentration.

* The patient must receive regular fixed doses

Define trough levels

Aka the lowest therapeutic range; minimum blood serum concentration before the next scheduled dose

Define biological half-life

This is the time for serum medication concentration to be halved

* Meds with a short half life needs to be given more frequently than a med with a longer half life
* the half life does not change no matter how much medication is given

Define plateau

The Point at which blood serum concentration is reached and maintained

Explain time critical meds

Medication whose early or delayed administration of maintenance doses more than 30 mins before or after the scheduled dose most likely will cause harm or will result in sub-therapeutic responses

Define side effects

unintended, often predictable, physiological effects of the med to which patients usually adapt

Define primary side effects

Aka therapeutic effects of meds that are predicted, intended, and desired

* basically why the med was prescribed

Define palliative effects

relieve the S/S of a disease but have no effect on the disease itself

Define supportive effects

These support the integrity of body functions until other meds or treatments can become effective

Define substitutive effects

These effects replace either body fluids or a chemical required by the body for improved functioning

Explain secondary effects

These effects are unintended or non-therapeutic

* any med can produce these kinds of effects
* They can be harmless or cause injury which can sometimes be predicted

Define cumulative effects

The increased response to repeated doses of a drug that occurs when the rate of administration is greater than the rate of metabolism and excretion.

* This happens when the body cannot metabolize a dose of the med before the next dose is given
* Excretion is slowed by absorption is normal or rapid
* Absorption is slowed

Define adverse reactions

These reactions are harmful, unintended, usually unpredicted reactions to a drug administered at the normal dosage

* more severe than side effects and often require discontinuation of the drug
* dose related: result from the known pharmacological effect of the med

Define idiosyncratic reactions

An unexpected, abnormal, or peculiar response to a med

Describe the nursing assessment before the administration of drugs

* measure VS
* assess whether the patient’s general condition is appropriate for the med
* evaluate your knowledge of the med
* identify biological factors that affect drug metabolism

Describe the nursing assessment while administrating drugs

* mental status
* coordination
* ability to self-administer the drug
* swallowing

Describe the nursing assessment immediately following the administration of drugs

* evaluate the effectiveness of the drug
* side effects
* signs of adverse reactions or toxicity

Are you allowed to delegate any part of the medication administration process to a nursing assistive personnel?

No

* you can delegate for others to look out for allergic reactions

Name the eight rights of medication administration

* right patient
* right med
* right dose
* right route
* right reason
* right response
* right time
* right documentation

Explain parenteral routes

This route medication that is injected in the body anywhere other than the mouth or __**alimentary canal:**__ the passage along which food passes through the body from mouth to anus

* generally the most reliable, direct, and rapidly absorbed way or administering meds
* intradermal - ID
* subcutaneous - SubQ
* intramuscular - IM
* intraarterial - IA
* intracardiac - IC
* intravenous - IV
* intrathecal - IT
* epidural
* intraperitoneal
* These sites are all faster than oral, but they can have complications like the risk of infection, tissue damage, pain, and anxiety.

Explain nonparenteral routes

Involves the administration of oral meds, topical meds, and suppositories

* sublingual
* topical
* transdermal
* ophthalmic
* otic
* nasal
* rectal
* vaginal
* mucosal
* percutaneous

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Explain metered dose inhalers

Pressurized container prefilled with several doses of a drug and an eco-friendly substance called hydrofluoroalkane to propel the med forward

* the pt. inhales while pushing the canister’s pump

What is the correct way to explain how to use a MDI?

* Lift your head back slightly and inhale slowly and deeply through the mouth for 3-5 seconds while depressing the canister fully
* Hold your breath for 10 seconds
* instruct them to wait 20-30 secs between inhales of the same med & 2-5 mins of different meds
* 2 minutes after last dose, rinse your mouth with warm water and spit it out

Name the routes of drug absorption from fastest to slowest

IV, IM, SubQ, and oral

Describe the first-pass effect

Refers to the metabolism of a drug when it is absorbed from the gastrointestinal tract and delivered to the liver before reaching systemic circulation. This process can significantly alter the drug's concentration and effectiveness in the body.

Explain the appropriate tissue, volume, angle, needle gauge, and needle length for Intramuscular sites

* **tissue:** skeletal muscle
* **max volume:** 1 mL for deltoid. 3-5 mL in vastus lateralis and ventrogluetal
* **angle:** Spread the skin and inject at a 90-degree angle, unless the patient has a smaller muscle mass, You may pinch up before the injection
* **needle gauge:** 21-25 gauge
* needle length: 1 - 1 1/2 inch. 1 inch is for the deltoid site, but you may use 3 inches for a larger person
* **Aspiration is not required!**

What is one thing that we never do for insulin injections?

Massage the site!

Describe the deltoid site for Intramuscular injections

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* This injection site is only for small amounts: **1 mL** or when other sites are inaccessible
* Avoid usage in infants
* **location: acromion process; axilla**
* examples: flu shots and other vaccines

Describe the ventrogluteal site for Intramuscular injections

greater trochanter of the femur, anterior superior iliac spine, iliac crest

* the preferred IM site for adults and young children
* located away from any major blood vessels and nerves

Describe the vastus lateralis for Intramuscular injections

greater trochanter of the femur, lateral femoral condyle

* the preferred site for infants
* can accommodate a larger volume of med than the deltoid
* for children and smaller adults: you can pinch the body of muscles tissue and the needle does not penetrate to underlying bone

Describe subcutaneous injection sites

* back of arms, anterior thighs, and the abdomen: below costal margins to iliac crests at least 2 inches away from the umbilicus

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Explain the appropriate tissue, volume, angle, needle gauge, and needle length for Subcutaneous sites

* **tissue:** adipose (fat) tissue above the muscle layer
* **max volume:** no more than 1 mL!
* **angle**: pinch up the skin and inject a 45-degree angle for a thinner person, and spread the skin and inject at a 90-degree angle for a larger person
* **needle gauge:** 25-27 gauge
* **needle length:** 3/16th - 1 inch

Describe Intradermal injection sites

Inner forearm (used for TB); in between scapulae (used for allergy testing

Explain the appropriate tissue, volume, angle, needle gauge, and needle length for Intradermal sites

**tissue:** dermis - just under the top layer of the skin

**max volume:** 0.1 mL used for TB skin test injections

**angle:** Inject just below the skin at 5-15 degrees with bevel up - you should see a wheal form

**needle gauge:** 25-28 gauge. Use a special TB syringe with a pre-attached needle

**needle length:** 5/8th of an inch

What are the TB skin test parameters?

* Administered intradermally


* Read after 48-72 hours
* Positive result: induration ≥ 5 mm
* Someone who had recent contact with someone with active TB
* Positive for high-risk individuals: induration ≥ 10 mm
* people with medical conditions that increased the risk of progressing from latent TB to active TV. HC providers too
* Positive for low-risk individuals: induration ≥ 15 mm


* Negative result: induration < 5 mm

Why is the dorsogluteal site no longer recommended from IM injections?

We avoid this site because of its proximity to the sciatic nerve and superior gluteal artery increases the risk of infection into major blood vessel and damage to the sciatic nerve.