Medication Administration Notes

Medication Administration Part I

Introduction

  • The nurse must have a full understanding of medication administration and related nursing implications.
  • Safe medication administration requires good judgment, critical thinking, and clinical decision-making skills.
  • The nurse must perform a thorough patient assessment and have an understanding of pharmacotherapeutics, pharmacokinetics, growth and development, nutrition, and mathematics.
  • Minimize harm to patients.

Medication Errors

  • Medication errors can have severe consequences, such as almost killing patients or leading to imprisonment for the nurse involved.

Resources

  • Purchasing a drug guide text is highly recommended to prevent medication errors.

Rights of Medication Administration

  • The rights of medication administration are put in place to prevent medication errors and ensure safe nursing practice.
  • The rights include:
    • The right medication
    • The right dose
    • The right patient
    • The right route
    • The right time
    • The right documentation
    • The right indication
  • Nurses need to know policies to know what they can or cannot do.
  • Lifelong learning and reasoning are essential.
  • Consider physical effects of medications.

Pharmacological Considerations

  • Medication forms and the reason for giving the medication must be determined.
  • Determine the medication’s route of administration.
Medication Forms
  • Solid Forms:
    • Caplet: Shaped like a capsule and coated for ease of swallowing.
    • Capsule: Medication encased in a gelatin shell.
    • Tablet: Powdered medication compressed into a hard disk or cylinder.
      • Contains binders (adhesive to allow powder to stick together), disintegrators (to promote tablet dissolution), lubricants (for ease of manufacturing), and fillers (for convenient tablet size).
    • Enteric coated: Coated tablet that does not dissolve in the stomach; the coating dissolves in the intestine, where medication is absorbed.
  • Liquid Forms:
    • Elixir: Clear fluid containing water and alcohol; often sweetened.
    • Extract: Concentrated medication form made by removing the active part of the medication from its components.
      • Extracts are prepared as a syrup or dried form of pharmacologically active medication, usually made by evaporating solution
    • Aqueous solution: Substance dissolved in water and syrups
    • Aqueous suspension: Finely dissolved drug particles in liquid medium must be shaken; when left standing, particles settle to the bottom of the container.
    • Syrup: Medication dissolved in concentrated sugar solution.
    • Tincture: Alcohol extract from plant or vegetable.
  • Topical Route:
    • Ointment (salve or cream): Semisolid, externally applied preparation, usually containing one or more medications.
    • Liniment: Usually contains alcohol, oil, or soapy emollient applied to skin.
    • Lotion: Semiliquid suspension that usually protects, cools, or cleans skin.
    • Paste: Medication preparation that is thicker than ointment; absorbed through skin more slowly than ointment; often used for skin protection.
    • Transdermal patch or disk: Medicated disk or patch embedded with medication that is applied to skin
      • Drug absorbed through the skin over a designated period of time (e.g., 24 hours).
  • Parenteral Route:
    • Solution: Sterile preparation that contains water/normal saline with one or more dissolved compounds.
    • Powder: Sterile particles of medication that are dissolved in a sterile liquid (e.g., water, normal saline) before administration.
  • Instillation Into Body Cavities:
    • Suppository: Solid dosage form mixed with gelatin and shaped in the form of a pellet for insertion into a body cavity (rectum or vagina).
      • The suppository melts when it reaches body temperature and is then absorbed.
  • Always wear gloves when handling medications.
  • Do not prepare medication in advance.

Pharmacodynamics

  • The study of a drug's molecular, biochemical, and physiologic effects or actions.
  • From the Greek words "pharmakon," meaning "drug," and "dynamikos," meaning "power."
  • Focuses on what the drug does and how it does it in the body.

Pharmacokinetics

  • Study of how medications enter the body, reach their site of action, are metabolized, and exit the body (ADME).
  • ADME stands for Absorption, Distribution, Metabolism, and Excretion.
  • Proper timing and dose are crucial.
  • Intravenous (IV) medications have a faster rate of action.
  • Factors affecting pharmacokinetics include the route of administration, the ability of the medication to dissolve, cell membrane permeability, circulation, body surface area, and lipid solubility.
  • Kidneys and liver play a significant role in metabolizing medications.

Types of Medication Action

  • Medication dose responses.
  • Half-life: The time it takes for the serum level of the drug to be cut in half.
  • The medication goal is to achieve a constant blood level within a safe therapeutic range.
  • Onset: Begins working
  • Peak: Highest level
  • Trough: Lowest level
  • Duration: How long it lasts
  • Plateau

Pharmacological Concepts: Medication Names

  • Chemical Name: The scientific name of the drug.
  • Generic Name: The official name of the drug (e.g., Acetaminophen).
  • Trade or Brand Name: The name under which the drug is marketed (e.g., Tylenol).
  • Classification: Indicates the effect of the medication on the body system, the symptoms the medication relieves, and the desired medication effect (e.g., antipyretic).

Interpreting Medication Labels

  • Correct identification of medications is essential.
  • Be aware of look-alike/sound-alike medications that are NOT the same (e.g., hydralazine vs. hydroxyzine).
  • Medication labels include:
    • Generic Name
    • Trade Name
    • Classification
    • Concentration (e.g., 40 mg40 \, mg per 1.25 ml1.25 \, ml)
    • Amount of Drug per volume

Medication Prescription

  • Medication prescription pads include information such as the patient's name, address, date of birth (DOB), the medication prescribed (e.g., Amoxil), the dosage (e.g., 400 mg400 \, mg), the form (e.g., chewable tabs), the quantity to dispense (e.g., #56), instructions for use (Sig), refills, and prescriber information.

Medication List

  • A medication list should include the medication name, dosage, how often to take it, the route of administration, and the indication (diagnosis).

Medication Administration Record (MAR)

  • The MAR includes patient information, allergies, admitting diagnosis, height, weight, BMI, active medications (scheduled, PRN, continuous), and details about medication administration.

Medical Abbreviations

  • Understanding medical abbreviations is essential for interpreting prescriptions and medication orders.
  • Examples: OD, SOS, BID, TID, PO, AC, HS, QD, INH, PRN.

"Do Not Use" Abbreviations

  • Avoid using trailing zeros.
  • Always use a leading zero.

Age Considerations

  • Absorption, metabolism, and excretion of medications differ with age.
  • Considerations for:
    • Children
    • Elderly

Medication Preparation: Lifespan

  • Pediatric Doses:
    • Calculation requires caution.
    • Children are at risk for Adverse Drug Events (ADEs) due to metabolic rate.
    • Age, weight, and body system maturity affect the ability to metabolize and excrete medications.
  • Older Adult Dosages:
    • Have altered pharmacokinetics.
    • Polypharmacy is common.
    • Follow safety precautions.
    • Socioeconomic status also needs to be considered. Be sure to know if they're taking other medications, including OTC.

Beer’s List

  • Beer’s List: Medications to be used with caution in the elderly; poses a much higher risk for older people
    1. Avoided by most older people (outside of hospice and palliative care settings);
    2. Avoided by older people with specific health conditions;
    3. Avoided in combination with other treatments because of the risk for harmful “drug-drug” interactions;
    4. Used with caution because of the potential for harmful side effects; or
    5. Dosed differently or avoided among people with reduced kidney function, which impacts how the body processes medicine.

Rights of Medication Administration (Reiterated)

  • Right Person
  • Right Medication
  • Right Dose
  • Right Time
  • Right Route
  • Right Reason
  • Right Documentation

Medication Administration: Using Good Judgment

  • Scenario: A client is admitted to the hospital for a hip fracture after falling at home. The client has a history of hypertension and takes atenolol once per day. Atenolol is a beta blocker that lowers blood pressure and heart rate. The nurse takes the client’s vital signs and notes the following results:
    • T 37.037.0 P 5656 R1818 BP 96/5096/50 O2 Sat 98%98\%%
  • The client feels dizzy when standing up.
  • The nurse should not administer the medication as ordered because the heart rate and blood pressure are already low, and the patient is symptomatic.
  • Chart that you're holding the med
  • Chart assessment
  • Contact provider