N100 Week 7 – Comprehensive Medication & CAM Review

Week 7 Objectives Snapshot

• Assessment 6 covers 25 testable competencies – from CAM questions to IV complications.
• Mastery = ability to explain, calculate, administer, educate, and evaluate medications across all routes while integrating CAM and holistic pain care.

Complementary & Alternative Medicine (CAM)

• Definitions
– Complementary = used alongside allopathic care.
– Alternative = used instead of allopathic care; framed holistically.
– Together they form Integrative Health Care (whole-person focus).
• When a client requests “natural” options or refuses meds:
→ Assess their familiarity with CAM and whether plan is complementary vs alternative.
• Major CAM Systems
– Whole Medical Systems (homeopathy, Traditional Chinese Medicine, Ayurveda).
– Biological-Based (herbs, vitamins, probiotics).
– Manipulative & Body-Based (massage, chiropractic, acupressure).
– Mind-Body (yoga, guided imagery, meditation, psychotherapy).
– Energy (Reiki, therapeutic touch, magnet therapy).
– Movement (Pilates, dance, tai chi).
• Common Modalities & Key Points
– Acupuncture/Acupressure → stimulates meridians to ↓ pain.
– Chiropractic → spinal manipulation for alignment & pain relief.
– Homeopathy → “like treats like” using diluted substances.
– Naturopathy → diet + herbs + lifestyle to promote self-healing.
– Massage → loosens tissue, ↑ circulation, promotes relaxation.
– Therapeutic Touch → rebalance client’s energy field through hands-on healing.
– Biofeedback → sensors teach voluntary control of HR, muscle tension, etc.

CAM Safety & Herbal Supplements (GI-Focused)

• Clinical Pearl: “Anything that starts with G (garlic, ginkgo, ginseng, ginger) thins blood.”
• Drug-Herb Interactions
– Example: Garlic + Warfarin → ↑ bleeding risk.
– Polyherbacy & polypharmacy dramatically ↑ interaction probability.
• Surgical Considerations
– Stop ginkgo, garlic, ginseng 1\text{–}2 weeks pre-op to limit hemorrhage.
• High-risk Populations
– Hepatic/renal dysfunction → impaired metabolism/excretion.
– Clients on multiple meds → cumulative/duplicate actions.
• Lab & VS Monitoring
– Coagulation (INR/PT) when on “G” herbs.
– LFTs for kava or valerian.
– BP & HR for ginseng or licorice root (may cause HTN, tachycardia).
– Sedation scales when combining valerian, chamomile, CBD with CNS depressants.

Nutritional-Supplement Component Therapy

• Assess macro/micronutrient purpose (protein powders for anabolism, iron for anemia, omega-3 for dyslipidemia).
• Match formulation to deficit, monitor labs (CBC, lipid panel, CMP) for efficacy/toxicity.

Holistic Nursing Pain Interventions

● Interventions NOT requiring certification
– Guided imagery ("picture the beach…") to distract pain pathways.
– Breathwork → slow rhythmic breaths, ↓ SNS firing.
– Meditation/music → focus, frontal-lobe modulation.
– Therapeutic communication → presence, reflection to lower anxiety.
– Simple touch → hand-holding if culturally acceptable.
● Interventions REQUIRING certification
– Acupuncture/Acupressure
– Chiropractic manipulation
– Massage therapy
– Homeopathy/Naturopathy

Routes of Medication Administration

• Oral (PO)
– Needs intact GI tract & swallow reflex.
– Vomiting within 15 min → questionable absorption.
– Food, pH, diarrhea alter uptake.
• Subcutaneous (SubQ)
– Needle: 25\text{–}27\;\text{gauge},\;\tfrac{3}{8}\text{–}\tfrac{5}{8}\,\text{in}.
– Volume ≤ 1.5\,\text{mL}.
– Sites: abdomen, thighs, posterior upper arm.
• Intramuscular (IM)
– Needle: 22\text{–}25\;\text{gauge},\;1\text{–}1.5\,\text{in}.
– Volume ≤ 3\,\text{mL} (deltoid ≤ 2\,\text{mL}).
– Preferred sites: ventrogluteal, deltoid, vastus lateralis.
• Intravenous (IV) = highest risk
– No absorption barrier; instant onset; ideal for emergencies, NPO, or drugs destroyed by GI.
• Angles of insertion
– Intradermal 10^{\circ}!\text{–}15^{\circ}. SubQ 45^{\circ} (or 90^{\circ} on obese). IM 90^{\circ}.

Pharmacokinetics Essentials

• ADME: Absorption → Distribution → Metabolism → Excretion.
• Plasma-Protein Binding
– Drug bound to albumin = inactive; only free drug works → low albumin ⇒ \uparrow free drug, toxicity.
• Metabolism
– Liver is primary site; subject to first-pass effect (PO may need higher dose or alternative route).
– Metabolism slows with age, hepatic disease, malnutrition.
– Enzyme inducers/inhibitors (e.g., phenytoin vs warfarin) create interactions.
• Excretion
– Kidneys—check Cr, GFR, urine output.
– Impairment ⇒ prolonged half-life, toxicity (signs: confusion, lethargy, nausea).
• Circulatory status modulates distribution (PVD → delayed effect).

Therapeutic Index & Levels

• Therapeutic Index (TI) =\tfrac{\text{lethal dose}}{\text{effective dose}}.
– High TI ⇒ wide margin.
– Low TI ⇒ narrow margin → frequent serum levels.
• Half-Life (t_{1/2}) = time for plasma concentration → 50\%.
• Peak = highest serum level (assess absorption).
• Trough = lowest serum level, drawn immediately before next dose (assess accumulation).
• Steady state after 4\text{–}5 half-lives when intake = elimination.

Medication Safety & The 5 (+5) Rights

Right Patient (2 identifiers).
Right Medication (match MAR, label, order).
Right Dose.
Right Route.
Right Time.
6-10. Right Documentation, Education, Evaluation, Refusal, Reason.

Pre-Administration Checklist

• Verify prescription legibility & allergies.
• Clarify ambiguous orders (e.g., “hold BP med if SBP < 100”).
• Review labs, VS, organ function relevant to drug.
• Think injury prevention (rails, sitter, fall protocol).

High-Risk Medications (Double-Check!)

• Warfarin → monitor INR, bruising, hematuria.
• Heparin → platelets (watch HIT), aPTT.
• Lithium → serum Na, hydration, tremor.
• Vancomycin → trough, Cr/BUN, ototoxicity (ringing ears).

Drug-Specific Assessments & Labs

• Diuretics (furosemide) → K⁺, Na⁺, lung sounds, daily weight, I&O.
• Digoxin → apical HR × 1\;\text{min} (hold < 60), K⁺.
• Insulin → capillary glucose pre-dose, LOC, meal timing.
• ACE-I → Cr (renal), K⁺ (hyper-K).
• Beta-blockers → HR, BP (watch brady, hypo-T).
• Antiarrhythmics → ECG (QT prolongation, blocks).
• Neuro meds (phenytoin) → ataxia, nystagmus (toxicity).

Preventing & Managing Medication Errors

• If error suspected: 1) Assess patient, 2) Notify provider, 3) Incident report (never chart blame).
• Remain transparent & support client/family if harm.
• Root-cause analysis to prevent recurrence.

IV Therapy & Complications

• Before giving IV med: inspect site for infiltration (cool, swollen) & phlebitis (warm, red).
• Flush with NSS to verify patency; confirm drug/solution compatibility.
• Monitor for speed shock (dizziness, chest tightness).

Transdermal, Rectal & Vaginal Drug Delivery

• Transdermal Patch
– Gloves on; remove old patch; rotate hair-free sites; date/time/initial patch; leftovers (e.g., fentanyl) still potent.
• Rectal → Sims’ (left lateral), insert just past sphincter, hold \ge 5 min.
• Vaginal → dorsal recumbent, insert to posterior wall; pericare PRN.

Skills Checklists

Metered-Dose & Dry-Powder Inhalers

• Shake MDI (not DPI).
• Exhale fully → slow deep inhale while actuating.
• Hold breath 10\,\text{s}, wait 1 min between puffs.
• Use spacer for children/coordination issues.
• Rinse mouth after corticosteroids → prevents oral thrush.

Otic (Ear) Drops

• Warm to room temp (cold → vertigo).
• < 3 yrs: pull pinna down & back; ≥ 3 yrs/adult: up & outward.
• Hold dropper 1\,\text{cm} above canal; instill; press tragus gently; stay side-lying 2\text{–}3 min.

Ophthalmic Drops/Ointment

• Pull lower lid to form conjunctival sac.
• Dropper above sac w/o touching eyelashes.
• Multiple meds: wait ≥ 5 min between.
• Ointment: apply thin ribbon inner → outer canthus.
• To reduce systemic absorption: press inner canthus 30\text{–}60 s.

Medication Refusal & Clarification

• Respect autonomy; assess reasons (side effects, beliefs).
• Provide risk/benefit education; document refusal; notify provider if critical dose missed.
• For unclear orders – always clarify before administration.

Medication Calculations (Quick Review)

• Standard formula: \text{Desired}\div\text{Have}\times\text{Volume}=\text{Dose}.
• High-alert (heparin, insulin) require independent double-check.
• Use weight-based dosing for peds: \text{mg}\/\text{kg}\,/\,\text{day}.

Administration of “Wrong” Medication Scenario

• If wrong med given: immediate assessment (VS, focused exam), anticipate reversal (e.g., naloxone for opioids).
• Document factual events only; complete incident report; debrief with team – fosters safety culture.

Integrating CAM Questions Into Care Plans

• Ask: “What vitamins, herbs, or spiritual practices do you use?”
• Clarify goal (complementary vs alternative).
• Teach clients to share CAM use with every provider; provide evidence-based data on interactions.

Linking Concepts (Clinical Logic)

• Always connect Drug → Organ → Lab → Symptom.
– Example: ACE-I → kidneys (Cr up) → labs (Cr ↑) → symptom (GFR ↓ → fatigue).
• Promotes early detection & safe intervention.

Big-Picture Takeaways

• Safe med administration is a multifactorial skill: right drug, patient, knowledge, route, dose, time, environment, and post-monitoring.
• Holistic care means honoring CAM, emotional states, and physiologic parameters simultaneously.
• Ongoing education, transparency, and lab/VS vigilance keep clients from harm and propel you toward Ticket to Success!