Pharmacology and Medication Administration
ATI Engage: Pharmacology Overview
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Learning Objectives
Objective 1: Describe the variations in medication administration across the lifespan, including dosage adjustments, formulations of medications, and monitoring parameters.
Objective 2: Demonstrate an understanding of the importance of identifying compatibility and incompatibility when administering medications.
Objective 3: Incorporate the principles of medication reconciliation and the nurse’s role in ensuring accurate and complete medication histories during transitions of client care.
Objective 4: Identify the principles of medication administration, including the 10 rights of medication administration.
Objective 5: Recognize the role of the nurse in monitoring clients for effectiveness of medications.
Clinical Judgment and Medication Administration
Clinical Judgment: A fundamental aspect of safe medication administration that requires careful assessment and decision-making.
Six Steps in Clinical Judgment:
Step 1: Noticing
Step 2: Interpreting
Step 3: Responding
Step 4: Reflecting
Step 5: Planning
Step 6: Evaluating
Key Questions to Ask: Critical inquiries that should be made at each step to ensure safe medication practices.
Discussion Questions
How does clinical judgment guide safe medication administration, especially in clients with complex medical histories or polypharmacy?
Medications Across the Lifespan
Dosage Adjustments: Importance of altering medication dosages based on age, weight, organ function, and overall health.
Formulations of Medications: Various forms (e.g., liquid, tablet) can impact availability and tolerability in different populations.
Monitoring Parameters: Essential factors that must be tracked to ensure medication efficacy and safety across different age groups.
Topics Related to Lifespan Medications
Polypharmacy: The concurrent use of multiple medications, particularly common in older adults and those with chronic conditions.
Beers List: A guideline for healthcare providers to avoid potentially inappropriate medications in older adults.
KIDs List: Recommendations on pediatric medications.
Pregnancy and Lactation Labeling Rule: Guidelines for medication use in pregnant or lactating women.
Discussion Questions on Lifespan Considerations
What considerations should a nurse make when administering a new medication to a pregnant or lactating client?
How should a nurse adjust medication teaching and administration for pediatric or older adult clients?
Medication Incompatibility and Drug-Drug Interactions
Medication Incompatibility: Situations where two or more drugs cannot be mixed or administered together.
Physical Incompatibility: Changes in appearance or behavior of medications when mixed.
Chemical Incompatibility: Changes in the chemical structure or effectiveness of the drug when mixed.
Drug-Drug Interactions: Adverse effects resulting from the interaction of two or more drugs in a patient.
Discussion Questions on Incompatibilities
What questions should a nurse ask when assessing a client for potential medication incompatibilities or drug-drug interactions?
Medication Reconciliation
Steps of Medication Reconciliation:
Obtain List: Collect a complete list of current medications from the patient.
Validate Each Medication: Ensure all medications in the record are accurate and up-to-date.
Compare Current List Against Medical Record: Check for discrepancies between current and historical medication records.
Communicate Changes: Effectively relay any changes in medications to all members of the healthcare team.
Discussion Questions on Medication Reconciliation
Why is medication reconciliation critical during transitions of care, and what are the nurse’s responsibilities in this process?
Principles of Medication Administration
Principles of Medication Administration: Core concepts that guide safe and effective medication practices.
Rights of Medication Administration: The 10 rights essential for safe medication administration:
Right patient
Right medication
Right dose
Right route
Right time
Right reason
Right documentation
Right response
Right to refuse
Right education
Discussion Questions on Medication Administration
How can a nurse use the "10 Rights of Medication Administration" to reduce medication errors in clinical practice?
Routes of Medication Administration
Overview of Medication Administration Routes:
Oral: Medications taken by mouth.
Sublingual and Buccal: Medications placed under the tongue or in the cheek.
Rectal: Medications administered rectally.
Intravenous (IV): Direct administration into the bloodstream.
Intramuscular (IM): Injection into muscle tissue.
Subcutaneous: Injection below the skin.
Intradermal: Injection into the dermis layer of the skin.
Inhalation: Medications delivered directly to the lungs.
Otic: Ear drops.
Ophthalmic: Eye drops or ointments.
Transdermal: Medications delivered through the skin.
Nasal: Medications administered through the nasal passages.
Vaginal: Medications applied in the vaginal area.
Role of the Nurse in Client Monitoring
Monitoring Therapeutic Effect: Assessing whether medications are achieving the desired effect on the client.
Monitoring for Adverse Effects: Identifying and responding to negative side effects or complications resulting from medications.
Appendix 1: Clinical Judgment Models
Models Overview:
Tanner Clinical Judgment Model: Incorporates four components: interpreting, noticing, reflecting, and responding.
Nursing Process: Involves planning, analyzing, assessing, evaluating, and implementing care.
Action Model (Cognitive Operations): Consists of recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes.
Alignment of Steps:
Interpreting (Tanner) aligns with Planning and Analysis (Nursing Process) and Generate Solutions, Analyze Cues, Prioritize Hypothesis (Action Model).
Noticing (Tanner) aligns with Assessment (Nursing Process) and Recognize Cues (Action Model).
Reflecting (Tanner) aligns with Evaluation (Nursing Process) and Evaluate Outcomes (Action Model).
Responding (Tanner) aligns with Implementation (Nursing Process) and Take Actions (Action Model).
Visual Representation: The relationships between the three models are illustrated in an integrated format to enhance understanding of clinical judgment behaviors during medication administration.