Chapter 23: Administering Medications

Chapter 23: Administering Medications

Introduction

Professor Constanting presents the concepts revolving around the administration of medications, focusing on nomenclature, systems, pharmacokinetics and more in the healthcare setting.

Drug Nomenclature and Classification

1. Types of Drug Names
  • Chemical Name: An exact description of the drug's chemical composition and molecular structure.
  • Generic Name: The name assigned to the drug by the manufacturer, simpler than the chemical name, signaling that the manufacturer is ready to market the drug.
  • Official Name: The generic name that is listed in publications such as the United States Pharmacopeia (USP) and National Formulary (NF).
  • Prescription Drugs: Require a written prescription from a healthcare provider to obtain.
  • Brand (Trade) Name: The name under which a drug is sold in stores, easily recognizable as it begins with a capital letter and often carries a registration mark (®).
  • Nonprescription (OTC) Drugs: Can be purchased without a prescription. Assumed safe for the general population if consumers follow manufacturer’s directions.

Medication Systems

2. Types of Medication Supply Systems
2.1 Stock Supply
  • Bulk Quantity: Centralized location not specific to a patient.
  • Measuring Doses: Requires the healthcare provider to measure the dose each time a patient needs it, increasing potential for measurement error.
  • Cost-effective: Generally provides savings on medication costs.
2.2 Unit Dose
  • Individually Packaged: Tailored specifically for each patient.
  • Patient-Specific Drawers: Contains a 24-hour supply for each patient reducing errors in dosing.
2.3 Automated Dispenser
  • Access: Requires a password and is a locked cart.
  • Computerized Tracking: Combines functionalities of stock and unit doses for efficient management.
2.4 Self-Administration
  • Individual Containers: Medications kept at the patient's bedside for administration.

Pharmacological Considerations

3. Pharmacokinetics and Pharmacodynamics

Pharmacokinetics: Refers to what happens to the drug in the body, encompassing absorption, distribution, metabolism, and excretion.

  • Determines the intensity and duration of the drug's actions, each drug exhibiting unique pharmacokinetic characteristics.

Pharmacodynamics: Involves how the drug affects the body.

Pharmacokinetics Processes

4. Absorption
  • The movement of the drug from the administration site into the bloodstream.
  • Determining Factors:
    • Route of administration
    • Solubility of the drug
    • pH effects
    • Local blood flow
    • Body surface area
5. Distribution
  • Transportation of the drug through body fluids, mainly the bloodstream to various tissues/organs.
  • The rate of distribution depends on:
    • Adequacy of local blood flow
    • Permeability of capillaries to drug molecules
    • Protein-binding capacity of the drug
6. Metabolism (Biotransformation)
  • Chemical inactivation of the drug, converting it into a more water-soluble compound or metabolite for easier excretion.
  • Primarily occurs in the liver, but detoxification can take place in kidneys, plasma, intestinal mucosa, and lungs.
7. Excretion
  • Drug removal from sites of action and elimination from the body.
  • Common organs involved in excretion include:
    • Lungs
    • Exocrine glands
    • Liver
    • GI tract
    • Kidneys

Nursing Considerations in Medication Orders

8. Types of Medication Orders
  • Written Order: Valid until modified or stopped by the prescriber.
  • Automatic “Stop” Date: Medications are discontinued after a specific timeframe unless renewed by the healthcare provider.
  • STAT Order: Requires immediate and one-time dosage administration.
  • Standing Order: Pre-established orders for specific conditions.
  • A prn (as needed) Order: Nurse collaborates with the patient to determine when to administer medication based on specific criteria.
9. Communication of Orders
  • Handwritten: Can be handwritten on prescriptions or preprinted protocols.
  • Oral: Must be documented and include the nurse's name and credentials alongside the provider's.
  • By Telephone: Must be co-signed by the provider within 24 hours.

Components of Medication Orders

10. Essential Components
  • Patient’s full name and possibly address
  • Date and time of the order
  • Medication name
  • Dosage size, frequency, number of doses
  • Route of administration
  • Prescriber’s printed name, signature, credentials and legal registration identifier (including DEA number for controlled substances).

Medication Errors

11. Causes of Medication Errors
11.1 Lack of Knowledge or Information
  • Common issues include incorrect dosages, improper mixing, rapid infusion, interactions.
11.2 Faulty Communication
  • Factors include unclear handwriting, confusions between similar-sounding drug names, and poor documentation.
11.3 Equipment Errors
  • Related to usage or malfunctions of the administration equipment.
11.4 Calculation Errors
  • Errors in dosage calculations due to the confusion in units like kilograms versus pounds.
11.5 Other External Factors
  • Inadequate lighting, nurse fatigue, or distractions leading to errors in administration.

Responding to Medication Errors

12. Steps to Take
  1. Assess the patient's vital signs and physical status immediately.
  2. Report findings to the primary care provider (PCP).
  3. Notify the nurse manager and report the incident circumstances.
  4. Follow institutional policies for incident reporting.

Assessment: Evaluating Medications

13. Pre-Administration Assessment
  • Measure vital signs and assess general patient condition.
  • Evaluate knowledge of the medication.
  • Identify factors affecting drug metabolism.
14. Administration Phase Assessment
  • Monitor: Mental status, coordination, self-administration capacity, and swallowing ability for oral medications.
15. Post-Administration Assessment
  • Assess drug effectiveness and observe for side effects or adverse reactions including signs of toxicity.

Medication History Assessment

16. Key Elements of Patient History
  • Inquiry about allergies (medication and food)
  • Past medical history, attitudes towards medications, and relevant lab results.
  • Verify current medications (both prescription and OTC) and ability to comply with treatment plans, especially in economic contexts.