MEDICATION

The administration of medication is a primary responsibility of nurses, playing a critical role in patient care and treatment outcomes.
It ensures a systematic, organized, and precise approach to drug preparation, administration, and thorough documentation, which is essential for maintaining patient safety.
Nurses are accountable for every medication administered, necessitating thorough assessment before administration, ongoing evaluation during therapy, and vigilant monitoring of patient responses.
The nurse's responsibilities include understanding pharmacology, recognizing potential drug interactions, and being aware of individual patient needs and allergies.

Definition of Medication

A medication or drug is defined as a substance administered for various purposes, including:
- Diagnosis: Identifying disease or condition.
- Cure: Eradicating disease or infection.
- Treatment or relief of symptoms: Alleviating discomfort associated with medical conditions.
- Prevention of disease: Stopping the onset of disease or infection, which may involve vaccination or prophylactic treatment.

Therapeutic Actions of Drugs

Palliative - Relieves symptoms without curing the disease.
- Examples: Mefenamic acid for pain relief, Morphine for severe pain management, Aspirin for mild pain and inflammation.
Supportive - Maintains body function until treatment takes effect.
- Example: Paracetamol for fever management, providing symptomatic relief while the underlying cause is treated.
Curative - Cures the disease process.
- Examples: Antibiotics such as Penicillin for bacterial infections, Antivirals like Acyclovir for viral infections such as herpes.
Substitutive - Replaces body fluids or substances that are deficient.
- Example: Insulin for diabetes management, restoring normal glucose levels in individuals with insulin deficiency.
Chemotherapeutic - Destroys malignant cells in cancer treatment.
- Example: Vincristine for leukemia, targeting rapidly dividing cancer cells.
Restorative - Restores health and improves bodily functions.
- Examples: Vitamins and mineral supplements to restore nutritional deficiencies and promote overall health.

Medication Orders & Responsibilities of Nurses

Medication orders are issued by a physician and must be understood and followed by nurses, as they vary by urgency and context (e.g., routine vs. emergency).

Important Parts of Medication Orders

Client’s Name - Ensures accurate patient identification.
Date and Time - Essential for documentation; narcotics orders typically valid for 48 hours.
Drug Name - Should be clearly indicated in either generic or brand name form to avoid any confusion.
Dosage - Determined by the doctor, nurses are responsible for verifying the dosage against standard protocols and practices (e.g., 500 mg of Ampicillin).
Frequency - Specifies how often the medication should be taken or administered (e.g., QID - four times a day).
Route of Administration - Method of delivery must be specified (e.g., p.o. for oral ingestion, SC for subcutaneous injection).
Signature - Confirms the order is legal and complete.

Types of Drug Orders

Standing Order - Administered until changed or canceled (e.g., Bactrim Forte 500 mg 1 tab BID).
Single Order - Administered a single time (e.g., Dexamethasone 8 mg IM before discharge).
Stat Order - Immediate administration required (e.g., Morphine sulfate 10 mg IV stat).
PRN Order - Administered as needed (e.g., Buscopan 10 mg for abdominal pain management).

Common Medical Abbreviations for Medications

OD- once a day - the drug is given at 8 am or 9 am unless specified by the doctor
BID- twice a day- the drug is given at 8 am and 6 pm
TID- thrice a day- the drug is given at 8 am, 12 nn or 1pm and 6 pm
QID- four times a day- the drug is given at 8am, 12nn, 4pm and 8 pm
q- every
q4 hrs- every for hours. The drug is given at 4am-8am-12nn-4pm-8pm-12mn. The drug is given 6x a day (24 hrs divided by 4 hrs) or RTC (Round-the-clock)
q6 hrs- every 6 hours. The drug is given at 6 am-12nn-6pm- 12 mn. The drug is given 4x a day (24 hrs divided by 6 hours) or RTC
q8 hrs- every 8 hours. The drug is given at 8am-4pm-12mn. The drug is given 3x a day (24hrs divided by 8) or RTC
SC - subcutaneous administration
IM - intramuscular administration
IV - intravenous administration
P.O. - per orem or by mouth
SL- sublingual- the medication is placed under the tongue
ID- intradermal
SC-Subcutaneous
IM-Intramuscular
IV-Intravenous
IO-intraoseous
o.d.- occulus dexter or right eye
o.s.- occulus sinister or left eye
o.u.- occulus uterque or both eyes or each eye
a.d. –right ear
a.s- left ear
a.u.-both ears
HS- hours of sleep, at bed time or half strength
mg- milligrams
gm or G- gram
gr- grain
ml-milliliter
cc-cubic centimeters
L-liter
Neb-nebule
Amp-ampule
syr- syrup
susp- suspension
elix-elixir
supp- suppository (rectal)
gtt- drop;
gtts- drops

Interpreting Drug Orders

Accurate interpretation and translation of drug orders into actionable steps is vital for patient safety and effective administration.
Examples include:
1. “Tetracycline 250 mg 1 tab p.o. TID” translates to “Administer 1 tablet of 250 mg Tetracycline orally three times a day.”
2. “Nifedipine 10 mg SL stat” becomes “Immediately administer 10 mg of Nifedipine sublingually.”

10 Rights of Medication Administration

Right Patient - Always verify the patient's identity before administration to prevent medication errors.
Right Medication - Ensure the medication matches the physician’s order and is appropriate for the patient’s condition.
Right Dose - Validate the dosage against normal ranges and specific patient needs.
Right Time - Follow the prescribed schedule for medication administration.
Right Route - Confirm that the route of administration is appropriate for the medication and patient condition.
Right Patient Education - Inform the patient about their medications, including side effects and purpose.
Right to Refuse - Patients have the right to refuse treatment, which should be documented appropriately.
Right Assessment - Conduct assessments before medication administration, including vital signs and relevant health history.
Right Evaluation - Monitor the patient’s response to the medication, noting both positive and negative outcomes.
Right Documentation - Thoroughly document all administration details, any observations, and reasons for any missed doses.

Routes of Drug Administration

Oral Route - Includes tablets, capsules, and liquids, commonly used for their convenience and safety.
Sublingual & Buccal - Medications placed under the tongue or in the cheek for quick absorption.
Topical - Applied directly to the skin or mucous membrane for localized effects (e.g., creams, ointments).
Parenteral Route:
- Intradermal (10°-15°) - For small volume injections primarily for allergy tests.
- Subcutaneous (45°) - For medications such as insulin, absorbed slowly into the system.
- Intramuscular (90°) - For larger volumes, ensuring quicker absorption compared to subcutaneous.
- Intravenous (25°) - Delivers medication directly into the bloodstream for immediate effect.

Medication Calculation Basics

Knowledge of conversions between metric and apothecary systems is crucial for accurate dosing:
- 60 mg = 1 grain
- 1 g = 15 grains
- 4 g = 1 dram
- 30 g = 1 ounce
- 1,000 g = 2.2 lb

Basic Calculation Formula:

$D \times V = \text{Amount to Administer}$ or $D \times Q = \text{Amount to Administer}$ Where:
- D = desired dose
- H or S = dose on hand
- V or Q = quantity/amount of the drug or vehicle.

Example Calculation:

Order: Amoxicillin 375 mg p.o. TID
Available: Amoxicillin suspension 125 mg/5 ml.
Calculate the volume needed using the basic formula to ensure accurate dosing based on the orders provided.

Conclusion

Accurate drug administration is essential in nursing practice, ensuring patient safety and the efficacy of treatment plans.
Nurses must be well-acquainted with drug orders, medication rights, and possess sound pharmacological knowledge to provide optimal patient care, actively engaging in patient education and advocacy.