Chapter 31 Medication Administration

Scientific Knowledge Base

• Medication Legislation and Standards

  • Federal, state, and local regulations affect medication practices.

  • Health care agencies also have medication-related laws.

  • Nurses must follow specific medication regulations for safe practice.

• Pharmacological Concepts

  • Medication Names: Chemical, generic, and trade names.

  • Classification: Based on effects on body systems.

  • Forms: Tablets, capsules, injectables, etc.

• Pharmacokinetics

  • Describes how drugs move through the body.

  • Absorption: Affected by route, dissolution, blood flow, surface area, lipid solubility.

  • Distribution: Influenced by circulation, membrane permeability, protein binding.

  • Metabolism: Mostly in the liver.

  • Excretion: Primarily through kidneys; also by lungs, intestines, and sweat.

• Medication Actions

  • Therapeutic effects: Intended outcomes.

  • Adverse Effects: Undesirable outcomes.

  • Side Effects: Minor adverse effects.

  • Toxicity: Harmful, overdose-related effects.

  • Idiosyncratic Reactions: Unusual responses.

  • Allergic Reactions: Immune response with potential for anaphylaxis.

  • Interactions: Effects due to combination with other medications.

• Dose Timing

  • Minimum Effective Concentration: Lowest effective dose.

  • Therapeutic Range: Safe and effective concentration.

  • Biological Half-Life: Time to halve the medication’s concentration in the body.

Routes of Administration

• Oral: By mouth, including sublingual and buccal methods.

• Parenteral: Injection methods, including intradermal, subcutaneous, intramuscular, intravenous.

• Topical: Applied to skin and mucous membranes.

• Inhalation: Inhalers for respiratory administration.

• Intraocular: Directly into the eye.

Measurement Systems

• Metric System: Standard in medical dosages.

• Household Measurements: Less precise, used for patient education.

• Solutions: Concentration measured in mg/mL or similar units.

Nursing Knowledge Base

• Clinical Calculations

  • Involves converting units and calculating doses using ratio/proportion, formula method, or dimensional analysis.

  • Pediatric doses often require weight-based calculations.

• Roles in Medication Administration

  • Health Care Provider: Orders medication, including verbal, standing, STAT, and PRN orders.

  • Pharmacist: Dispenses, advises, and helps prevent errors.

  • Nurse: Responsible for verifying orders, ensuring patient safety, and documenting.

• Medication Errors

  • Defined as preventable events with potential harm.

  • In case of errors, assess the patient, report to provider, and document the incident.

Critical Thinking in Medication Administration

• Eleven Rights: Ensuring correct medication, dose, patient, route, time, documentation, education, right to refuse, reason, assessment, and evaluation.

Nursing Process in Medication Administration

1. Assessment

   • History, allergies, current medications, coordination, attitude, and adherence factors.

2. Analysis and Diagnosis

   • Identifies medication-related problems like knowledge deficit or polypharmacy.

3. Planning and Outcomes

   • Setting priorities and collaborating with team members.

4. Implementation

   • Includes patient education, accurate transcription, correct administration, and special handling.

5. Evaluation

   • Assess patient response to therapy and adjust as needed.

Medication Administration Techniques

• Oral Administration: Pills, liquids, and sublingual options.

• Topical Applications: Creams, patches for skin, or mucous membranes.

• Inhalation Devices: pMDIs, BAIs, DPIs for respiratory medications.

Parenteral Administration

• Syringes and Needles: Selecting appropriate sizes and techniques for injections.

• Injection Sites

  • Subcutaneous: Fatty areas (45° or 90° angle).

  • Intramuscular: Larger muscle sites (90° angle) like deltoid, ventrogluteal, and vastus lateralis.

  • Intradermal: For skin tests (5-15° angle).

• IV Administration

  • Types: Large-volume, IV bolus, piggyback.

  • Home IV: Long-term treatments like antimicrobials and total parenteral nutrition.

Safety in Medication Administration

• Use Needlestick Safety and Prevention Act to avoid injuries.

• Dispose of sharps properly.

• Follow guidelines to prevent errors and ensure patient safety, including verifying medication three times and using patient identifiers.