Chapter 35: Medication Administration

Chapter 35: Medication Administration

LO 35.1 Medications and Regulations (1 of 4)

• Drugs and Medications:

  • Drug: Any substance that either positively or negatively alters physiological function.

  • Medication: A drug specifically administered for its therapeutic effect on physiological function.

  • Medication Designations:

  • Chemical Name: The scientific name that reflects the molecular structure of the drug.

  • Official Name: The name recognized in official pharmacopoeias.

  • Generic Name: The nonproprietary name reflecting the medication's active component.

  • Trade Name: The brand name given by the manufacturer.

LO 35.1 Medications and Regulations (2 of 4)

• Medication Standards and Regulations:

  • Enacted to ensure uniform quality and predictable effects.

  • The Pure Food and Drug Act of 1906:

  • Established authorities: United States Pharmacopeia (USP) and National Formulary (NF).

  • These authorities can establish official drug standards.

  • U.S. Food and Drug Administration (FDA):

  • Responsible for enforcing medication legislation.

  • Mandates that all medications undergo safety testing.

LO 35.1 Medications and Regulations (3 of 4)

• Controlled Substances:

  • Comprehensive Drug Abuse Prevention and Control Act (1970):

  • Established five categories of scheduled drugs.

  • Mandates regulations for handling and distributing controlled substances.

  • Drug Enforcement Administration (DEA):

  • Monitors compliance with controlled substance regulations.

LO 35.1 Medications and Regulations (4 of 4)

• State and Local Medication Regulations:

  • Health care facilities develop policies and procedures complying with federal, state, and local regulations; they may be more restrictive than government controls to prevent adverse patient outcomes.

  • Nurse Practice Act:

  • Defines functions and professional responsibilities of nurses.

  • Health care facilities cannot modify or expand the nurse practice act.

LO 35.2 Principles of Drug Actions (1 of 5)

• Pharmacokinetics:

  • Therapeutic Effect: The desired result or action of a medication.

  • To achieve a therapeutic effect, a medication must:

    • Be taken into the body.

    • Be absorbed and distributed in cells and tissues.

    • Alter physiological functioning.

  • Effectiveness is influenced by:

  • Medication dose.

  • Route of administration.

  • Frequency of administration.

  • Function of metabolizing organs.

  • Age of patient.

LO 35.2 Principles of Drug Actions (2 of 5)

• Pharmacokinetics:

  • Absorption: Passage of a drug from the administration site into the bloodstream.

  • Distribution: Process of delivering the medication to tissues and organs.

  • Metabolism: Process by which a drug is altered to a less active form to prepare for excretion.

  • Excretion: Process that removes the less active drug or its metabolites.

LO 35.2 Principles of Drug Actions (3 of 5)

• Pharmacodynamics:

  • Biochemical Response: Can be local or systemic; evaluation is based on the patient's clinical condition.

  • Drug Action Factors:

  • Onset of Action: Time taken for the body to respond to a drug.

  • Half-life: Time required for the blood concentration of a drug to reduce to one-half of the original dose.

  • Peak Plasma Level: Highest serum (blood) concentration of a drug.

  • Trough: Lowest serum level of a drug.

LO 35.2 Principles of Drug Actions (4 of 5)

• Side Effects, Adverse Effects, and Interactions:

  • Side Effects: Unwanted effects that are typically mild.

  • Adverse Effects: More severe than side effects and can be harmful.

  • Toxic Effects: Severe adverse effects often leading to dose adjustments or discontinuation.

  • Allergic Reactions: Immune responses to a drug that can vary in severity.

  • Anaphylactic Reaction: Severe, potentially life-threatening allergic response.

  • Idiosyncratic Reaction: Abnormal, unexpected response to a drug that cannot be explained.

LO 35.2 Principles of Drug Actions (5 of 5)

• Medication Interactions:

  • Synergistic Effect: Two drugs' combined effect is greater than the sum of their individual effects.

  • Antagonism: One drug reduces or blocks the effect of another.

• Administering Parenteral Medications:

  • Drug Incompatibility:

  • Precipitation: Formation of an insoluble compound from mixing drugs.

  • Adverse Chemical Reaction: Unpredictable reactions when drugs are mixed.

  • Compatibility must be verified before mixing or administering medications.

LO 35.3 Nonprescription and Prescription Medications (1 of 5)

• Nonprescription Medications:

  • Over-the-Counter (OTC) Medications: Do not require a prescription and are regulated by the FDA.

  • Considerations for Selecting an OTC Medication:

  • Desired effect and potential side and adverse effects of all ingredients.

  • Possible allergic reactions.

  • Potential interactions with other medications and herbs.

  • Warnings, directions, and dosage.

  • Safety features of the medication.

LO 35.3 Nonprescription and Prescription Medications (2 of 5)

• Nonprescription Medications:

  • Vitamins:

  • Record vitamin use in the patient history.

  • Regulated by the FDA as dietary supplements.

  • Alternative Therapies:

  • Herbal Supplements:

    • Regulated by the FDA through the Dietary Supplement Health and Education Act (DSHEA).

    • Their action in the body is similar to prescription medications.

    • Consumers may not disclose herbal supplement use to primary care providers.

LO 35.3 Nonprescription and Prescription Medications (3 of 5)

• Prescription Medications:

  • Medication Order Components:

  • Patient's name.

  • Date and time of the order.

  • Drug name.

  • Dosage of medication.

  • Drug route of administration.

  • Frequency of administration.

  • Signature of the prescriber.

LO 35.3 Nonprescription and Prescription Medications (4 of 5)

• Prescription Medications:

  • Medication Administration Record (MAR): Essential for accurately tracking medication administered.

  • Specific documentation is required when a medication is not administered as prescribed.

LO 35.3 Nonprescription and Prescription Medications (5 of 5)

• Common Types of Medication Orders in Acute Care Settings:

  • Routine Orders: Medications given on a scheduled basis.

  • PRN Orders: Medications administered as needed.

  • One-time or On-call Orders: Administered once as per instructions or when called.

  • Stat Orders: Medications that are to be administered immediately.

  • Now Orders: Medications given soon but not immediately.

LO 35.4 Forms of Medication and Routes of Administration (1 of 5)

• Forms of Medication: Different formulations exist for various routes of administration.

• Routes of Medication Administration:

  • Oral Administration: Includes swallowed, sublingual, buccal, and through feeding tubes (nasogastric, gastric, intestinal, and jejunal).

LO 35.4 Forms of Medication and Routes of Administration (2 of 5)

• Topical Medications: Applied to skin or mucous membranes.

• Inhaled Medications: Administered through the respiratory tract.

LO 35.4 Forms of Medication and Routes of Administration (3 of 5)

• Parenteral Medications:

  • Major sites of injection include:

  • Intradermal (ID): Shallow injection into the dermal layer under the epidermis.

  • Subcutaneous (Subcut; Subcutaneously): Injection into the subcutaneous tissue beneath the skin.

  • Intramuscular (IM): Injection into a muscle of adequate size to accommodate the amount and type of medication.

  • Intravenous (IV): Injection or infusion directly into the bloodstream through a vein.

LO 35.4 Forms of Medication and Routes of Administration (4 of 5)

• Parenteral Medication Preparation:

  • Supplies:

  • Syringes:

    • Sizes: Ranges from 0.5 to 60 mL or larger.

    • Types: Standard, tuberculin, and insulin syringes.

    • Common Gauges: From 18 to 30.

    • Needle Length: Ranges from ¼ to 3 inches.

LO 35.4 Forms of Medication and Routes of Administration (5 of 5)

• Parenteral Medication Preparation:

  • Filter Needles or Straws: Used when withdrawing medications from a glass ampule.

  • Needleless Delivery Systems:

  • Significantly reduce needlestick injuries and exposure to bloodborne pathogens.

  • Disposed in the same manner as regular needles.

LO 35.5 Safe Medication Administration (1 of 3)

• Interpreting the Order:

  • Use clinical judgment to clarify unclear medication orders.

• Medication Errors:

  • Be aware of common causes of medication errors.

• Abbreviations:

  • Use approved abbreviations and consult The Joint Commission's Do Not Use list.

• Measurement Systems:

  • Utilize metric, apothecary, and household systems appropriately.

LO 35.5 Safe Medication Administration (2 of 3)

• Calculation Methods:

  • Dimensional Analysis Method:

  • Identify the units of measure required.

  • Start the equation with the dose to be given, followed by the concentration or the supply available.

  • Account for any conversions needed within the equation.

  • Cross out units that appear in both the numerator and denominator.

  • Multiply the numbers in the numerator and the denominator separately.

  • Divide the numerator by the denominator and append the correct units to the numeric answer.

LO 35.5 Safe Medication Administration (3 of 3)

• Administering Medications Using the Six Rights:

  • Verify:

  • Right drug.

  • Right dose.

  • Right time.

  • Right route.

  • Right patient.

  • Right documentation.

  • Perform Three Medication Safety Checks: to minimize errors.

• High-risk Situations for Medication Administration:

  • Follow established safeguards for preventing medication errors.

• Patient Rights:

  • Familiarize with the American Hospital Association’s Patient Care Partnership program.

LO 35.6 Assessment

• Initial Assessment: Produces baseline data essential for effective medication management.

• Ongoing Assessment: Evaluates medication effectiveness and enables early identification of adverse effects.

• Important Data to be Collected:

  • Patient's medical history, including allergy information and medication history.

  • Physical examination results.

  • Relevant laboratory results.

LO 35.7 Nursing Diagnosis

• Examples of Nursing Diagnoses:

  • Lack of Knowledge:

  • Supporting Data: Lack of exposure to information; patient took a double dose of furosemide; patient unaware of possible side effects.

  • Constipation:

  • Supporting Data: Opioid pain medication use; reported hard stools; painful defecation.

  • Impaired Health Maintenance:

  • Supporting Data: Verbalized misunderstanding of therapeutic regimen; refusal to continue prescribed medications.

LO 35.8 Planning

• Patient Goals Based on Nursing Diagnoses:

  • The patient will verbalize side effects of medications before discharge.

  • During outpatient visit, the patient will verbalize understanding of the need for adequate fluid and fiber intake to prevent constipation.

  • The patient will take medications daily until the next appointment.

LO 35.9 Implementation and Evaluation (1 of 16)

• Medication Administration:

  • Each medication a nurse administers must be prescribed by a healthcare provider and suitable for the patient.

  • Utilize the Medication Administration Record (MAR) when preparing and administering all medications.

  • Follow established protocols for safely administering medications by each route.

  • Use special techniques for children and elderly individuals.

LO 35.9 Implementation and Evaluation (2 of 16)

• Oral Medications:

  • Easiest and most convenient route of administration.

  • Assess the patient's ability to swallow medications.

  • Utilize alternative routes for NPO patients.

  • Verify post-administration that the medication was swallowed.

  • Use calibrated syringes or medication cups for liquid medications not premeasured.

  • Avoid medications from containers with missing or hard-to-read labels and do not return unused medications to multidose containers.

  • Medications may also be administered through the enteral route.

LO 35.9 Implementation and Evaluation (3 of 16)

• Sublingual and Buccal Medications:

  • Allow for rapid absorption.

  • Sublingual Medication: Placed under the tongue for absorption.

  • Buccal Medication: Placed against the inner cheek for absorption.

  • Use standard precautions to avoid contamination.

• Topical Medications:

  • Placed on skin, mucous membranes, and body cavities.

  • Cleanse the skin prior to application.

  • Utilize gloves and applicators to prevent absorption through the caregiver's skin.

LO 35.9 Implementation and Evaluation (4 of 16)

• Transdermal Medications:

  • Designed for absorption through the skin for systemic effects.

  • Remove existing patches and clean skin before applying a new one.

  • Rotate patch placement sites to prevent local irritation.

  • Document patch removal and placement in MAR.

• Ophthalmic Instillation:

  • Used to treat eye irritation, infections, or disorders such as glaucoma.

  • Eyedrops may also be used for diagnostic procedures or to anesthetize the eye for surgery.

  • Avoid cross-contamination during application.

LO 35.9 Implementation and Evaluation (5 of 16)

• Otic Instillation:

  • Treats ear infections, associated pain, softens earwax for easier removal, local anesthesia application, and removes foreign particles.

  • Use eardrops at room temperature and maintain sterile technique if the tympanic membrane is damaged.

LO 35.9 Implementation and Evaluation (6 of 16)

• Nasal Medications:

  • Administered via drop or nebulizer formulations into the nose.

  • Employ medical asepsis during administration.

  • Decongestant Sprays or Drops:

  • Most commonly administered nasal medications.

  • May exert systemic effects as well.

LO 35.9 Implementation and Evaluation (7 of 16)

• Inhaled Medications:

  • Devices used include MDIs (Metered Dose Inhalers), DPIs (Dry Powder Inhalers), and nebulizers.

  • Assess patients before and after administering inhaled medications.

  • Provide education on calculating remaining doses in inhalers.

• Vaginal Medications:

  • Available in various forms: creams, foams, tablets, liquids, suppositories, and gels.

  • Refrigerate vaginal suppositories, and provide absorbent pads and comfortable undergarments to manage drainage post-administration.

  • Avoid using tampons after administering vaginal medications.

LO 35.9 Implementation and Evaluation (8 of 16)

• Rectal Medications:

  • May produce local or systemic effects.

  • Rectal suppositories are often stored in the refrigerator.

  • Use clean, disposable gloves when administering.

  • Place an unwrapped suppository above the internal anal sphincter against the mucous membrane.

  • Liquid medications can be instilled using an enema solution.

LO 35.9 Implementation and Evaluation (9 of 16)

• Parenteral Medications:

  • Administered via injection into tissues, muscles, or veins.

  • Standard precautions and sterile techniques must always be observed.

  • Maintain close observation of the patient for responses to the medication.

  • Equipment: Includes syringes, needles, and the appropriate vial or ampule containing the medication.

LO 35.9 Implementation and Evaluation (10 of 16)

• Preparing Parenteral Medications:

  • Containers Include:

  • Ampules and Vials: Common forms for injectable medications.

  • Reconstituting Powdered Medications: Necessary for certain medications that need to be diluted before administration.

  • Prefilled Cartridge or Syringe: Ready-to-use administration form.

  • Mixing Medications in one syringe if compatible.

LO 35.9 Implementation and Evaluation (11 of 16)

• Intradermal Administration:

  • Given into the dermis.

  • Common uses include local anesthetics, allergy testing, and tuberculosis testing.

  • Common sites include: inner forearm, upper arm, and scapular area.

LO 35.9 Implementation and Evaluation (12 of 16)

• Subcutaneous Administration:

  • Administered into fat layer underneath the dermis.

  • Common sites include: abdomen, lateral upper arm, thigh, scapular area of the back, and upper ventrodorsal gluteal area.

LO 35.9 Implementation and Evaluation (13 of 16)

• Intramuscular Administration:

  • Common sites include: ventrogluteal, vastus lateralis, deltoid regions for injection.

  • Z-track Method: A technique utilized to minimize irritation and leaks of medications.

  • Epinephrine Auto-Injectors: Commonly used for emergencies, such as anaphylaxis.

LO 35.9 Implementation and Evaluation (14 of 16)

• Intravenous Administration:

  • Administered through a catheter inserted into a vein.

  • IV medications can be delivered via:

  • IV Push (IVP) or bolus administration.

  • Intermittent Small-Volume Administration or IV piggyback (IVPB).

  • Volume Control Administration Set: Utilizes IV pump or controller.

  • Before administering:

  • Assess patient allergies.

  • Verify medication or IV solution incompatibilities.

  • Determine amount and type of diluent needed for the medication.

  • Assess rate of medication administration.

  • Verify IV access site conditions.

LO 35.9 Implementation and Evaluation (15 of 16)

• Medications and Home Care:

  • Provide education to patients and caregivers about medications.

  • Types of medications administered in the home include:

  • Oral.

  • Transdermal.

  • Peritoneal dialysis.

  • IV treatments utilizing infusion pumps.

LO 35.9 Implementation and Evaluation (16 of 16)

• Evaluation:

  • Clinical observation is crucial for evaluating medication effectiveness.

  • Subjective and Objective Data: Indicators of patient response to medications.

  • Assess for adverse effects of medications diligently.

  • Laboratory tests may indicate patient responses to specific medications.

  • Report significant patient deviations from expected responses to the primary care provider without delay.