Medication Administration

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Medication Administration
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What is a Medication?

• . . . substance used in the diagnosis,
  treatment, cure, relief, or prevention of health
  alterations. (PP, p. 822)

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What is the Role of the Nurse?

• Preparation
• Administration
• Teaching
• Evaluation
• Knowledge

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Pharmacological Concepts

• Drug names
• Chemical
• Generic
• Trade
• Classification
• Medication forms

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Legislation and Standards

• Federal
• State
• Health Care Institution
• Medication Regulations and Nursing Practice

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Pharmacokinetics

• . . . study of how medications enter the body,
  reach their site of action, are metabolized, and
  exit the body. (PP, p. 825)
• Nurse utilizes understanding of pharmacokinetics
• Timing of medications
• Selecting route
• Judging risks for altered action
• Observing client response

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Factors Influencing Absorption

• Route of administration
• Ability of medication to dissolve
• Blood flow to the site of administration
• Body surface area
• Lipid solubility of a medication

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Factors Influencing Distribution

• Circulation
• Membrane permeability
• Protein binding

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Metabolism and Biotransformation

• Metabolized changed to a less active or inactive
  form
• Biotransformation process influenced by enzymes
  that detoxify, degrade, and removes biologically
  active substances
• Liver is the predominant organ of
  biotransformation
• Many toxic substances are oxidized and
  transformed by liver

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Excretion

• Exit of metabolites
• Kidneys
• Liver
• Bowel
• Lungs
• Exocrine glands

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Medication Actions

• Therapeutic effects
• Side effects
• Adverse effects
• Toxic effects
• Idiosyncratic reactions
• Allergic reactions

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Medication Interactions

• When one medication modifies the action of
  another medication. (PP. p. 829)
• Risk for interaction increases with number of
  medications taken
• Synergistic effect
• Not always undesirable

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Medication Dose Responses

• Concentration
• Peak
• Trough
• Serum half-life

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Dosage Administration Schedules

• Before meals ac
• Twice a day bid
• At bedtime HS
• Every morning Q am
• As needed prn
• Three times a day TID
• Four times a day QID
• Immediately STAT

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Routes of Administration

• Oral sublingual, buccal
• Parenteral intradermal, subcutaneous,
  intramuscular, intravenous
• Topical
• Inhalation
• Intraocular

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Systems of Measurement

• Metric
• Apothecary (grains)
• Household

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Metric System

• Grams (g)
• Milligrams (mg)
• Kilograms (kg)
• Liters (L)
• Milliliters (ml)

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Household Measurements

• Tablespoons
• Teaspoons
• Ounces
• Cups
• Pints
• Quarts

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Clinical Calculations

• Conversions within systems
• Conversions between systems
• Formula
• Dose ordered X Amount
• Dose on hand on hand
• 5 X 2 ml 1 ml
• 10

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Proportional Analysis

• Dose on hand is to amount on hand as desired dose
  is to desired amount.
• 10 mg 2 ml as 5 mg X ml
• 10 times X 10 X 2 times 5 10
• 10
  10
• X 1 ml

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Prescribers Role

• Types of orders
• Standing orders
• Prn orders
• Single orders
• Stat orders

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Distribution System

• Stock supply
• Unit dose
• Computer controlled

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Nurses Role

• Six rights
• Triple-check before administration
• Client assessment

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Six Rights

• Right medication
• Right dose
• Right client
• Right route
• Right time
• Right documentation

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Clients Rights

• Information
• Refusal
• Careful assessment
• Informed consent
• Safe administration
• Supportive therapy
• No unnecessary medications

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Assessment

• Medical history
• History of allergies
• Medication data
• Diet history
• Perceptual or coordination problems
• Current condition
• Attitude about medication use
• Knowledge of therapy
• Learning needs

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Associated Nursing Diagnoses

• Deficient knowledge (medications)
• Noncompliance (medications)
• Disturbed sensory perception
• Impaired swallowing
• Ineffective therapeutic regimen management

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Planning

• Goals and Outcomes
• Setting priorities
• Continuity of care

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Implementation

• Teaching client and family
• Orders receipt, transcription, communication
• Calculation and measurement
• Correct administration techniques
• Recording (documentation)

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Special Considerations

• Infants and children
• Older adults
• Polypharmacy
• Self-prescribing
• Over-the-counter medications
• Misuse
• Noncompliance

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Evaluation

• Response (client)
• Ability to self administer (client and family)

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Oral Administration

• Considerations
• Presence of GI alterations
• Ability to swallow
• Use of gastric suction
• Positioning

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Topical Administration

• Considerations
• Skin applications
• Gloves or applicators
• Skin preparation
• Thickness of application

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Nasal Instillations

• Considerations
• Assessment of nares
• Client instructions and self-administration
• positioning

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Eye Instillation

• Considerations
• Drops, ointments, disks
• Assessment of eyes
• Asepsis
• Positioning

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Ear Instillation

• Considerations
• Assessment of ear canal
• Warming of solution
• Straightening of canal for children and adults
• Positioning

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Vaginal Instillation

• Considerations
• Suppositories, foams, creams
• Use of gloves and applicator
• Client positioning, comfort, and hygiene

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Rectal Instillation

• Considerations
• Suppositories
• Use of gloves
• Client positioning, comfort, and hygiene

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Inhalation

• Considerations
• Metered-dose inhalers (MDIs) and dry powder
  inhalers (DPIs)
• Client assessment and instruction
• Use of spacer
• Determination of doses in canister

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Irrigation

• Medications used to wash out a body cavity
  delivered with a stream of solution
• Sterile water
• Sterile saline
• Antiseptic solution
• Asepsis

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Parenteral Administration

• Equipment
• Syringes size (volume), types
• Needles length, gauge
• Disposable units Tubex, Carpuject
• Ampules
• Vials

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Parenteral Administration (contd)

• Mixing medications
• Determine compatibility of medications
• Do not contaminate one medication with another
• Ensure final dose is accurate
• Maintain aseptic technique

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Parenteral Administration (contd)

• Insulin
• Syringes and needle size
• Types of insulin
• Mixing of insulin
• Rotation of vials before withdrawal of solution

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Administration of Injections

• Minimize discomfort
• Use smallest suitable needle
• Position client comfortably
• Select proper site
• Divert clients attention
• Insert the needle quickly and smoothly
• Hold the syringe steady
• Inject the medication slowly and steadily

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Administration of Injections (contd)

• Subcutaneous injections
• Sites condition of area, rotation of use
• Amount of solution
• Length and gauge of needle
• Pinch or spread skin
• Angle of insertion

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Administration of Injections (contd)

• Intramuscular injections
• Sites landmarks, condition of area
• Amount of solution
• Length and gauge of needle
• Angle of insertion
• Aspiration
• Air-lock method
• Z-track technique

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Administration of Injections (contd)

• Sites
• Ventrogluteal
• Vastus lateralis
• Deltoid

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Administration of Injections (contd)

• Intradermal injections
• Skin testing
• Sites
• Length and gauge of needle
• Angle of insertion
• Formation of small bleb

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Prevention of Needle Sticks

• Needleless devices
• Sharps disposal
• One-handed recapping technique

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Intravenous Administration

• Large volume infusions
• Bolus injection
• Volume-controlled infusions
• Piggyback
• Tandem
• Volume control set
• Mini-infusor pump