Principles for Nursing Practice

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Principles for Nursing Practice

• Medication Administration

Dr. Belal M. Hijji, RN, PhD February 11, 2012
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Objectives

• By the end of this lecture, students will be able
  to
• Discuss pharmacology applications in nursing
  practice.
• Describe the Jordan Drug and Food Administration
  guidelines for safe narcotics administration and
  control
• Recognise types of medications actions.
• Describe factors influencing choice of
  administration routes.
• Correctly calculate a prescribed medication
  dosage, and identify the five rights of
  medication administration.
• Describe the roles of the pharmacist, physician,
  and nurse in medication administration.

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Pharmacology Applications in Nursing Practice

• Names
• Generic Acetaminophen
• Trade (brand) Tylenol
• Classification Medications with similar
  characteristics are grouped into classifications.
  Some medication have more than one
  classification.
• Hypoglycemic agents
• Antihypertensive agents
• Forms
• Tablets Capsules Intraocular Lotion Ointment
• Solution Suppository Suspension Syrup Sustained
  relase

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Jordan Drug and Food Administration Guidelines
For Safe Narcotics Administration And Control

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Types of Medication Action

• Therapeutic This is the expected or predictable
  physiological response a medication causes. For
  example, nitroglycerin reduces cardiac workload
  and increases myocardial oxygen supply
• Side effects This is predictable, unintended,
  secondary effect. For example, asymptomatic blood
  loss, skin reactions
• Adverse effects Are generally severe responses
  to medication. For example, when a client
  experiences cardiac arrest following rapid
  administration of KCL.
• Toxic effects These may develop after prolonged
  intake of medication. For example, respiratory
  depression caused by morphine.

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Factors Influencing Choice of Administration
Routes

• Oral routes Are convenient, comfortable,
  economic, and rarely cause anxiety
• Disadvantages Avoid in nausea vomiting,
  reduced motility, gastric suction, and reduced
  ability to swallow.
• SC, IM, IV, ID routes Are used when oral routes
  are C/I. Absorption is more rapid than with oral
  and topical routes. IV route is valuable in
  critically ill clients.
• Disadvantages Risk of infection, expensive, not
  suitable for clients with bleeding tendencies,
  risk of tissue damage with SC injections, IV and
  IM routes are dangerous due to rapid absorption,
  and anxiety.

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• Topical routes Provide local or systemic effect,
  painless, limited side effects, prolonged
  systemic effects (transdermal), rapid relief for
  local respiratory problems.
• Disadvantages Skin abrasions facilitate rapid
  absorption and systemic effects, clothes soiling,
  rectal and vaginal applications are embarrassing,
  ruptured eardrum cannot receive irrigations,
  suppositories are C/I in rectal bleeding and
  rectal surgery, some inhalation agents can cause
  serious systemic effects such as cardiac
  arrhythmias due to salbutamol inhalation.

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Dosage Calculation

• When preparing solid and liquid forms
• Dose ordered x Amount on hand Amount to
  administer
• Dose on hand
• Example (1) Give Demerol 50 mg (dose ordered)
  IM. Each ampoule contains 100 mg (dose on hand)
  in 1 ml (amount on hand). How many ml should be
  given?
• 50 x 1 0.5 ml (amount to administer)
• 100
• Example (2) The doctors order is 0.125 mg PO of
  Digoxin. Each tablet contains 0.25 mg. How many
  tablets should be given?
• 0.125 x 1 0.5 tablet
• 0.25

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• Example (3) Give Erythromycin suspension 250 mg
  PO. Each 5 ml contains 125 mg. What amount would
  you give?
• 250 x 5 10 ml, OR
• 125
• 5 ml 125 mg
• ? 250 mg

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Rights of Medication Administration

• Right medication When preparing medication,
  compare the label of the medication container
  with a physicians well-written and clear order.

• Handwritten prescriptions can be difficult to
  decipher ????? ???? ??? ????. For example, in
  the following prescription the drug name Avandia
  was incorrectly interpreted as Coumadin.
• Only administer the medication you prepare
                                                    
                                  

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• Right dose
• Chances for errors increase when a medication
  must be prepared from a larger volume or strength
  than needed.
• When performing medication calculations or
  conversion, check the calculated dose with
  another nurse.
• After calculations, prepare the medication using
  standard measurement devices such as graduated
  cups, syringes, and scaled droppers.

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• When it is necessary to break a scored tablet,
  the break should be even. Unevenly broken tablet
  should be discarded
• When crushing a tablet, the crushing device
  should always be completely cleaned

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• Right client To ensure safe medication
  administration, the right client must be
  identified. This can be done by
• Matching client identification details on his/
  her bracelet with those on the prescription chart
• Asking the client to state his/ her full name
• Right route
• Consult the physician if the route of
  administration is not specified or not
  recommended
• When administering injections, it is important to
  prepare them from preparations designed for
  parenteral use. The injection of a liquid
  designed for oral use can cause sterile abscess
  formation or fatal systemic effects.

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• Right time The timing a medication is to be
  administered at is at the discretion of the
  physician. For example
• Give Augmentin 375 mg every 8 hour (q8h)
• Give iron tablet 3 times a day (tid) after meals
• Give valium 10 mg IM preoperatively
• Give Demerol 50 mg IM stat
• All routinely prescribed medications should be
  given within 30 minutes of the times ordered.
• However, sometimes the nurse should judge the
  proper time when a medication is to be
  administered. For example
• PRN (Pro Re Nata) sleeping or pain medications

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The roles of Prescriber, Pharmacist, and Nurse in
Medication Administration.

• Prescribers role
• The prescriber could be a physician or an
  advanced practice nurse
• Institutional policies vary regarding the
  personnel who can take verbal or telephone
  orders.
• Common abbreviations are often used when writing
  orders. These include AC (before meals), ad lib
  (as desired), BID (twice a day), HS (hour of
  sleep), PC (after meals), prn (when needed), and
  od or qd (every day).
• However, the current recommendation is that
  abbreviations should not be used because of the
  high number of medication errors related to their
  use.

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• Pharmacists role is to
• Prepare and distributes prescribed medications
• Assess the medication plan and evaluate the
  clients medications-related needs
• Fill prescription accurately and ascertaining
  their validity
• Nurses role is to
• Administer medication correctly to clients
• Assess client ability to self medicate
• Determine whether a client should receive
  medication at a given time
• Monitor the effect of prescribed medications
• Provide education to client and family regarding
  medication administration and monitoring