Transcript Medication Administration

Medication Administration
Teresa V. Hurley, MSN, RN
Pharmacological Concepts

Drug Names

Chemical Name: molecular composition


Generic Name: common name


N-acetyl-para-aminophenol
acetaminophen
Trade Mark: official name, brand name

tylenol
Pharm Concepts

Classification



Effects on body system
Symptoms relieved
Desired effect


Oral hypoglycemic agents
Aspirin (analgesic, antipyretic, anti-inflammatory)
Pharm Concepts


Medication Forms: determines route
Examples




Tablets
Capsules
Elixirs
Suppositories
Regulatory Bodies
FDA (Food and Drug Administration)
enforcement of laws
 State and Local (regulate tobacco and alcohol)
 Health Care Institutions
 Nurse Practice Acts
Pharmocokinetics

Absorbed






Administration route
Rate differs (skin, mucous membranes,
respiratory airways, GI system)
Dissolved (acidic versus base)
Blood Flow to site of administration
Body Surface Area
Lipid Solubility, with or between meals

Distribution




Circulation
Membrane Permeability
Protein Binding (free form does not bind to
albumin and is the active form of medication)
What happens in liver disease, malnurtition and
elderly?

Metabolism

Bio-tranformation (detoxify) medications



Liver main organ
Less extent lungs, kidneys, intestines
Excretion

Kidneys( main) and liver, bowel, lungs, skin

Gases and alcohol through the lungs
Medication Action

Therapeutic Effect

ASA






Analgesic
Antipyretic
Anti-inflammatory
Reduces platelet agglutination
Anti-hypertensives and Mood elevators in small
doses given for night sweats
Nitroglycerine to increase o2 supply to heart and
reduce cardiac workload

Side Effects


Adverse Effects


Minimal or serious effect
Severe response as coma
Toxic
Prolonged use, metabolism or excretion impairments lead
to build-up
Opiod Toxicity: morphine leads to respiratory depression and
death; antagonist narcon to reverse


Allergic Reactions




Medication acts as antigen
Antigen triggers release of antibodies
Mild (uriticaria; rash, pruritus, rhinitis)
Anaphylactic


constriction muscles, pharyngeal and laryngeal
edema, wheezing, SOB, hypotension,
Medic Alert Bracelet
Medication Interactions


One medication increases or lessens effect the
other
Synergistic: combined effect produces greater
effect than if given separately

Alcohol and antihistamines, antidepressants,
barbiturates and narcotics
Therapeutic Ranges





Onset: time it takes to produce a response
Peak: highest effective concentration
Trough: lowest concentration just before next
scheduled dose
Duration: concentration great enough to
produce a response
Plateau: concentration reached and
maintained after administration of fixed doses
Administration Routes
Oral Medications



PO
Buccal
Sublinguinal
Parenteral Administration (Injections)
Intradermal (ID) dermis layer
Parenteral

Subcutaneous (Sub-Q)
Tissues below the Dermis
Parenteral

Intramuscular (IM)
Parenteal

Intravenous
Topical Administration

Transdermal: 24 hours to 7 days with a
systemic effect (nitroglycerine, estrogens)

Topical provide local effects (eye, ear, nose
gtts, gargling, swabbing; rectal or vaginal
suppositories; flushing or spraying)
The Five Rights






Right Drug
Right Dose
Right Route
Right Time
Right Client
Three checks before administration
Types of Orders

Standing or Routine


Tetracycline 500 mg PO q6h
prn: when ever necessary is a subjective and
objective determination


Morphine sulfate 2 mg IV 12 hr prn for incisional
pain
Document assessment, time given, effectiveness
Order Types

Single (one time only) as pre-op or prediagnostic




Valium 10 mg PO at (9:00 am)
STAT (single dose, immediately)
Surgery Automatically cancels all of client’s
existing medication orders
New Orders Written: Transfer to another
Health Care Facility; from 1 unit to another
Distribution Systems




Must be kept under lock and key
Must be under surveillance
Stock Supply Delivery: costly and extremely
high incidence of errors
Unit Dose System: mandated by states and
regulatory agencies (NYS) and supply only
for 24 hours
Newer Technological Systems

Automated Medicine Dispensing Systems
(AMDS)



Computer control of unit doses and narcotics via
client profile
Access via nurse security code, client ID, desired
med, dosage, route from computer screen and
drawer opens, records and charges
Bar Code Scans (client and medication (name,
dosage and strength) and nurse administering
Medication Administrative Records






Check written order against the MAR
Check written order when administering IV solutions
Document all medications given on MAR
Document unusual side effects in nurses notes
Document IV solutions given on I and O sheet and in
nurses notes
Document amount of fluid given PO with
medications on the I&O sheet if client on intake and
output
Administer Medications Safely
Never recap
a needle

Place in Sharps
Container
Medication Orders




Name of Drug
Dosage
Route
Frequency



Colace 100mg PO every hs
Demerol 50 mg IM every 4 h for x
MOM 30 mL PO prn for constipation
Prevention of Errors







Check orders
Clarify illegible orders
Check B/P
Check A or A/R pulse
Check for allergies
Check lab results
Check calculations
Calculation Conversions

Not always exact between systems


60 mg = gr 1
65 mg = gr 1


ASA gr V = 300 mg
ASA gr V = 335 mg