Transcript Roach: Introductory Clinical Pharmacology

Introduction to Clinical
Pharmacology
Chapter 02Administration of Drugs
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Introduction
• Drug administration
• Understand basic concepts
• Nurse’s role:
– Monitor the therapeutic response
– Report adverse reactions
– Teach the patient and family members
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*The Five +1 Rights of Drug
Administration
• Right patient: Check patient’s wristband; ask
patient to identify himself, DOB, pictures
• Right drug: Compare medication; container
label; medication record
• Right dose
• Right route
: Obtain written order
• Right time
• Right documentation: Record immediately*
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Considerations in Drug Administrations
• General principles of drug administration
– *Factual knowledge of each drug given:
Reasons for use; general action; common
adverse reactions; special precautions in
administration; normal dose ranges
– Check current and approved references
for all drug information
– *Consider before administering a drug:
*Patient’s allergy history; previous
adverse reactions; patient comments;
change in patient condition
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Considerations in Drug Administrations
(cont’d)
• The medication order: To administer
medication a physician’s order is essential
– *Common orders: Standing; single; PRN;
STAT
• Once-a-Week drug: Doses designed to
replace daily doses of drugs; beneficial for
those experiencing mild adverse reactions
– Example: Alendronate (Fosamax) - Treat
osteoporosis
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Considerations in Drug Administrations
(cont’d)
• Guidelines for preparing a drug for administration
– Check health care provider’s written orders and
compare label of the drug with MAR
– Wash hands and do not let hands touch capsules
or tablets
– Never remove a drug from: An unlabeled
container; a package with an illegible label
– Never crush tablets or open capsules or
administer a drug prepared by someone else
– Alert: Drugs with similar names
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Considerations in Drug Administrations
(cont’d)
• Guidelines for preparing a drug for
administration (cont’d)
– Return drugs requiring special storage to
the storage area immediately after they
are prepared for administration
– Unit dose: Remove wrappings when the
drug reaches the patient; chart
immediately after administering the drug
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Considerations in Drug Administrations
(cont’d)
• *Precautions taken by the nurse:
– Confirm any questionable orders
– verify calculations with another nurse
– listen to the patient
– Never administer a drug until you answer the
patients questions
– concentrate on only one task at a time
• Most common occurrence of errors: Insulin and
heparin
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Considerations in Drug Administrations
(cont’d)
• Drug Errors - patient receives:
– The wrong dose
– The wrong drug
– An incorrect dosage of the drug
– A drug by the wrong route
– A drug given at the incorrect time
• Nurses: Last defense against detecting drug
errors; if error occurs, report immediately
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Considerations in Drug Administrations
(cont’d)
• Drug dispensing system
– Computerized Dispensing System
– Unit Dose System
– Bar Code Scanner
– Bar codes are used to identify the patient and to
record and charge routing and PRN drugs
– Provider identification badges are scanned
during the procedure, identifying the nurse
giving the medication
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Administration of Drugs by Oral Route
• Most frequent route of drug administration
• Oral Drug Forms: Tablets; capsules; liquids
• Sustained-release drugs
• **Nursing responsibilities:
–
Verify the drug
– identify the patient
–
–
assess; keep water readily available
instruct; never leave a drug at the patient’s bedside
to be taken later
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NGT or g-tubes*
• Always check for placement
• Dilute and flush liquid drugs through the tube
• Crush tablets and dissolve them in water before
administering them through the tube
• Flush tube with water after the drugs are placed in
the tube to clear the tubing completely
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Administration of Drugs by Parenteral
Route
• Parenteral drug administration routes:
Subcutaneous (SC); intramuscular (IM);
intravenous (IV); intradermal route;
intralesional; intra-arterial; intracardiac;
intra-articular
• Nursing responsibilities: Wear gloves; use
standard precautions; cleanse skin
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Administration of Drugs by Parenteral
Route (cont’d)
• Administration of drugs by subcutaneous
route: Places the drug into the tissues
between the skin and the muscle
• Nursing responsibilities:
– Volume of injection: Single/multiple sites
– SC injection sites: Upper arms; upper
abdomen; upper back-ROTATE sites
– Needle length and angle of insertion:
Obese/thin patients-23-25 gauge needle
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Administration of Drugs by Parenteral
Route (cont’d)
• Administration of drugs by intramuscular route:
Administration into a muscle
• Nursing responsibilities: 20-22 gauge needle
– Volume of injection: Single/multiple sites; 1-3
mls
– Injection sites, needle length and angle of
insertion: Deltoid muscle; ventrogluteal or
dorsogluteal sites; *vastus lateralis-infants and
small children
• Z-Track technique: Prevents backflow of drug into
the SC tissue
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IM route
• Wash hands
• Don gloves
• Verify drug allergies
• Aspirate 5-10 seconds
• Place pressure on area after removing needle
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Administration of Drugs by Parenteral
Route (cont’d)
• Drug administration- intravenous route: Directly
into blood; needle inserted into a vein
• Methods of administration: Slow; rapid; piggyback
infusions; existing IV line; using intermittent
venous access device; added to an IV solution;
venipuncture
• Intravenous infusion controllers, pumps: Detectors,
alarms alert the nurse
– Possible problems: Air in line; occlusion; low
battery; completion of infusion; inability to
deliver preset rate
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Administration of Drugs by Parenteral
Route (cont’d)
• Administration of drugs by intravenous route
(cont’d)
• Nursing responsibilities:
– Record type of IV fluid and drug added to
the IV solution after start of infusion;
check infusion rate and inspect needle
site
– Swelling around the needle:
Extravasation or infiltration
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Administration of Drugs by Parenteral
Route (cont’d)
• Drug administration- intradermal route:
Sensitivity tests - Tuberculin; skin allergy
• Nursing responsibilities:
– Injection sites: Inner part of forearm; upper
back; hairless; avoid areas near moles, scars,
or pigmented skin
– 1-mL syringe; 25- to 27-gauge needle; 1⁄4 to
5⁄8 inch
– Needle insertion: 15-degree angle; do not
aspirate syringe or massage the area
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Administration of Drugs by Parenteral
Route (cont’d)
• Other parenteral routes of drug
administration: Intracardial; intralesional;
intra-arterial; intra-articular
• Nursing responsibilities:
– Prepare drug for administration; Ask
primary care provider
– Venous access ports: For chemotherapy
or long-term therapy
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Administration of Drugs Through the Skin
and Mucous Membranes
• Application to the skin and mucous
membranes
• Several routes
– Topical
– Transdermal
•Rotate patch sites
– Inhaled through the membranes of the
upper respiratory tract
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Administration of Drugs Through the Skin
and Mucous Membranes (cont’d)
• Administration of drugs by the topical route
– Act on the skin; not absorbed through the
skin
• Nursing responsibilities:
– Follow special instructions: Drug action
may depend on correct administration of
the drug
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Administration of Drugs Through the Skin
and Mucous Membranes (cont’d)
• Administration of drugs by the transdermal
route
– Readily absorbed from the skin
– Drug dosages: Implanted in a small
patch-type bandage
– Drug system maintains: Constant blood
concentration; reduces the possibility of
toxicity
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Administration of Drugs Through the Skin
and Mucous Membranes (cont’d)
• Administration of drugs by the transdermal
route (cont’d)
• Nursing responsibilities:
– Wear gloves; apply patch on clean, dry,
nonhairy areas of intact skin; apply next
dose to new site: Remove old patch
– Commonly used sites: Chest, flank, and
upper arm
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Administration of Drugs Through the Skin
and Mucous Membranes (cont’d)
• Administration of drugs through inhalation
– Drug droplets, vapor, or gas: Through
mucous membranes of the respiratory
tract
– Use face mask, nebulizer, or positivepressure breathing machine
• Nursing responsibilities:
– Provide proper instructions
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Nursing Responsibilities after Drug
Administration
• Record: Administration of the drug; IV flow
rate, site used for parenteral administration;
problems with administration; vital signs
taken immediately before administration
• Evaluate and record: Patient’s response to
the drug
• Observe and record: Adverse reactions and
frequency
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Administration of Drugs in the Home
• Home setting caregivers: Patient or family
members
• Ensure: Patient or caregiver understands the
treatment regimen
• Home care checklist: For administering drugs
safely in the home
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