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Transcript Dose ordered
Principles for Nursing Practice
Medication Administration
Dr. Belal M. Hijji, RN, PhD
February 11, 2012
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
– Solution Suppository
relase
Intraocular
Suspension
Lotion Ointment
Syrup Sustained
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Jordan Drug and Food Administration Guidelines For Safe
Narcotics Administration And Control
يجب تحديد مسؤول التمريض في كل قسم من أقسام المستشفى ويتم تسليم العقاقير الخطرة لكل قسم
مقابل ضبط استالم وتسليم موقع من قبل الممرض المسؤول في القسم والصيدلي المسؤول في
المستشفى .يجب أن يتم حفظ العقاقير الخطرة في خزانة محكمة االغالق.
على مسؤولي التمريض تسليم مفتاح خزانة العقاقير الخطرة فقط للممرض المسؤول في الورديات
االخرى.
يجب ان يكون هناك سجل خاص بالعقاقير الخطرة في المستشفى يسجل فيه اسم المريض ورقم ملفه
ورقم السرير واسم الطبيب الواصف للحقنة المخدرة واسم الممرضة وتوقيعها والتاريخ واسم الممرض
الشاهد على االعطاء .ويجب على السجل أن يبين االستالم والتسليم بين الورديات وموقع من قبل
الممرضين المسؤولين.
تصرف العقاقير الخطرة من قبل الصيدلي المسؤول المعتمد فقط لرئيسة ممرضات القسم.
يجب على الممرض المسؤول اعطاء حقنة المادة المخدرة للمريض بعد التأكد من توقيع الطبيب على
الوصفة وعلى اضبارة المريض ،وأن يوقع الممرض على االضبارة بعد االعطاء.
في حالة اعطاء المريض جزء من محتويات حقنة عقار خطر يجب اتالف الكمية المتبقية بحضور
الطبيب والذي يبين ذلك على الوصفة بتوقيعه مع التاريخ والوقت.
في حالة وقوع حادث كسر لحقنة يجب استدعاء الصيدلي المسؤول لمشاهدة الحادث وعمل محضر يبين
تفاصيل ما حدث وتوقيع الشهود عليه مع الصيدلي المسؤول .وفي حالة عدم وجود الصيدلي ضرورة
استدعاء الطبيب المناوب لمشاهدة حادث الكسر وليقوم بالتوقيع على المحضر بعد توقيع الشهود وحفظ
الحقن المكسورة لدى الصيدلي المسؤول بعد ذلك من اجل اجراءات تبليغ مديرية الدواء ورفع تقرير عن
الحادثة فورا ً وحفظ نسخة لدى الصيدلي ونسخة في ملف المتسبب بحادثة الكسر.
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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 doctor’s 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 physician’s wellwritten and clear order.
Handwritten prescriptions can be difficult to decipher []يكتشف معنى شيء غامض.
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.
• Prescriber’s 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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• Pharmacist’s role is to:
– Prepare and distributes prescribed medications
– Assess the medication plan and evaluate the client’s
medications-related needs
– Fill prescription accurately and ascertaining their validity
• Nurse’s 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
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