Transcript Basic Nursing: Foundations of Skills and Concepts Chapter 24

Basic Nursing: Foundations of
Skills & Concepts
Chapter 24
MEDICATION
ADMINISTRATION
Medication Management
Requires the collaborative efforts of many
health care providers.
 Nurses are responsible for administering
medications.
 Medication administration requires
specialized knowledge, judgment, and
nursing skills.
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Drug Standards and Legislation
A drug is a chemical substance intended
to elicit a specific effect.
 Standards are set to ensure drug
uniformity in:
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Strength.
Purity.
Efficacy.
Safety.
Bioavailability (readiness to produce a drug effect).
Standards
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The United States Pharmacopeia and the
National Formulary (USP and NF) are
books of drug standards for use in the
United States.
Legislation: The FDA
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The Food and Drug Administration (FDA)
tests all drugs for toxicity before granting
a company the right to market a drug.
Drug Nomenclature
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Drugs are usually referred to by their
generic name (not capitalized) or by their
trade name (always capitalized).
Drug Action
A drug’s ability to combine with a cellular
drug receptor.
 Depending on the location of the cellular
receptor, the drug can have a local effect,
a systemic effect, or both.
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Pharmacology
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The study of the effects of drugs on living
organisms.
Medication Management
Its purpose is to produce the desired drug
action by maintaining a constant drug
level.
 Drug action is based on the drug’s half-life
(the time it takes the body to eliminate
half of the blood concentration level of the
original drug dose).
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Terms Relating to Drug Action
Onset of action (the time it takes for the
body to respond to a drug after
administration).
 Peak plasma level (the highest blood
concentration of a single drug dose before
the elimination rate equals the rate of
absorption).
 Plateau (maintenance of a certain level).
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Routes of Drug Absorption
Oral.
 Topical.
 Inhalants.
 Parenteral (injectable).
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Intradermal (into the dermis).
Subcutaneous (into the subcutaneous tissue).
Intramuscular (into the muscle).
Intravenous (into a vein).
Pharmokinetics
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The study of the absorption, distribution,
metabolism, and excretion of drugs to
determine the relationship between the
dose of a drug and the drug’s
concentration in biological fluids.
The 4 Properties of Drug Action
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Absorption (passage of a drug from the site of
administration into the bloodstream).
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Distribution (the movement of drugs from the blood into
body fluids and tissues).
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Metabolism (the physical and chemical processing of a
drug by the body).
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Excretion (the elimination of drugs from the body.
Drug Interaction
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The effect one drug can have on another
drug.
Side Effects and Adverse
Reactions
Drug Allergy.
 Drug Tolerance.
 Toxic Effect.
 Idiosyncratic Reaction.
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Food and Drug Interactions
Certain drugs may interfere with the
absorption, excretion, or use in the body
of one or more nutrients.
 Certain foods may increase or decrease
the absorption of a drug into the body.
 Other foods may alter the chemical
actions of drugs, preventing their
therapeutic effect on the body.
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Factors Influencing Drug Action
Genetic factors.
 Age.
 Height.
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Weight.
 Physical
conditions.
 Mental conditions.
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Medication Orders
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All medication orders should contain:
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Client’s name
Date & Time
Name of Drug to be administered
Doasage
Route of administration
Time & frequency
signature of person ordering
Types of Orders
Stat (those that should be administered
immediately).
 Single-Dose (one-time medications).
 Scheduled (administered routinely until
order is canceled by another order).
 PRN (on as-needed basis).
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Three Systems
of Weight and Measure
Metric (simple system based on units of
10).
 Apothecary (based on the weight of one
grain of wheat).
 Household (drops, teaspoons,
tablespoons, etc.).
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Five “Rights” of
Safe Drug Administration
Right drug.
 Right dose.
 Right client.
 Right route.
 Right time.
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Documentation of Drug
Administration
A critical element of drug administration is
documentation.
 The standard is “if it was not documented
it was not done.”
 The nurse should document that a drug
has been given after the client has
received the drug.
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Drug Supply and Storage
Scheduled drugs for each client are
usually dispensed in a unit dose form.
 Certain drugs may be stock supplied
(dispensed and labeled in large
quantities) and stored in the medication
room.
 Narcotics and controlled substances must
be administered in accordance with
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Medication Compliance
The client’s understanding of why a
medication was ordered and how a
medication can decrease the likelihood of
getting a disease or how it can lessen the
effects of an existing disease.
 Clients refusing medication or adjusting
the scheduling or dose are noncompliant.
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Responsibilities of Nurses
Regarding Drug Administration
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Nurses are both legally and morally
responsible for correct administration of
medications.They must:
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Follow institutional policy.
Consider clients’ desires and abilities.
Foster compliance.
Correctly document all actions related to medication
administration and medication errors.
Assessment
Drug History (Allergies, Prescription
Drugs taken, Over-the-Counter Drugs
used).
 Medical History (Biographical data,
Lifestyle and beliefs, Sensory and
cognitive status).
 Physical Examination.
 Diagnostic and Laboratory Data.
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Nursing Diagnosis
Health Maintenance, Altered.
 Knowledge Deficit.
 Management of Therapeutic Regimen,
Ineffective.
 Physical Mobility, Impaired.
 Sensory/Perceptual Alterations.
 Swallowing, Impaired.
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Nursing Interventions
Primary nursing interventions related to
medication management are:
 Assessment.
 Administration.
 Teaching.
Oral Drugs
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Oral medications should be poured and
measured at eye level to ensure
accuracy.
Parenteral Drugs
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Although the physician will determine the
dose and route of a parenteral drug, the
nurse is responsible for choosing the
correct gauge and length of the needle to
be used.
Equipment to Administer
Parenteral Drugs
Syringes (three basic parts: the hub, the
barrel, the plunger).
 Needles (three basic parts: the hub, the
cannula, or shaft, and the bevel).
 Ampules (glass containers of single-dose
drugs).
 Vials (glass, single- or multiple-dose
rubber-capped drug containers).
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Intradermal Injection
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Injections typically used to diagnose
tuberculosis, identify allergens, and
administer local anesthetics.
Subcutaneous Injection
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Injections into the subcutaneous tissue,
between the dermis and the muscle.
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Commonly used in the administration of
medications such as insulin and heparin.
Intramuscular Injection
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Used to promote rapid drug absorption
and to provide an alternate route when
the drug is irritating the subcutaneous
tissue.
Intravenous Therapy
Requires parenteral fluids (hypotonic fluid,
isotonic fluid, hypertonic fluid)
 Special equipment needed:
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Administration set.
IV pole.
Filter.
Regulators to control IV flow rate.
Established venous route.
Blood Transfusion
To replace blood loss (deficit) with whole
blood or blood components.
 Special equipment needed:
 Administration set.
 IV pole.
 Filter.
 Regulators to control IV flow rate.
 Established venous route.
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The Importance of Monitoring
The nurse must always carefully monitor
client reactions to medications and ensure
that clients are appropriately educated as
to the actions, side effects, and
contraindications of all medications they
are receiving.
 Clients receiving IV therapy or blood
transfusions require constant monitoring
for complications.
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Topical Medications
Eye medications.
 Ear medications.
 Nasal instillations.
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Respiratory
inhalants.
 Rectal instillations.
 Vaginal
instillations.
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