Transcript Medication Administration

Medication Administration
By: Diana Blum MSN
NURS 1510
History
• Definition: Substance administered for diagnosis,
cure, treatment, or relief of a symptom or for
prevention of disease.
• Opium, castor oil, vinegar used in ancient times
Names
• Generic
– Given before drug officially approved
• Official
– Name under which it is listed in publications
• Brand/TRADE
– Given my manufacturer
– Several names if several manufacturers
• Chemical
– Name by which the chemists know it
Legal Aspects
• U.S. drug legislation
• Sets official drug standards
• Defines prescription drugs
• Regulates controlled
substances
• Improves safety
• Requires proof of efficacy
• Nurse Practice Acts
• Identify nursing
responsibilities for
administration and client
monitoring
Standards
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Vary in strengths and activities
Controlled by law
NURSES can be punished if error made
Controlled substances locked up in hospital
Effects of Drugs
• Therapeutic/Desired: what is intended or reason it
was prescribed
• SE: secondary effect: effect that is not intended
– May be harmful or harmless
• Adverse Effects: more serious side effects or a
reaction to the drug
• Drug toxicity: related to overdose, ingestion when
meant to be external in use, or build up in blood.
• Allergic Reaction: immune response to drug
• Anaphylactic Reaction: severe allergy to drug that
could become fatal
Tolerance
• Person requires increase dose to maintain
effectiveness (opiates, tobacco, etc)
• Cumulative effect: increased response to repeated
doses. Toxic symptoms may occur.
• Idiosyncratic effect: unexpected result. Under
response or over response
• Interaction: response to 2 drugs at once
Drug Misuse
• Improper use of common meds
• Abuse: inappropriate intake of drug
• Dependence: reliance of a drug may be physiologic
or psychologic
• Habituation: feels better after taking drug
• Illicit: street drug
Actions of Drugs on the Body
• Half life: the time it takes for half of the drug to be
excreted from the body
• If you don’t receive steady amount of the drug it
concentration decreases.
• Onset of action: time it takes for the body to
respond to drug
• Peak plasma level: the highest level achieved by a
single dose
• Plateau: maintained level during a series of
scheduled doses
• Agonist acts to respond to a substance
• Antagonist acts to inhibit a response to a substance
Pharmacokinetics
• Process by which drug is excreted absorbed
distributed or biotransformed.
• Absorption: process of passing in the blood stream
• Distribution: transportation from site of absorption to
site of action.
• Biotransformation: process that converts the drug to
a less active form by way of a detox or metabolism
• Excretion: leaves the body
Factors that affect med action
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Developmental factors
Gender
Genetics/culture
Diet
Environment
Psychologic
Illness/disease
Time of administration
Medication Systems
Stock Supply:
Unit Dose:
• Bulk quantity
• Central location
• Not client-specific
• Individually packaged
• Client-specific drawers
• 24-hour supply
Medication Systems
Automated Dispenser:
• Password-accessible locked cart
• Computerized tracking
• Can combine stock and unit doses
Self-Administration:
• Individual containers
• Kept at client’s bedside
Orders
• Types
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STAT
Standing
PRN
Single
• Parts of the Order
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Name
Date and time
Name of drug
Dose
Frequency
Route
why
signature
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TORB
VORB
Handwritten
preprinted
Nursing Considerations: Medication
Administration Safety
Three checks:
• Before you pour:
• Check the medication label against the MAR
• After you pour:
• Verify the label against the MAR
• At the bedside:
• Check the medication again
Nursing Considerations: Medication
Administration Safety
Six Rights:
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Right drug
Right client
Right dose
Right time
Right route
Right documentation
Other Rights:
• Right reason
• Right to know
• Right to refuse
Routes
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PO
SL
Buccal
Parenteral: SQ, IM, IV, intrdermal
Topical
Parenteral Medication Administration
Equipment Preparation:
• Syringe/needle (size, gauge)
Medication Preparation:
• Vials and ampules
• Reconstituting from powder
• Two medications in one syringe
• Never recap dirty needle
• Use the correct site
• Wrong site could mean wrong route
• Be familiar with the technique required for the
medication (e.g., heparin, insulin)
Avoiding Medication Errors
• Use the six rights
• Calculate doses carefully; double-check with a second
RN
• Watch for drugs with similar names
• Watch for clients with same last names
• Clarify illegible orders
• Know and use your resources
• Keep up with changes in medication orders
•Conversions
Systems of measurement
Metric
Ordered by units of 10
Decimal system
Liter and gram are basic units
kilogram
milligram
microgram
milliliter
Apothecaries
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Older than metric
Grain
Minum
Pound
Pints
quarts
Household
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Drops
Teaspoons
Tablespoons
Cups
Glasses
Equivalents of Measurements
Metric: decimal system, most logically organized.
Each unit is organized into units of 10. In X the
decimal moves to the “R”; in division it moves “L”
Basic measurement=meter(L), liter(volume),
gram(weight)
• Basic units:
– Deci 1/10 or 0.1
– Centi 1/100 or 0.01
– Milli 1/1000 or 0.001
• 500mg or 0.5g, not 1/2g
• 10ml or 0.01L, not 1/100L
– With fractions the zero is always place in front of the decimal
to prevent error
Conversion in One System
• In metric system, division or multiplication are used,
ie, to change mg to g. divide by 1000 or move the
decimal 3 points to the left
• To convert liters to ml, multiply by 1000 or move the
decimal 3 points to the right
• To convert units of measurement within the
apothecary or household system, must know the
equivalent.
• Example: To convert ounces to quarts must know
32 oz is = to 1 quart
• To convert 8 oz to a quart measurement, divide 8
by 32 to get the equivalent, ¼ or 0.25 quart
Setting Up the Calculations
• When looking at a medication order, ask yourself 3
questions:
What did the MD order? (desired quantity)
What do I have on hand? (dose available)
What conversion factor (conversion
do I need?
factor)
• The desired quantity is the MD order, (10mg, v gr)
• The dose available is found on the drug label,
(tablet, number of capsules, ml)
• *Remember, the quantity of tablets, capsules, or ml
is always the numerator of the dose available; the
amount (or dosage) is in the denominator
• To decide which equivalent measure should be in
the numerator and which should be in the
denominator, look at the units of measure in the
desired quantity.
• The units of measure in the desired quantity
should be in the denominator of the conversion
factor (i.e.,if the desired quantity is 100 mg and
the equivalent conversion factor is 1000 mg = 1 g,
then the conversion factor in fraction form should
be 1 g / 1000mg
Formula
Desired quantity x Dose available X Conversion (if
factor needed) = Amount to Administer
This is a simple formula that uses ratio and
proportions which will help you both correctly set up
and solve dosage calculation problems
• MD order: ASA 300 mg q4h prn pain
• Drug label: ASA 1 tab = v gr
• Conversion factor: 1 gr = 60 mg
• 5gr x 1 tab x 60 mg = x
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300mg
1 gr
• 5 x 1 tab x 60 = 300 tab = x
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300
300
continued
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300 tab = x
300
x = 1 tab
More Formulas
• Another basic formula that can be used when
preparing solid or liquid forms:
Desire dose X Amt on hand = Amt to give
dose Have
Demerol 50 mg ordered comes in 100 mg vial in I cc
Rate of infusions
• Amount in cc’s X drip factor = gtt/min
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time in minutes
Conversions to know
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1 gram (G) = 1000 milligrams (mg)
1000 micrograms (mcg) = 1 mg
60-65 mg = 1 grain (gr)
1 fluid ounce = 30 ml or 2 tablespoons
1 teaspoon = 5 ml
1000 ml = 1 quart or 1 liter
1 kg = 2.2 pounds (lb)
1 inch = 2.54 cm
1 mL=15 gtts
30mL=1 ounce
1 tbsp= 15mL