Transcript PowerPoint 演示文稿

给 药
(二)
中国医科大学护理学院
王健
Medications
(two)
FACTORS AFFECTING
MEDICATION ACTION
A number of factors other than
the drug itself can affect its action.
A person may not respond in the
same manner to successive doses
of a drug. In addition, the identical
drug and dosage may affect
different clients differently.
1.Developmental Factors
·During pregnancy women must be very
careful about taking medications.
·Infants usually require small dosages
because of their body size and the
immaturity of their organs, especially the
liver and kidneys.
·Older adults have different responses to
medications due to physiologic changes
that accompany aging.
2.Gender
Differences in the way men and
women respond to drugs are chiefly
related to the distribution of body fat
and fluid and hormonal differences.
3.Cultural, Ethnic, and Genetic Factors
Recent research has indicated
ethnicity and culture may contribute to
differences in responses to
medications.
4.Diet
Nutrients can affect the action of
a medication.
5.Environment
The client’s environment can
affect the action of drugs,
particularly those used to alter
behavior and mood.
6.Psychologic Factors
A client’s expectations about what
a drug can do can affect the response
to the medication.
7.Illness and disease
Illness and disease can also affect the
action of drugs.
8.Time of Administration
The time of administration of oral
medications affects the relative speed
with which they act.
ROUTES OF ADMINISTRATION
Pharmaceutical preparations are
generally designed for one or two
specific routes of administration. The
route of administration should be
indicated when the drug is ordered.
When administering a drug, the nurse
should ensure that the pharmaceutical
preparation is appropriate for the route
specified.
1.Oral
Oral administration is the most
common, least expensive, and most
convenient route for most clients. In
oral administration, the drug is
swallowed. Because the skin is not
broken as it is for an injection, oral
administration is also a safe method.
The major disadvantages are
possibly unpleasant taste of the
drugs, irritation of the gastric
mucosa, irregular absorption from
the gastrointestinal tract, slow
absorption, and in some cases,
harm to the client’s teeth.
2.Sublingual
In sublingual administration a
drug is placed under the tongue,
where it dissolves (Figure 33-2). In a
relatively short time, the drug is
largely absorbed into the blood
vessels on the underside of the
tongue. The medication should not be
swallowed. Nitroglycerin is one
example of a drug commonly given in
this manner.
3.Buccal
Buccal means “pertaining to the
cheek.” In buccal administration, a
medication (eg, a tablet) is held in the
mouth against the mucous membranes
of the cheek until the drug dissolves
(Figure 33-3). The drug may act locally
on the mucous membranes of the mouth
or systemically when it is swallowed in
the saliva.
4.Parenteral
Parenteral administration is
administration other than through
the alimentary tract; that is, by
needle. The following are some of
the more common routes for
parenteral administration:
·Subcutaneous (hypodermic): into
the subcutaneous tissue, just below
the skin
·Intramuscular: into a muscle
·Intradermal: under the epidermis
(into the dermis)
·Intravenous: into a vein
5.Topical
Topical applications are those
applied to a circumscribed surface
area of the body. They affect only the
area to which they are applied.
Topical applications include the
following:
•Dermatologic preparations: applied to the
skin
•Instillations and irrigations: applied into
body cavities or orifices, such as the
urinary bladder, eyes, ears, nose, rectum,
or vagina
•Inhalations: administered into the
respiratory tract by a nebulizer or positive
pressure breathing apparatus. Air, oxygen,
and vapor are generally used to carry the
drug into the lungs. See Chapter 47.
Essential Parts of a Drug Order
•Full name of the client
•Date and time the order is written
•Name of the drug to be administered
•Dosage of the drug
•Route of administration
•Frequency of administration
•Signature of the person writing the
order
ADMINISTERING
MEDICATIONS SAFELY
The nurse should always assess
a client’s health status and obtain a
medication history prior to giving
any medication.
•The medication history includes
information about the drugs the client is
taking currently or has taken recently.
•An important part of the history is
clients’ knowledge of their drug allergies.
•Also included in the history are the
client’s normal eating habits.
•Any problems the client may have in
self-administering a medication must
also be identified.
Clinical guidelines for administering
medications
1.Nurses who administer medications
are responsible for their own actions.
Question any order that you consider
incorrect.
2.Be knowledgeable about medications
you administer.
3.Federal laws govern the uses of
narcotics and barbiturates. Keep these
medications in a locked place.
4.Use only medications that are in a
clearly labeled place.
5.Do not use liquid medications that
are cloudy or have changed color.
6.Before administering a medication,
identify the client correctly using the
appropriate means of identification,
such as checking the identification
bracelet or asking clients to state
their name or both.
7.Do not leave medications at the bedside,
with certain exceptions (eg, nitroglycerin,
cough syrup). Determine agency policy.
8.If a client vomits after taking an oral
medication, report this to the nurse in
charge or the physician or both.
9.Take special precautions when
administering certain medications, for
example, have another nurse check the
dosages of anticoagulant, insulin,and
certain IV preparation.
10.Most hospital policies require new
orders from the physician for the
client’s postsurgery care.
11.When a medication is omitted for
any reason, record the fact together
with the reason.
12.When a medication error is made,
report it immediately to the nurse in
charge or the physician or both.
Process of Administering Medications
1.Identify the client.
2.Inform the client.
3.Administer the drug.
4.Provide adjunctive interventions as
indicated.
5.Record the drug administered.
6.Evaluate the client’s response to the
drug.
Five “Rights” of Drug Administration
• Right drug
• Right dose
• Right time
• Right route
• Right client
ORAL MEDICATIONS
1.Organize the supplies.
2.Verify the client’s ability to take
medication orally.
3.Verify the order for accuracy.
4.Obtain appropriate medication.
5.Prepare the medication.
•tablets or capsules (Figure 338,9,10)
•liquid medication (Figure 3311,12)
6.Administer the medication at
the correct time.
7.Document each medication
given.
8.Dispose of all supplies
appropriately.
9.Evaluate the effects of the
medication.
Thank you !