Transcript Helen Harkreader

NUR 51/45A
Non-Parenteral Medication
Administration
Charlene Gagliardi, RN, MSN
Drug Names
Generic or Nonproprietary Name
• Name assigned when a drug is first manufactured
i.e. acetaminophen
Trade Name, Brand Name, or Proprietary Name
• Copyrighted name given by manufacturer of
medication
• Medication may have several trade names
i.e. Tylenol
Four Parts of Pharmacokinetics
Absorption
• Transference of blood molecules from the
point of entry in the body into the
bloodstream
Distribution
• Begins with absorption of the drug into
the circulation and ends when the drug
arrives at its site of action
Four Parts of Pharmacokinetics
Metabolism
• Process of inactivating and breaking down
a medication
Excretion
• Movement of a drug from its site of
metabolism back into circulation and its
transport to the site of exit from the body
Drug Actions
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Therapeutic Effect
Side Effects
Adverse Effects
Allergic Responses
• Idiosyncratic
Responses
• Drug Tolerance
• Drug Interactions
Adverse Drug Effects
Components of a Medication
Order
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Date and Time of Order
Medication Name
Dose of Medication
Route of Administration
Frequency of Administration
Signature of Prescriber
Types of Medication Orders
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Standing Orders
PRN Orders
Single Orders
STAT Orders
Routes of Administration
• Oral: given by mouth
– Oral (PO)
– Sublingual
– Buccal
• Parenteral: given by injection
– Intradermal (ID)
– Subcutaneous (SC or SQ)
– Intramuscular (IM)
– Intravenous (IV)
Routes of Administration
• Topical Route: given directly to a body site
• Inhalation: given into the respiratory tract via
the nose or throat
• Rectal or vaginal – suppository/cream
• Nasogastric / G-Tube / J-Tube
Comparison of Onset, Peak and
Duration of an Oral & IV Drug
Distribution Systems
• Stock supply
• Unit dose
• Computer controlled
Pyxis Medication cart
The Six Rights of Medication
Administration
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Right Drug
It is vitally important for the
nurse to elicit information
Right Dose
about known drug and food
Right Patient
allergies before the patient
Right Route
receives a medication for
the first time.
Right Time
Right Documentation
Assessment
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Medical history
History of allergies
Medication data
Diet history
Perceptual or
coordination problems
• Current condition
Assessment (cont’d)
• Attitude about medication use
• Knowledge of therapy
• Learning needs
Prevention of Medication Errors
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Know agency policies and procedures
Question over 3 tablets
Be aware of drugs with similar names
Check you math; check the decimal point
Question abrupt/ excessive > or < in dose
Don’t guess with illegible handwriting
Always check orders against the MAR
Know pt’s history and allergies (food/drug)
Prevention of Medication Errors
• Know your medications – never give a med that
you are unfamiliar with
• Do all necessary pt assessments – VS, labs. etc.
• Always perform the six rights
• Do your patient teaching with all meds
• Do not leave medications at the bedside
• Always administer NG or GT meds one at a time
with a water flush before, between and after
• Report any med errors
Assessment of Apical Pulse
Procedure
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Perform all checks and assessments
Have water, cups, straws at bedside
Wash hands
Using MAR, remove meds in order,
checking med name, dose, expiration date
• Keep meds in unit dose packaging and
place in med cups
• Take MAR and meds to pt room
Comparison to MAR
Procedure
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Perform all ID checks
Assist pt to comfortable position
Pt teaching with each med administered
Remove meds from packaging one at a time
Make sure pt swallows the medication
Reposition patient / discard trash
Document
Nursing Diagnoses
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Deficient knowledge (medications)
Noncompliance (medications)
Disturbed sensory perception
Impaired swallowing
Ineffective therapeutic regimen
management
Planning
• Goals and outcomes
– Example:
Patient will verbalize therapeutic
and adverse effects of
medications
• Setting priorities
• Continuity of care
Implementation
• Patient and family teaching
• Medication orders: receipt, transcription,
communication
• Calculation and measurement
• Correct administration technique
• Recording
Evaluation
• Patient response to medications
• Patient and family ability to administer
medications
Oral Administration
• Presence of GI
alterations
• Ability to swallow
• Use of gastric suction
• Positioning
Solid Oral Medications
Scored Tablet
Enteric Coated/Extended Release
Pouring Liquid Medications
Sublingual Placement
Buccal Administration
NG/G Tube Medications
• Make sure the medications can be crushed or
are in liquid form
• Check for proper placement of NG tube prior to
giving meds and check for residual for all tubes
• Each medication is administered separately by
gravity syringe method followed by a small water
flush
• Water flush at the end of administration of
medication
Individual Preparation of NG/G
Tube Medications
Checking Residual before NG/G
Tube Medications
Gravity Administration of NG/G
Tube Medications
Topical Administration
• Skin applications
– Use of gloves or applicators
– Preparation of skin
– Thickness of application
Transdermal Patch
Nitroglycerine Ointment
Medicated Cream
Medicated Cream
Nasal Instillation
• Assessment of nares
• Patient instruction and selfadministration
• Positioning
Nasal Medications
Application of Nose Drops
Nasal Spray
Eye Instillation
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Drops, ointments, disks
Assessment of eyes
Asepsis
Positioning
Eye Drops
Applying Pressure to Prevent
Systemic Absorption
Applying Eye Ointment
Ear Instillation
• Assessment of ear canal
• Warming of solution
• Straightening of canal for children and
adults
• Positioning
Ear Drops
Vaginal Instillation
• Suppositories, foams, creams
• Use of gloves and applicator
• Patient positioning, comfort, and
hygiene
Vaginal Creams/Suppositories
Angle of Insertion for Vaginal
Medications
Rectal Instillation
• Suppositories
• Use of gloves
• Patient positioning, comfort, and
hygiene
Always Use Water Soluble
Lubricant
Insertion of a Rectal Suppository
Inhalation
• Metered-dose inhalers (MDIs) and dry
powder inhalers (DPIs)
• Patient assessment and instruction
• Use of spacer
• Determination of doses in canister
Types of Inhalers
Using a Metered Dose Inhaler
Irrigation
• Medications used to wash out a body
cavity delivered with a stream of
solution (sterile water, saline, or
antiseptic)
• Asepsis
Reading a Drug Label
Medication Math
• Metric System - - mL, L, gram
• Apothecary System – grain, minim, dram, ounce,
pint, quart, gallon, pound
• Apothecary metric conversion - clock
• Household – tsp, tbsp, ounce, pint, qt, gallon
• Solutions - %, 1:100 vs. 1:10
• Converting Measurement Units
• Dosage Calculation Formulas
Calculation Formulas
• Ratio / Proportion: shows relationship
between two ratio’s – The order is for 10
mg and we have 8 mg per mL.
8 mg/ 1 mL = 10 mg / X mL 8X=10
X=10/8
X = 1.25 mL
Calculation Formulas
• D/H X Q (Dose, Have, Quantity)
• Dose ordered 10 mg; have 5 mg per ml
10/5 X 1 = 2 mL
• Solid medication – Q is always one
• Liquid medication – Q will vary. If there is 5 mg
in 10 mL, the Q is 10
10/5 X 10 = 20 mL
Drug Measure Rules
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Use Arabic
Fractions most often stated as decimals
Use zero rules!!!
Space goes between number and unit of
measurement i.e. 1 mg
• Symbol follows the number with the
exception of gr, oz and dr
• Use correct abbreviations