Transcript Chapter_034x

Chapter 34
Administering Oral, Topical, and
Inhalant Medications
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
1)
Describe the legal and professional responsibilities of
the LPN/LVN related to medication administration.
2)
Identify the parts of a valid medication order.
3)
Compare and contrast various medication record
systems such as the hard copy medication
administration record (MAR) and computerized
systems.
4)
Discuss medication dispensing and delivery systems.
5)
Analyze the advantages and disadvantages of the
unit-dose system and the prescription system.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 2
Learning Objectives
Clinical Practice
1)
Demonstrate the accounting for doses of controlled
drugs that must be withdrawn from the locked
narcotics cabinet or dispensed from an automatic
dispensing unit.
2)
Prepare and apply topical medications such as eye
ointments, eardrops, nasal medications transdermal
patches, and topical ointments.
3)
Review a care plan for a patient who is receiving
medication that includes patient-specific data, an
identified nursing diagnosis, and interventions that
you used.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Nursing Responsibilities in
Medication Administration
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Be accurate during all steps of medication
administration
Follow exactly all procedures related to medication
administration
Report any error promptly
Interpret the medication order correctly, then give
the correct medication to the patient
Make an assessment of the patient after
medication has been administered
Follow the Six Rights of medication administration
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Medication Orders
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Nurses must question unclear, incomplete, or
ambiguous medication orders
Complete drug orders must contain:
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Full name of the patient
 Name of the drug and how it is to be given
 Dosage to be given and route of administration
 Date, time, and signature of the prescribing
physician
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Slide 5
Dosages
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Dosages may be ordered in the metric
system (most often used) or in the apothecary
system
Nurses must be able to calculate the dosage
in either system
Nurses must be able to convert from one
system to the other
Checking conversions with another nurse
may prevent medication errors from
conversions
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 6
Routes of Oral Medications
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PO (per os [by mouth])—solid or liquid
medications (oral, sublingual, buccal) or via
feeding tube
Patients with difficulty in swallowing may
need pills crushed or changed to liquids
Medications that should not be crushed:

Sublingual medications, enteric-coated
medications, and sustained-release preparations
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 7
Figure 34-4: Reading the dose prepared
at the meniscus of the liquid
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 8
Routes of Topical Medications
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Applied in the form of:
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Drops (eye or ear)
Ointments, pastes, or lotions
Rectal suppositories
Transdermal medication
• Should be applied to a hairless area
Inhalants
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 9
Administering Meds via Feeding
Tube
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If patient unable to swallow meds
Meds in liquid form best
Tablets can be used if place in liquids
Do not mix meds with formula or tube feeding
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 10
Routes of Eye and Ear Medications
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Ophthalmic (eye) medications may be in the
form of drops, ointment, or eye disk
The word ophthalmic must be clearly visible
on container
Otic (ear) medications are usually
administrated as drops or irrigation
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 11
Figure 34-5: Straightening the
ear canal for otic drops
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 12
Routes of Nasal Medications
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Come in atomizers or dropper bottles
Have patient block one nostril and inhale
through nose as atomizer is squeezed
Drops should be administered with patient
lying on the back with neck hyperextended
while medication is dropped into the nostrils
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 13
Figure 34-6: Instilling nose drops
(Proetz’s position)
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 14
Routes of Inhalation Medications
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May be administered through a nebulizer,
spray, or atomizer to penetrate the lungs
Metered-dose inhaler: prescribed amount of
medication is administered in each spray; it is
held in front of the mouth and medication is
inhaled as the inhaler is triggered
May require a spacer for effective use
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 15
Figure 34-8: Using a
metered-dose inhaler
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 16
Routes of Vaginal Medications
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Used to:
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Cleanse the vagina for surgery
Reduce bacterial growth
Remove odors and discharge
Apply heat or cold to inflamed tissues
Absorb medication into local mucosa
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 17
Figure 34-9: Inserting vaginal
medications
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 18
Routes of Rectal Medications
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Dispensed in the form of suppositories; used
to:
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Prevent vomiting
 Soothe hemorrhoids
 Prevent bladder spasms
 Promote bowel evacuation
 Reduce fever
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 19
Figure 34-10: Inserting a
rectal suppository
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 20
Routes of Transdermal Medications
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Supplied as paste or patch
Should be applied to clean, hairless area and
left in place
Typical drugs available
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Nitroglycerin, scopolamine, estrogen, fentanyl
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 21
Regularly Scheduled Medication Orders
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Maintain desired level of medication in the
bloodstream, often given several times a day
Physician’s order will specify how often the
medication is to be given
Three times a day (tid), every 4 hours (q4hr),
etc.
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Slide 22
PRN Medication Orders
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Some PRN medication orders specify when
or how often the medication can be given
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hs PRN, meaning “hour of sleep as needed”
q4hr PRN, meaning “as often as every 4 hours as
needed”
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 23
Stat and Single-Dose Medication Orders
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May consist of more than one drug or may
involve spacing drops or tablets over a short
period
Stat orders indicate that the order has top
priority and medication must be administered
without delay
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Slide 24
Renewal Orders
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Many hospitals have medication policies
limiting the time for which certain types of
medication orders are valid
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Opiate analgesics generally have a 48- or 72-hour
limit
Sedatives and antibiotics may have a 5- or 7-day
limit
A 30-day limit may be imposed by some agencies
on all medications
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Slide 25
Stop or Discontinue Orders
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Medications given to patient until the
specified number of doses have been
administered or until the order has expired or
has been canceled
All medication orders automatically canceled
whenever a patient undergoes surgery or
general anesthesia
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 26
Medication Administration
Record (MAR)
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Used to record a patient’s medications
Nurses record the doses of drugs
administered each day
Referred to when giving regularly scheduled
and PRN medications
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 27
Medication Administration and
Technology
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Improve medication administration safety
Computerized physician order entry systems (CPOE)
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Bar code scanners
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Prescriber directly enters the medication order in the
computer; this decreases potential for transcription
errors
Scan the medication package and the patient ID bands
Personal digital assistants
Download and upload specific patient information to a
PDA that is connected to the larger hospital
information system
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 28
Unit-Dose System
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Provides premeasured, prepackaged, prelabeled
dose
Safest because dose prescribed is dose dispensed
May be dispensed from mobile cart, or the fixed
medication preparation center
Benefits
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Pharmacy supplies the exact dose of medication
ordered
 Saves time for the nurse
 Patient is charged only for medications used
 Allows keeping a minimum amount of drugs on the
nursing units
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Figure 34-2: Unit-dose medications
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Slide 30
Prescription System
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Prescription is written for each drug ordered
and is filled by the pharmacist, who provides
individual containers holding doses for
several days
In the long-term care facility, a week’s or
month’s supply of each medication is often
provided in a bubble pack
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 31
Preparation of Oral Controlled
Substances from a Dispenser
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A controlled dispensing system is used for
distributing opiate analgesics and hypnotics
Legally controlled substances must be under
lock and key
Automated controlled substance dispensing
machines are often used in the clinical setting
to monitor and control narcotic use
When not in a dispensing machine, drugs are
supplied in a controlled dispenser or a
commercially prepared package
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 32
Figure 34-3: Nurse obtaining medication
from automated dispensing unit
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 33
Medication Errors
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All medication errors must be reported
An incident or occurrence form is filled out for
the medication error
After notifying the physician, orders are
carried out to safeguard the patient
The goal is to prevent harm to the patient
from the error and to prevent similar errors
from happening again
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 34