Chapter 23 Medication Administration - Napa Valley ?· Chapter 23 Medication Administration ... Two…

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1

    Chapter 23Medication Administration

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 2

    PharmacologyPharmacology

    This is the study of drugs and their action This is the study of drugs and their action on the living body.on the living body. The action of any drug on the body is a The action of any drug on the body is a

    complicated process.complicated process.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 3

    Pharmaceutical PhasePharmaceutical Phase The The discovery or making of the drugdiscovery or making of the drug

    Pharmacokinetic PhasePharmacokinetic Phase The The movement of the drugmovement of the drugs active ingredientss active ingredients

    to the site where the intended action of the to the site where the intended action of the drug drug

    PharmacodynamicPharmacodynamic PhasePhase Interaction of the drugInteraction of the drugss active ingredient with active ingredient with

    the the bodybodys cellss cells

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 4

    PharmacologyPharmacology Drug DosageDrug Dosage The amount of a drug prescribed for the The amount of a drug prescribed for the

    patient by the physician.patient by the physician. The prescribed amount/dose of drug given at The prescribed amount/dose of drug given at

    one time.one time.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 5

    PharmacologyPharmacology

    Drug Actions and InteractionsDrug Actions and Interactions Two general typesTwo general types Local:Local: affect only the area where the drug is affect only the area where the drug is

    placedplaced SystemicSystemic: affect the entire body: affect the entire body

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 6

    Drug interaction: one drug alters another drugDrug interaction: one drug alters another drug

    PotentiationPotentiation: one drug increases the action or: one drug increases the action oreffect of another drugeffect of another drug

    Incompatibility: drugs that do not combine Incompatibility: drugs that do not combine chemically with other drugschemically with other drugs

    Antagonist: drug that will block the action of Antagonist: drug that will block the action of another druganother drug

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 7

    Idiosyncratic responseIdiosyncratic response to a drug is an to a drug is an individualindividuals unique hypersensitivity to a s unique hypersensitivity to a particular drug.particular drug. A reduced response to a drug is called A reduced response to a drug is called

    tolerancetolerance.. AnAn adverse drug reactionadverse drug reaction is a harmful, is a harmful,

    unintended reaction to a drug administered at a unintended reaction to a drug administered at a normal dosage.normal dosage. ContraindicationsContraindications are conditions under are conditions under

    which the drug should not be given.which the drug should not be given. Interactions Interactions are modifications of the effect of are modifications of the effect of

    a drug when administered with another drug.a drug when administered with another drug.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 8

    PharmacologyPharmacology Factors that may affect how patients Factors that may affect how patients

    respond to medication: What do think? respond to medication: What do think? AgeAge WeightWeight Physical healthPhysical health Psychological statusPsychological status Environmental temperatureEnvironmental temperature GenderGender Amount of food in the stomachAmount of food in the stomach Dosage formsDosage forms

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 9

    Medication OrdersMedication Orders The PT is ethically and legally responsible for ensuring The PT is ethically and legally responsible for ensuring

    that the patient receives the correct medication ordered that the patient receives the correct medication ordered by the physician.by the physician.

    Medication orders should include the following:Medication orders should include the following: Patient's namePatient's name Date and time of the orderDate and time of the order Name of the drugName of the drug Dosage of the drugDosage of the drug Route of administrationRoute of administration Time or frequency drug is givenTime or frequency drug is given Signature of the physicianSignature of the physician Any special instructionsAny special instructions

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 10

    Medication OrdersMedication Orders Controlled SubstancesControlled Substances OpioidsOpioids, barbiturates, and other controlled drugs that , barbiturates, and other controlled drugs that

    have a high possibility for abuse or addiction are have a high possibility for abuse or addiction are doubledouble--locked.locked.

    Narcotic keysNarcotic keys are kept by designated med person are kept by designated med person per shift.per shift.

    Each controlled drug used is logged into the narcotic Each controlled drug used is logged into the narcotic log book.log book.

    At the end of each shift, controlled drugs are carefully At the end of each shift, controlled drugs are carefully counted by a team member from the outgoing shift counted by a team member from the outgoing shift and a team member from the incoming shift.and a team member from the incoming shift.

    Always have a witness to the Always have a witness to the wastingwasting of a controlled of a controlled substance.substance.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 11

    Medication OrdersMedication Orders Types of OrdersTypes of Orders Standing OrdersStanding Orders Already written by a physician for all patients on Already written by a physician for all patients on

    a particular unit or areaa particular unit or area Carried out without having to call the physicianCarried out without having to call the physician

    Verbal OrdersVerbal Orders May be given in the presence of an PT, LPN/LVN May be given in the presence of an PT, LPN/LVN

    or an RN directly or over the telephoneor an RN directly or over the telephone Should be written on the chart and signed by the Should be written on the chart and signed by the

    physician as soon as possible (policy & physician as soon as possible (policy & procedure)procedure)

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 12

    Medication AdministrationMedication Administration

    Six RightsSix Rights Right medicationRight medication Right doseRight dose Right timeRight time Right routeRight route Right patientRight patient Right documentationRight documentation

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 13

    Medication OrdersMedication Orders Important Considerations of Medication Administration. Important Considerations of Medication Administration.

    Everyone read out loud !Everyone read out loud !

    If you did not pour it, do not give it.If you did not pour it, do not give it. If you gave it, chart it.If you gave it, chart it. Do not chart for someone else or have someone else Do not chart for someone else or have someone else

    chart for you.chart for you. Do not transport or accept a container that is not Do not transport or accept a container that is not

    labeled.labeled. Do not put down an unlabeled syringe.Do not put down an unlabeled syringe. If given a verbal order, repeat it to the physician.If given a verbal order, repeat it to the physician.

    If you make an error, report it immediatelyIf you make an error, report it immediately..

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 14

    Medication OrdersMedication Orders

    Never leave a medication with a patient or family Never leave a medication with a patient or family member. Watch the patient take it and swallow it.member. Watch the patient take it and swallow it.

    Always return to assess the patientAlways return to assess the patients response.s response. Chart as soon as possible after giving medication.Chart as soon as possible after giving medication. If a patient refuses medication, do not force it; chart If a patient refuses medication, do not force it; chart

    Refused medication because ofRefused medication because of .. If you elect to omit a dose based on your nursing If you elect to omit a dose based on your nursing

    judgment, let another PT or nurse help make the judgment, let another PT or nurse help make the decision. If medication is not given, document decision. If medication is not given, document Dose omitted becauseDose omitted because .. Report to the physician.Report to the physician.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 15

    Routes of AdministrationRoutes of Administration

    EnteralEnteral Via the GI TractVia the GI Tract PowdersPowders PillsPills TabletsTablets Liquids or suspensionsLiquids or suspensions SuppositoriesSuppositories

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 16

    Routes of AdministrationRoutes of Administration

    PercutaneousPercutaneous Through the Skin or Mucous MembranesThrough the Skin or Mucous Membranes TopicalTopical InstillationInstillation InhalationInhalation

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 17

    Routes of AdministrationRoutes of Administration

    ParenteralParenteral Methods Other than the GI Tract; Needle Methods Other than the GI Tract; Needle

    RouteRoute AmpulesAmpules VialsVials IntramuscularIntramuscular SubcutaneousSubcutaneous IntradermalIntradermal IntravenousIntravenous

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 18

    EnteralEnteral AdministrationAdministration Preparation of Tablets, Pills, and CapsulesPreparation of Tablets, Pills, and Capsules These preparations enter the GI tract and are These preparations enter the GI tract and are

    absorbed more slowly into the bloodstream absorbed more slowly into the bloodstream than via any other route.than via any other route. The slow absorption rate makes the PO (by The slow absorption rate makes the PO (by

    mouth) route relatively safe.mouth) route relatively safe. Some PO medications are irritating to the Some PO medications are irritating to the

    patientpatients GI tract, and larger tablets may be s GI tract, and larger tablets may be difficult for some patients to swallow.difficult for some patients to swallow.

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 19

    Skill 23Skill 23--1: Step 51: Step 5

    Administering tablets, pills, and capsules.

    (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 20

    EnteralEnteral AdministrationAdministration

    Preparation of Liquid MedicationsPreparation of Liquid Medications Liquid medications are often given to children; to Liquid medications are often given to children; to

    patients who cannot swallow tablets, pills, or patients who cannot swallow tablets, pills, or capsules; and to geriatric patients.capsules; and to geriatric patients.

    Medications may be given via a Medications may be given via a nasogastricnasogastric, , gastrostomygastrostomy, or , or jejunostomyjejunostomy tube.tube.

    Liquids must not be given to unconscious patients Liquids must not be given to unconscious patients because of the possibility of aspirating.because of the possibility of aspirating.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 21

    Skill 23Skill 23--2: Step 132: Step 13

    Administering liquid medications.

    (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 22

    EnteralEnteral AdministrationAdministration

    Tubal MedicationsTubal Medications NasogastricNasogastric (NG) tubes are used to administer (NG) tubes are used to administer

    liquid medications to unconscious patients, liquid medications to unconscious patients, dysphagicdysphagic patients, and those who are too ill to eat.patients, and those who are too ill to eat.

    Many medications come in liquid form; if they do Many medications come in liquid form; if they do not, solid tablets may be pulverized in a mortar and not, solid tablets may be pulverized in a mortar and pestle, and capsules can be opened.pestle, and capsules can be opened.

    Not all tablets are safe to use when crushed, and Not all tablets are safe to use when crushed, and not all capsules are safe to use when opened.not all capsules are safe to use when opened.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 23

    Skill 23Skill 23--3: Step 133: Step 13

    Administering tubal medications.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 24

    Skill 23Skill 23--3: Step 163: Step 16

    Administering tubal medications.

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    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 25

    EnteralEnteral AdministrationAdministration SuppositoriesSuppositories ConeCone--shaped, eggshaped, egg--shaped, or spindleshaped, or spindle--

    shaped medication made for insertion into shaped medication made for insertion into the rectum or vaginathe rectum or vagina Dissolves at body temperature and Dissolves at body temperature and

    absorbed directly into the bloodstreamabsorbed directly into the bloodstream Useful for infants, patients who cannot take Useful for infants, patients who cannot take

    oral preparations, and patients with nausea oral preparations, and patients with nausea and vomitingand vomiting Stored in cool place so they do not meltStored in cool place so they do not melt

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 26

    PercutaneousPercutaneousAdministrationAdministration With these routes, medications are absorbed With these routes, medications are absorbed

    through the skin or the mucous membranes.through the skin or the mucous membranes. Most produce a local action, but some produce Most produce a local action, but some produce

    a systemic action.a systemic action. Drugs include topical applications, instillations, Drugs include topical applications, instillations,

    and inhalations and ointments, creams, and inhalations and ointments, creams, powders, lotions, and powders, lotions, and transdermaltransdermal patches.patches.

    Absorption is rapid but of short duration.Absorption is rapid but of short duration.

    Mosby items and derived items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 27

    PercutaneousPercutaneous AdministrationAdministration OintmentsOintments An oilAn oil-...

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