chapter 23 medication administration - napa valley …€¦ · chapter 23 medication administration...

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

Chapter 23Medication Administration


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.


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 drug’’s 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 drug’’ss active ingredient with active ingredient with

the the bodybody’’s cellss cells

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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.


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


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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Idiosyncratic responseIdiosyncratic response to a drug is an to a drug is an individualindividual’’s 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.


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


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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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.


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)


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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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..


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 patient’’s 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.


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



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

RouteRoute AmpulesAmpules VialsVials IntramuscularIntramuscular SubcutaneousSubcutaneous IntradermalIntradermal IntravenousIntravenous


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

patientpatient’’s 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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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.)


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.



Administering liquid medications.


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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.



Administering tubal medications.



Administering tubal medications.

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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


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.


PercutaneousPercutaneous AdministrationAdministration OintmentsOintments An oilAn oil--based semisolid medication; may be based semisolid medication; may be

applied to the skin or a mucous membraneapplied to the skin or a mucous membrane CreamsCreams Semisolid, Semisolid, nongreasynongreasy emulsions that contain emulsions that contain

medication for external applicationmedication for external application LotionsLotions Aqueous preparations that are used as Aqueous preparations that are used as

soothing agents that relieve soothing agents that relieve prurituspruritus, protect , protect the skin, cleanse the skin, or act as the skin, cleanse the skin, or act as astringentsastringents

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PercutaneousPercutaneous AdministrationAdministration TransdermalTransdermal Patches (Topical Disk)Patches (Topical Disk) AdhesiveAdhesive--backed medicated patches applied backed medicated patches applied

to the skin provide sustained, continuous to the skin provide sustained, continuous release of medication over several hours or release of medication over several hours or days.days.

EyedropsEyedrops and Eye Ointmentsand Eye Ointments Care should be taken to keep all ophthalmic Care should be taken to keep all ophthalmic

preparations sterile by not touching the preparations sterile by not touching the dropper or the tube to the eye.dropper or the tube to the eye.

EardropsEardrops Containers of solutions to be used as Containers of solutions to be used as

eardrops will be labeled eardrops will be labeled ““oticotic..”” They must be They must be at room temperature when applied.at room temperature when applied.


Figure 23Figure 23--33

A variety of medications are available as transdermal patches.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)


NosedropsNosedrops NosedropsNosedrops are for individual use only.are for individual use only.

Nasal SpraysNasal Sprays Sprays absorbed quickly; less medication is used and wasted Sprays absorbed quickly; less medication is used and wasted

when administered in this manner.when administered in this manner. InhalationInhalation Drugs may be absorbed through the mucous membranes of Drugs may be absorbed through the mucous membranes of

the respiratory tract.the respiratory tract. Inhalation produces a relatively limited effect or a systemic Inhalation produces a relatively limited effect or a systemic

effect.effect. This method is actively used by respiratory therapy and This method is actively used by respiratory therapy and

anesthesiologists.anesthesiologists.

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PercutaneousPercutaneous AdministrationAdministration Sublingual AdministrationSublingual Administration

Drug is administered by placing it beneath the tongue Drug is administered by placing it beneath the tongue until it dissolves.until it dissolves.

Drug may be a tablet or liquid squeezed out of a Drug may be a tablet or liquid squeezed out of a capsule.capsule.

It is rapidly absorbed into the bloodstream.It is rapidly absorbed into the bloodstream. BuccalBuccal AdministrationAdministration A tablet is placed between the cheek and teeth, or A tablet is placed between the cheek and teeth, or

between the cheek and the gums.between the cheek and the gums. Absorption into the capillaries of the mucous Absorption into the capillaries of the mucous

membranes of the cheek gives rapid onset of the membranes of the cheek gives rapid onset of the drugdrug’’s active ingredient.s active ingredient.


ParenteralParenteral AdministrationAdministration

EquipmentEquipment SyringesSyringes Syringe consists of a barrel, a plunger, and a tip.Syringe consists of a barrel, a plunger, and a tip. Outside of the barrel is calibrated in milliliters, Outside of the barrel is calibrated in milliliters,

minims, insulin units, and heparin units.minims, insulin units, and heparin units. TypesTypes Tuberculin syringeTuberculin syringe Insulin syringeInsulin syringe ThreeThree--milliliter syringemilliliter syringe SafetySafety--LokLok syringessyringes Disposable injection unitsDisposable injection units



Parts of a syringe.


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Tuberculin syringe calibration.

(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)



Calibration of U100 insulin syringe.




Reading the calibrations of a 3-mL syringe.

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Safety-Glide syringe.



Parts of a needle.



PercutaneousPercutaneousAdministrationAdministration Equipment (continued)Equipment (continued) NeedlesNeedles Parts are the hub, shaft, and beveled tip.Parts are the hub, shaft, and beveled tip. Opening at the needleOpening at the needle’’s beveled tip is the lumen.s beveled tip is the lumen. Size of the diameter of the inside of the needleSize of the diameter of the inside of the needle’’s s

shaft determines the gauge of the needle; the shaft determines the gauge of the needle; the smaller the gauge, the larger is the diameter.smaller the gauge, the larger is the diameter. Needle gauge selection is based on the viscosity Needle gauge selection is based on the viscosity

of the medication.of the medication.

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PercutaneousPercutaneousAdministrationAdministration Equipment (continued)Equipment (continued) Needle LengthNeedle Length Selected based on the depth of the tissue into Selected based on the depth of the tissue into

which the medication is to be injectedwhich the medication is to be injected IntradermalIntradermal: 3/8 to 5/8 inch: 3/8 to 5/8 inch Subcutaneous: 5/8 to 1/2 inchSubcutaneous: 5/8 to 1/2 inch Intramuscular: 1 to 1 1/2 inchIntramuscular: 1 to 1 1/2 inch

Intravenous NeedlesIntravenous Needles Butterfly (scalp needle)Butterfly (scalp needle) OverOver--thethe--needle catheter (needle catheter (AngiocathAngiocath, , JelcoJelco))



Needle length and gauge.



PercutaneousPercutaneousAdministrationAdministration EquipmentEquipment Needleless DevicesNeedleless Devices Devices are designed with a sheath or guard that Devices are designed with a sheath or guard that

covers the needle after it is withdrawn from the covers the needle after it is withdrawn from the skin.skin. Intravenous catheters have been designed with Intravenous catheters have been designed with

bluntblunt--edged edged cannulascannulas, valves, or needle guards , valves, or needle guards to minimize injuries.to minimize injuries. IV tubing with recessed and shielded needle IV tubing with recessed and shielded needle

connectors have been designed, further reducing connectors have been designed, further reducing needlesticksneedlesticks..

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PercutaneousPercutaneousAdministrationAdministration Intramuscular InjectionsIntramuscular Injections Involves inserting a needle into the muscle Involves inserting a needle into the muscle

tissue to administer medicationtissue to administer medication Site SelectionSite Selection GlutealGluteal sitessites VastusVastus lateralislateralis musclemuscle Rectus Rectus femorisfemoris musclemuscle Deltoid muscleDeltoid muscle

ZZ--track Methodtrack Method Used to inject medications that are irritating to the Used to inject medications that are irritating to the

tissuestissues


Figure 23Figure 23--15, 15, CC

Locating IM injection for ventrogluteal site.

(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)


Figure 23Figure 23--16, 16, CC & & DD

Locating right dorsogluteal site. Giving IM injection in left dorsogluteal site.

(C, D, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd

ed.]. St. Louis: Mosby.)

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Giving IM injection in vastus lateralis site on adult.




Rectus femoris muscle. A, Child/infant. B, Adult.




Giving IM injection in deltoid site.


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A, Z-track method. B, Using an air lock. C, Administering IM injection by airlock technique.



PercutaneousPercutaneous AdministrationAdministration IntradermalIntradermal InjectionsInjections Introduction of a hypodermic needle into the Introduction of a hypodermic needle into the

dermis for the purpose of instilling a dermis for the purpose of instilling a substance such as a serum, vaccine, or skin substance such as a serum, vaccine, or skin test agenttest agent Not aspiratedNot aspirated Small volumes (0.1 ml) injected to form a Small volumes (0.1 ml) injected to form a

small small bubblelikebubblelike wheal just under the skinwheal just under the skin Used for allergy sensitivity tests, TB Used for allergy sensitivity tests, TB

screening, and local anestheticsscreening, and local anesthetics A tuberculin syringe used with a 25A tuberculin syringe used with a 25--gauge, gauge,

3/83/8-- to 5/8to 5/8--inch needleinch needle



Angles of insertion for intramuscular (90°), subcutaneous (45°), and intradermal (15°).


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PercutaneousPercutaneous AdministrationAdministration Subcutaneous InjectionsSubcutaneous Injections Injections made into the loose connective Injections made into the loose connective

tissue between the dermis and the muscle tissue between the dermis and the muscle layerlayer Drug absorption slower than with IM Drug absorption slower than with IM

injectionsinjections Given at a 45Given at a 45--degree angle if the patient is degree angle if the patient is

thin or at a 90thin or at a 90--degree angle if the patient degree angle if the patient has ample subcutaneous tissuehas ample subcutaneous tissue Usual needle length is 1/2 to 5/8 inch and 25 Usual needle length is 1/2 to 5/8 inch and 25

gaugegauge Used to administer insulin and heparinUsed to administer insulin and heparin



Subcutaneous injection. Angle and needle length depend on the thickness of skinfold.



PercutaneousPercutaneousAdministrationAdministration Intravenous TherapyIntravenous Therapy Provide fluid and electrolyte maintenance, Provide fluid and electrolyte maintenance,

restoration, and replacementrestoration, and replacement Administer medication and nutritional Administer medication and nutritional

feedingsfeedings Administer blood and blood productsAdminister blood and blood products Administer chemotherapy to cancer patientsAdminister chemotherapy to cancer patients Administer patientAdminister patient--controlled analgesicscontrolled analgesics Keep a vein open for quick accessKeep a vein open for quick access

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Stress Stress

I canI can’’t take it anymoret take it anymore Its time to go for a med breakIts time to go for a med break How am I going to deliver it How am I going to deliver it Just do it Just do it


PercutaneousPercutaneous AdministrationAdministration Methods of Intravenous AdministrationMethods of Intravenous Administration IV pushIV push Intermittent venous access deviceIntermittent venous access device Intermittent infusion (or piggyback)Intermittent infusion (or piggyback) Continuous infusionContinuous infusion Electronic pumps and controllersElectronic pumps and controllers PatientPatient--controlled analgesiacontrolled analgesia Volumetric chambersVolumetric chambers



PCA infusion pump.


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The end The end

Psychiatric Technician students do not Psychiatric Technician students do not complain or cry, except these two complain or cry, except these two

chapter 23 medication administration - napa valley …€¦ · chapter 23 medication administration...

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