chapter 29 medication administration fundamentals of nursing: standards & practices, 2e
TRANSCRIPT
Chapter 29
Medication Administration
Fundamentals of Nursing: Standards & Practices, 2E
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Drug Standards and Legislation
Standards• Standards have been developed to
ensure drug uniformity so that effects are predictable.
• The United States Pharmacopeia and National Formulary (USP and NF) are books of drug standards for usage in the United States.
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Federal Legislation• The Pure Food and Drug Act of 1906
designated the USP and the NF as official bodies to establish drug standards.
• State and Local Legislation• Health Care Institution Regulations
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Drug Nomenclature
Drugs may be used as an aid in the diagnosis, treatment, or prevention of disease, in other abnormal conditions for the relief of pain or suffering, or to improve any physiological or pathologic condition.
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Drug Action
Pharmacology• Medication Management• Classification• Preparation and Route
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Pharmacokinetics
Absorption Distribution Metabolism Excretion Drug Interaction Side Effects and Adverse Reactions Food and Drug Interactions
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Factors Influencing Drug Action
Individual client characteristics, such as genetic factors, age, height and weight, and physical and mental conditions can influence the action of drugs on the body.
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Professional Roles in Medication Administration
Health Care ProvidersTypes of Medication Orders
• Stat Orders• Single-Dose Orders• Standing Orders• PRN Orders
Parts of the Drug Order
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System of Weight and Measure
Metric SystemApothecary SystemHousehold System
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Approximate Dose Equivalents
Converting Units of Weight and Volume• Measurement Conversions within the
Metric System• Measurement Conversions between
SystemsDrug Dose Calculations
• Pediatric Dosages
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Safe Drug Administration
Guidelines for Medication • Right Drug• Right Dose• Right Client• Right Route• Right Time
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Documentation of Drug Administration• Documentation is a critical element of
drug administration.• Nurse should document that a drug
has been given after the client has taken the drug.
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Drug Supply and Storage• Unit dose form is used to dispense
scheduled drugs for each client.• Stock supplied drugs (dispensed and
labeled in large quantities) are stored in the medication room or other area on the nursing unit.
• Narcotics and Controlled Substances
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Drug Abuse• Addiction is a physiological or
psychological dependence on a substance.
• Dependence is the reliance on, or need to take a drug.
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Medication Compliance
Compliance can be associated with the client’s understanding of why medication was ordered, and how medication can decrease the likelihood of getting a disease or how it can lessen the effects of an existing disease.
Noncompliance is when clients do not consistently take prescribed medications, or when they adjust the scheduling or dose of the medication.
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Legal Aspects of Administering Medications
Negligence exists any time the nurse fails to do something that a reasonable nurse would do under similar circumstances or does something that a reasonable nurse would not do.
Malpractice is any professional misconduct or unreasonable lack of skill in professional duties.
Questioning the Medication Order
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Assessment
Drug History• Allergies• Prescription Drugs• Over-the-Counter Drugs• Biographical Data• Lifestyle and Beliefs• Sensory and Cognitive Status
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Physical ExaminationDiagnostic and Laboratory Data
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Nursing Diagnosis
Nursing Diagnoses related to medication administration are• Deficient Knowledge• Ineffective Therapeutic Regimen
Management• Ineffective Health Maintenance• Impaired Physical Mobility
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Nursing Diagnosis
• Disturbed Sensory Perception• Impaired Swallowing
Nursing Diagnoses related to the addicted client are• Imbalanced Nutrition• Impaired Verbal Communication• Interrupted Family Processes
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• Impaired Social Interaction• Social Isolation• Spiritual Distress• Readiness for Enhanced Spiritual Well-
Being• Ineffective Coping
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Outcome Identification
Nurse develops goals and plans care on the basis of nursing diagnosis.
Client teaching based on medications prescribed is inherent in the plan of care.
Nursing interventions are identified and incorporated into the plan of care to promote the attainment of goals and to assist the client in achieving expected outcomes.
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Planning
The nurse needs to carefully plan nursing care activities to ensure safe administration of medications.
Adequate planning provides for questions and discussion by the client and demonstration of skills learned.
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Implementation
Administer Oral Drugs• Sublingual and Buccal Drug
Administration• Review Procedure 29-1 on
administering an oral medication.• Enteral Instillation of Drugs
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Administer Parenteral Drugs• Equipment• Review Procedure 29-2 on withdrawing
medication from an ampule.• Review Procedure 29-3 on withdrawing
medication from a vial.• Intradermal Injection• Subcutaneous Injection
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• Review Procedure 29-4 on mixing insulins in one syringe.
• Review Procedure 29-5 on administering an intradermal injection.
• Review Procedure 29-6 on administering a subcutaneous injection.
• Intramuscular Injection
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• Review Procedure 29-7 on administering an intramuscular injection.
• Intravenous Injections• Review Procedure 29-8 on
administering medications by IV Piggyback to an existing IV.
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Administer Topical Medications• Eye Medications• Review Procedure 29-9 on
administering an eye medication.• Ear Medications• Review Procedure 29-10 on instilling
an ear medication.
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• Nasal Instillations• Review Procedure 29-11 on instilling nose
drops.• Respiratory Inhalants • Review Procedure 29-12 on teaching self-
administration with a metered-dose.
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• Rectal Instillations• Review Procedure 29-13 on administering
a rectal suppository.• Vaginal Instillations• Review Procedure 29-14 on administering
a vaginal suppository.Complementary Therapy
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Evaluation
The nurse is responsible for ongoing evaluation of client’s response to medication.
Nurses in the community setting need to evaluate the client’s ongoing ability to manage his or her medication regime.