Chapter 35: Medication Administration

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Chapter 35: Medication Administration. Bonnie M. Wivell, MS, RN, CNS. Introduction. Medication is a substance used in the Diagnosis Treatment Cure Relief Prevention of health alterations The nurse is responsible for the following in regard to medications: Preparation Administration - PowerPoint PPT Presentation


<ul><li><p>Chapter 35: Medication Administration</p><p>Bonnie M. Wivell, MS, RN, CNS</p></li><li><p>IntroductionMedication is a substance used in the DiagnosisTreatmentCureReliefPrevention of health alterationsThe nurse is responsible for the following in regard to medications:PreparationAdministrationTeachingEvaluating response</p></li><li><p>Medication Legislation and StandardsThe role of the U.S. government in regulation of the pharmaceutical industry is to protect the health of the people by ensuring that medications are safe and effective.First law was passed in 1906Pure Food and Drug Act: requires all meds to be free of impure productsOther federal medication lawsControl medication sales and distributionMedical testingNaming and labelingRegulate controlled substances</p></li><li><p>Medication Legislation and Standards Contd.FDA = enforces laws, and ensures all meds on the market undergo vigorous testing before being sold to the publicMedWatch program = initiated in 1993 by FDA; a voluntary program that encourages nurses and other health care professions to report when a medication, product, or medical event causes serious harm to a clientState laws control substances not regulated by the federal government.Local government regulates the use of alcohol and tobacco</p></li><li><p>Medication Legislation and Standards Contd.An institution is concerned primarily with preventing poor health outcomes resulting from medication useMedication Regulations and Nursing Practice are governed by individual state Nurse Practice Acts (NPAs)NPAs have the most influence over nursing practice by defining the scope of a nurses professional functions and responsibilitiesNPAs are broad in scope and nature so as not to limit the nurses functional ability Health care agencies interpret the NPAs</p></li><li><p>Controlled SubstancesControlled substances (AKA narcotics) are carefully controlled through federal and state guidelines.Violation of the Controlled Substances Act is punishable by fines, imprisonment, and loss of nurse licensure.See Box 35-1</p></li><li><p>Patient SafetyPatient SafetyTo err is Human*</p></li><li><p>Pharmacological ConceptsDrug NamesGeneric: becomes the official name listed in publications and is the name generally used throughout the drugs useChemical: chemicals that make up drugBrand/Trade: the name under which a manufacturer markets a med; usually short and easy to rememberMany companies produce the same med so similarities in trade names are often confusingExample: Brand: HydrochlorothiazideTrade: Esidrix and HydroDiuril</p></li><li><p>Pharmacological Concepts Contd.ClassificationThe effect of the medication on a body systemThe symptoms the medication relievesThe medications desired effectSome medications are part of more than one classMedication FormsThe form of the medication determines its route of administrationThe composition of a medication enhances its absorption and metabolismMany meds come in several forms: Tablets, Capsules, Elixirs, Suppositories</p></li><li><p>PharmacokineticsPharmacokinetics = the study of how meds enter the body, reach their site of action, metabolize, and exit the bodyAbsorption = passage of med into bloodRoute of administrationAbility of med to dissolveBlood flow to site of administrationBSALipid solubility of a med</p></li><li><p>DistributionAfter absorption, distribution occurs within the body to tissues, organs, and to specific sites of action via blood stream.Distribution depends on:Circulation: limited blood flow can inhibit distributionMembrane permeabilityBlood brain barrier and PlacentaProtein Binding: most meds bind to albumin to some extentMeds bound to proteins cant do what they are supposed toFree or unbound medication is the active form of the medDecreased albumin due to disease process more active medication med toxicity</p></li><li><p>MetabolismMedications are metabolized into a less potent or an inactive form.Biotransformation occurs under the influence of enzymes that detoxify, degrade, and remove active chemicals.Most biotransformation occurs in the liverOther sites for metabolism: lungs, kidneys, blood, intestines</p></li><li><p>ExcretionMedications are excreted through: KidneyLiverBowelLungsExocrine glands</p></li><li><p>Types of Medication Action</p><p>Therapeutic effect:Expected or predictableSide effect:Predictable and often unavoidableAdverse effect:Unintended, undesirable, and often unpredictable severe responseToxic effect:Medication accumulates in the blood streamIdiosyncratic reaction:Over- or under-reaction to a medicationAllergic reaction:Unpredictable response to a medication</p></li><li><p>Medication InteractionsOccur when one medication modifies the action of anotherA synergistic effect occurs when the combined effect of two medications is greater than the effect of the medications given separately.Can be beneficial: Tylenol and CodeineETOH and antihistimines, antidepressants, or narcotics (all CNS depressants)HTN may be treated with diuretic and vasodilator </p></li><li><p>Medication Dose Responses</p></li><li><p>Routes of Administration</p></li><li><p> Effects of Nutrition on Drugs</p></li><li><p>Systems of Medication MeasurementRequires the ability to compute medication doses accurately and correctlyMetric system: organized in units of 10Apothecaries: older than metricHousehold system: least accurateSolution</p></li><li><p>Nursing Knowledge BaseSafe administration is imperativeNursing process provides a framework for medication administrationClinical calculations must be handled without errorConversions in and between systemsDose calculationsPediatric and elderly calculationsALWAYS double-check calculation and medication with a second nurse on high alert meds (insulin, heparin)</p></li><li><p>Prescribers Role Prescriber can be physician, nurse practitioner, or physicians assistant.Prescribers must document the diagnosis, condition, or need for each medication.Orders can be written, computer generated, verbal, or by telephone.DO NOT use abbreviations on pages 701-703 when documenting med orders or other information about meds</p></li><li><p>Types of Orders in Acute Care AgenciesStanding or Routine Medication OrdersPRN Orders: as neededSingle (one-time) OrdersSTAT Orders: within 15 minsNow Orders: up to 90 mins to administerPrescriptions: taken outside the hospital</p></li><li><p>Communication of Medication OrderOrder is written on clients chartBy provider or RN receiving TO or VOOrder copied to Medication Administration Record (MAR)MAR contains: name, room, bed, drug name, dose, route, times, allergiesVideo</p></li><li><p>Components of Medication OrdersClients full nameDate and time that the order is writtenMedication nameDoseRouteTime and frequency of administrationPRN orders must have a reasonSignature</p></li><li><p>*</p></li><li><p>Medication AdministrationPharmacists roleDistribution systemMedication errors (near miss)Medication ReconciliationVerifyClarifyReconcileTransmitNurses role*</p></li><li><p>The Six Rights of Medication AdministrationRight medicationRight doseRight patientRight routeRight timeRight documentationRight to refuse</p></li><li><p>Where Do Drugs Come From in the Hospital?Pyxis/OmnicellMachine on the nursing unit where a stock supply of meds are storedCommonly used medsNarcoticsPackaged in the pharmacy and delivered to the nursing unitUnit dose system: drugs are packaged individuallyLiquids can be unit dose or bottles Medication in bottles will be measured in Milliliters, teaspoons, ounces, etc.</p></li><li><p>Potential Medication Error</p></li><li><p>Critical ThinkingKnowledge: understand why you are giving a med; if you dont know, look it upExperience: skills become more refinedAttitudes: take adequate time to prepare and administerStandards: ensure safe practice6 Rights</p></li><li><p>The Nursing Process and Med AdministrationAssessmentMedical historyAllergiesMedication dataDiet historyClients perceptual or coordination problemsClients current conditionClients attitude about medication useClients knowledge and understanding of medication therapyClients learning needs</p></li><li><p>Nursing DiagnosisAnxietyIneffective health maintenanceHealth-seeking behaviorsDeficient knowledge (medications)Noncompliance (medications)Disturbed visual sensory perceptionImpaired swallowingEffective therapeutic regimen managementIneffective therapeutic regimen management</p></li><li><p>PlanningMinimize distractions or interruptions when preparing and administering medsThis will limit errorsPrioritize care when administering medsCollaborationPrescriberPharmacistCase manager/social worker</p></li><li><p>ImplementationHealth promotionClient and family teachingAcute careReceiving med orders (write it down and read it back)Correct transcription and communication of ordersAccurate dose calculation and measurementCorrect administrationRecording med administrationNEVER chart a med before administering itRestorative care: med administration varies across care settings</p></li><li><p>Special ConsiderationsInfants and childrenVary in age, weight, surface area and the ability to absorb, metabolize, and excrete medsLower doses; special calculationsAlternative forms, such as liquids or elixirs Psychological prepOlder adultsSimplifyAssess swallowingSome have greater sensitivityPolypharmacy</p></li><li><p>EvaluationYou must monitor a clients response to meds on an on-going basisThe goal of safe and effective med administration involves the clients response to therapy and ability to assume responsibility for self-careYou will evaluate the effectiveness of nursing interventions when you assess whether the client has met goals/outcomes</p></li><li><p>Will cover actual administration and other issues surrounding administration during tomorrows class</p><p>QUESTIONS?</p><p>Health Care Institutions and Medical Laws establish policies to meet federal, state, and local regulations.Regulate size of institution, types of services, types of medical personnel employed</p><p>Purpose is to protect the public from unskilled, undereducated, and unlicensed personnel. </p><p>*Leape, L. L. and Berwick, D. M. (2005). Five years after To Err Is Human: What have we learned? Retrieved 8/1/10 from</p><p>Absorption - depends on route, [skin slow, mucus membranes quick, oral slower, IV most rapid]Safe medication administration requires knowledge of factors that alter or impair absorption of prescribed medications. Because some medications interact with food, it is often appropriate to administer them before or after meals, with meals, or on an empty stomach. </p><p>2. Rate and extent of distribution depends on physical and chemical properties of medication and the physiology of the client.</p><p>3. Medication has entered into the bloodstream, -carried throughout the tissues and organs of the body. -speed of the distribution depends on the vascularity of the various tissues and organs.To be distributed to an organ, medication has to pass through the organs tissues and biological membranes. Some membranes serve as barriers to the passage of medications. For example, blood-brain area allows fat-soluble medications to pass into the brain and CSF. </p><p>Both fat-soluble and nonfat-soluble agents often cross the placenta and produce fetal abnormalities such as respiratory depression. </p><p>Narcotic use can create withdrawal symptoms.*What will happen to medications if the organs used for breakdown are not functioning correctly? TOXICITY*Ask students:1. What is the main organ for excretion? KIDNEYS</p><p>2. Which type of medications are excreted through the lungs? Anesthetic gases, alcohol</p><p>Why should certain medications not be taken during pregnancy? Some may pass through the placental barrier or mammary glands.Example opioids, tranquilizers, anti-emeticsTeratogenic*1. Therapeutic effect desired effect, primary effect intended, reason drug prescribed</p><p>Side Effects secondary effect produced at a usual therapeutic dose; may be either harmless or cause injury; If serious enough to negate benefit then d/c drug</p><p>Adverse effect sometimes immediate, but often take weeks or months to develop. Early recognition key; d/c immediately and report to MedWatch</p><p>Toxic effects results from overdose, buildup of the drug in the blood because of impaired metabolism or excretion</p><p>Idiosyncratic reaction one that is unexpected and may be individual to a clientMay have a completely different effect from the normal one Benedryl makes child hyper instead of sleepyAtivan makes adult hyper instead of drowsy</p><p>Allergic reaction immunologic reaction to a drug, or client may produce antibodies to the drug (antigen), its chemical preservatives or a metaboliteMild or severe anaphylactic life threatening, characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and SOB</p><p>.**Drug half life time required to reduce the concentration of the drug to it was at initial administration; to maintain therapeutic, need to receive drug at regular fixed intervals</p><p>Onset time after administration when the body initially responds to the drug</p><p>Peak highest plasma level achieved by the drug when elimination rate of drug equals absorption rate, so occurs just before the body absorbs the last of the medication</p><p>Trough Minimum blood serum concentration before next scheduled dose</p><p>Plateau maintained concentration of a drug in the plasma during a series of scheduled doses*Oral most common, least expensive, most convenientDisadvantage is taste, irritation of gastric mucosa, irregular absorption, slow absorption, some cases harm to teeth (liquid iron straw)Vomiting, NG tube, NPO</p><p>Sublingual under tongue, dissolves, absorbed into blood vessels on underside of tongueMed should not be swallowed Nitroglycerine</p><p>Buccal pertaining to the cheek held in mouth against mucous membranes of cheek until dissolvesDrug may act locally on mucous membranes or systemically when swallowed in saliva (example: Fentanyl lollypop)</p><p>Parenteral involves injecting a med into body tissuesBy needle SQ, IM, Intradermal, IV</p><p>Epidural into edipural spaceIntrathecal or intraspinal into subarachnoid space or one of the ventricles of the brain (ommaya reservoir)Intraosseous directly into bone marrow, most commonly used in infants and toddlers with poor IV accessIntraperitoneal peritoneal cavityIntrapleural pleural space via chest tubeIntraarterial IV</p><p>Topical applied to a certain surface area of body affecting only that area to which it is appliedDermatologic skin, transdermal patch has systemic effectsInstillations and irrigations body cavities, orifices (eyes, ears, nose, throat gargle or swab, vagina, bladder, rectum)Inhalations administered to respiratory tract by nebulizer, vapor, carried into lungs; work rapidly because of the rich vascular alveolar capillary network; have local or systemic effects*Metric, apothecaries and household</p><p>Metric organized in units of 10, Multiplied by moving decimal to rightDivided by moving decimal to leftUnits meter (length), liter (volume), gram (weight)Meds are ordered in weight (grams, mg, mcg) and administered by volume (mL)</p><p>Apothecaries older than metricBasic unit is grain (grain of wheat), minim (volume) volume of water the weight of a grain of wheatExpressed as Roman numerals - gr ii, &lt; 1 expressed as fraction gr 1/6</p><p>Household least accurateDrops, teaspoons, tablespoons, cups, glasses</p><p>Solutions are used for i...</p></li></ul>


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