Medication Medication AdministrationAdministration

Define selected terms related Define selected terms related to the administration of to the administration of

medications.medications.

MedicationMedication

Substance administered for the diagnosis, Substance administered for the diagnosis, treatment, or relief of a symptom or for the treatment, or relief of a symptom or for the prevention of diseasesprevention of diseases

Used interchangeably with the word Used interchangeably with the word drugdrug DrugDrug also has the connotation of an illegally also has the connotation of an illegally

obtained substanceobtained substance

PrescriptionPrescription

Written directions for the preparation and Written directions for the preparation and administration of a drugadministration of a drug

Generic name of a drugGeneric name of a drug

Name given before a drug becomes officially Name given before a drug becomes officially approved as a medicationapproved as a medication

Official name of a drugOfficial name of a drug

Name under which it is listed in one of the Name under which it is listed in one of the official publicationsofficial publications

Chemical name of a drugChemical name of a drug

Name by which a chemist knows the Name by which a chemist knows the drugdrug

Trade or brand nameTrade or brand name

Name given by the drug manufacturerName given by the drug manufacturer Usually short and easy to rememberUsually short and easy to remember

PharmacologyPharmacology

Study of the effect of drugs on living Study of the effect of drugs on living organismsorganisms

PharmacyPharmacy

Art of preparing, compounding, and Art of preparing, compounding, and dispensing drugsdispensing drugs

Also refers to the place where drugs are Also refers to the place where drugs are preparedprepared

Describe legal aspects of Describe legal aspects of administering medications.administering medications.

Legal Aspects of Administering Legal Aspects of Administering MedicationsMedications

– Nursing practice actsNursing practice acts– Responsibility for actionsResponsibility for actions– Question any order that appears Question any order that appears

unreasonableunreasonable– Refuse to give the medication until the Refuse to give the medication until the

order is clarifiedorder is clarified

Controlled SubstancesControlled Substances– Kept under lockKept under lock– Special inventory formsSpecial inventory forms– Documentation requirementsDocumentation requirements– Counts of controlled substancesCounts of controlled substances– Procedures for discardingProcedures for discarding

Nurses need to know how nursing Nurses need to know how nursing practice acts in their areas define and practice acts in their areas define and limit their functions and be able to limit their functions and be able to recognize the limits of their own recognize the limits of their own knowledge and skills. Under the law, knowledge and skills. Under the law, nurses are responsible for their own nurses are responsible for their own actions regardless of whether there is a actions regardless of whether there is a written order. Therefore, nurses should written order. Therefore, nurses should question any order that appears question any order that appears unreasonable and refuse to give the unreasonable and refuse to give the medication until the order is clarified. medication until the order is clarified.

Another aspect of nursing practice Another aspect of nursing practice governed by law is the use of governed by law is the use of controlled substances. Controlled controlled substances. Controlled substances are kept under lock. substances are kept under lock. Special inventory (Special inventory (list of itemslist of items) forms ) forms are used for recording the use of are used for recording the use of these substances these substances

The information usually required on The information usually required on these forms include the name of the these forms include the name of the client, date and time of client, date and time of administration, name of the drug, administration, name of the drug, dosage, and signature of the person dosage, and signature of the person who prepares and gives the drug. who prepares and gives the drug. The name of the primary care The name of the primary care provider who ordered the drug may provider who ordered the drug may also be listed. also be listed.

A verifying signature of another RN may be A verifying signature of another RN may be required by the agency when a drug is required by the agency when a drug is administered. Careful inventory control is administered. Careful inventory control is maintained. When a portion or all of a maintained. When a portion or all of a controlled substance is discarded, the nurse controlled substance is discarded, the nurse must ask another nurse to witness the must ask another nurse to witness the discarding. In most agencies, counts of discarding. In most agencies, counts of controlled substances are taken at the end controlled substances are taken at the end of each shift and the count total should tally of each shift and the count total should tally with the total at the end of the last shift with the total at the end of the last shift minus the number used.minus the number used.

Identify physiologic factors and Identify physiologic factors and individual variables affecting individual variables affecting

medication action.medication action.

Factors Affecting Medication Factors Affecting Medication ActionAction

– DevelopmentalDevelopmental– GenderGender– Cultural, ethnic, and geneticCultural, ethnic, and genetic– DietDiet– EnvironmentEnvironment– PsychologicPsychologic– Illness and diseaseIllness and disease– Time of administrationTime of administration

Medication action may be affected Medication action may be affected by developmental factors, gender, by developmental factors, gender, culture, ethnicity, genetics, diet, culture, ethnicity, genetics, diet, environment, psychologic factors, environment, psychologic factors, illness and disease, and time of illness and disease, and time of administration.administration.

The nurse needs to be aware of The nurse needs to be aware of developmental factors. Pregnant developmental factors. Pregnant women must be careful about taking women must be careful about taking medications, especially in the first medications, especially in the first trimester, because of the possible trimester, because of the possible adverse effects on the fetus. Infants adverse effects on the fetus. Infants usually require smaller doses usually require smaller doses because of their body size and the because of their body size and the immaturity of their organs. immaturity of their organs.

Older adults have different responses Older adults have different responses to medications due to physiologic to medications due to physiologic changes that accompany aging and changes that accompany aging and because they may be prescribed because they may be prescribed multiple drugs and incompatibilities multiple drugs and incompatibilities may occur.may occur.

Gender differences in medication action Gender differences in medication action are chiefly related to the distribution of are chiefly related to the distribution of body fat and fluid and hormonal body fat and fluid and hormonal differences. In addition, most research differences. In addition, most research studies on medications have been done on studies on medications have been done on men.men.

In addition to gender, a client’s In addition to gender, a client’s response to drugs is also influenced by response to drugs is also influenced by genetic variations such as size and body genetic variations such as size and body composition (pharmacogenetics).composition (pharmacogenetics).

Ethnopharmacology is the study of Ethnopharmacology is the study of the effects of ethnicity on response the effects of ethnicity on response to prescribed medications. Cultural to prescribed medications. Cultural factors and practices (values and factors and practices (values and beliefs) can also affect a drug’s beliefs) can also affect a drug’s action; for example, an herbal action; for example, an herbal remedy may speed up or slow down remedy may speed up or slow down the metabolism of certain drugs (see the metabolism of certain drugs (see Culturally Competent Care).Culturally Competent Care).

The diet may contain nutrients that The diet may contain nutrients that can interact with medications and can interact with medications and increase or decrease action.increase or decrease action.

It is important to consider the effects It is important to consider the effects of a drug in the context of the of a drug in the context of the client’s personality, milieu client’s personality, milieu ((surroundingssurroundings ), and environmental ), and environmental conditions (e.g., temperature, noise).conditions (e.g., temperature, noise).

Psychologic factors, such as a Psychologic factors, such as a client’s expectations about what a client’s expectations about what a drug can do, can affect the response drug can do, can affect the response to the medication.to the medication.

Illness and disease can affect how Illness and disease can affect how a client responds to a medication. For a client responds to a medication. For example, aspirin can reduce body example, aspirin can reduce body temperature of a feverish client but temperature of a feverish client but has no effect on body temperature of has no effect on body temperature of a client without a fever.a client without a fever.

Time of administration is important Time of administration is important because medications are absorbed because medications are absorbed more quickly if the stomach is more quickly if the stomach is empty; however, some medications empty; however, some medications irritate the gastrointestinal tract and irritate the gastrointestinal tract and are given after a meal.are given after a meal.

Routes of Medication Routes of Medication AdministrationAdministration

– Oral (PO)Oral (PO)– Sublingual (SL)Sublingual (SL)– BuccalBuccal– ParenteralParenteral

Subcutaneous (SC)Subcutaneous (SC) Intramuscular (IM)Intramuscular (IM)

Intradermal (ID)Intradermal (ID)

Intravenous (IV)Intravenous (IV) Intra-arterial (IA)Intra-arterial (IA) Intracardiac (IC)Intracardiac (IC) Intraosseous (IO)Intraosseous (IO) Intrathecal (intraspinal) (IT) (IS)Intrathecal (intraspinal) (IT) (IS)Epidural (ED)Epidural (ED) Intra-articularIntra-articular

TopicalTopical

– DermatologicalDermatological– Instillations and irrigationsInstillations and irrigations– InhalationInhalation– Ophthalmic, otic, nasal, rectal, and Ophthalmic, otic, nasal, rectal, and

vaginalvaginal

Routes of medication administration Routes of medication administration include oral, sublingual, buccal, include oral, sublingual, buccal, parenteral, and topical.parenteral, and topical.

In oral administration the drug is In oral administration the drug is swallowed. It is the most common, swallowed. It is the most common, least expensive, and most least expensive, and most convenient route for most clients convenient route for most clients

In sublingual administration a drug is In sublingual administration a drug is placed under the tongue, where it placed under the tongue, where it dissolves.dissolves.

Buccal means “pertaining to the Buccal means “pertaining to the cheek.” In buccal administration a cheek.” In buccal administration a medication is held in the mouth medication is held in the mouth against the mucous membranes of against the mucous membranes of the cheek until the drug dissolves.the cheek until the drug dissolves.

Some common routes for parenteral Some common routes for parenteral administration include subcutaneous administration include subcutaneous (hypodermic), into the subcutaneous (hypodermic), into the subcutaneous tissue just below the skin; tissue just below the skin; intramuscular, into the muscle; intramuscular, into the muscle; intradermal, under the epidermis intradermal, under the epidermis (into the dermis) (into the dermis)

intravenous, into a vein; intravenous, into a vein; intra-arterial, into an artery; intra-arterial, into an artery; intracardiac, into the heart muscle; intracardiac, into the heart muscle;

intraosseous, into the bone;intraosseous, into the bone; intrathecal or intraspinal, into the intrathecal or intraspinal, into the

spinal canal; spinal canal; epidural, into the epidural space; and epidural, into the epidural space; and

intra-articular, into a joint.intra-articular, into a joint.

Topical applications are those Topical applications are those applied to a circumscribed surface applied to a circumscribed surface area of the body. Routes for topical area of the body. Routes for topical applications include dermatologic, applications include dermatologic, applied to the skin; instillations and applied to the skin; instillations and irrigations, applied into body cavities irrigations, applied into body cavities or orifices such as the urinary or orifices such as the urinary bladder, eyes, ears, nose, rectum, or bladder, eyes, ears, nose, rectum, or vagina vagina

ophthalmic, otic, nasal, rectal, and ophthalmic, otic, nasal, rectal, and vaginal topical preparations; and vaginal topical preparations; and inhalations, administered into the inhalations, administered into the respiratory system by a nebulizer or respiratory system by a nebulizer or positive pressure breathing positive pressure breathing apparatus.apparatus.

Parts of a Medication OrderParts of a Medication Order

– Full name of the clientFull name of the client– Date and time the order writtenDate and time the order written– Name of drug to be administeredName of drug to be administered– DosageDosage– Frequency of administrationFrequency of administration– Route of administrationRoute of administration– Signature of person writing the orderSignature of person writing the order

Types of Medication Orders Types of Medication Orders and Examplesand Examples

– Stat orderStat order Demerol 100 mg IM statDemerol 100 mg IM stat

– Single orderSingle order Seconal 100 mg hs before surgerySeconal 100 mg hs before surgery

– Standing orderStanding order Multivitamin 1 capsule po dailyMultivitamin 1 capsule po daily Demerol 100 mg IM q 4 h x 5 daysDemerol 100 mg IM q 4 h x 5 days

– prn orderprn order Amphojel 15 mL prnAmphojel 15 mL prn

A stat order indicates that the A stat order indicates that the medication is to be given medication is to be given immediately and only once (e.g., immediately and only once (e.g., Demerol 100 mg IM stat).Demerol 100 mg IM stat).

The single order or one-time The single order or one-time order is for medication to be given order is for medication to be given once at a specified time (e.g., once at a specified time (e.g., Seconal 100 mg hs before surgery).Seconal 100 mg hs before surgery).

The standing order may or may not have a The standing order may or may not have a termination date, may be carried out termination date, may be carried out indefinitely (e.g., multiple vitamins daily) indefinitely (e.g., multiple vitamins daily) until an order is written to cancel it, or may until an order is written to cancel it, or may be carried out for a specified number of be carried out for a specified number of days (e.g., Demerol 100 mg IM q4h × 5 days (e.g., Demerol 100 mg IM q4h × 5 days).days).

A prn order or as-needed order permits A prn order or as-needed order permits the nurse to give a medication when, in the the nurse to give a medication when, in the nurse’s judgment, the client requires it (e.g., nurse’s judgment, the client requires it (e.g., Amphojel 15 mL prn).Amphojel 15 mL prn).

State systems of measurement State systems of measurement that are used in the that are used in the

administration of medications.administration of medications.

Systems of MeasurementSystems of Measurement

– MetricMetric– ApothecaryApothecary– HouseholdHousehold

List six essential steps to follow List six essential steps to follow when administering when administering

medication.medication.

Six Essential Steps for Six Essential Steps for Administering MedicationsAdministering Medications

– Identify the clientIdentify the client– Inform the clientInform the client– Administer the drugAdminister the drug– Provide adjunctive interventions as Provide adjunctive interventions as

indicatedindicated– Record the drug administeredRecord the drug administered– Evaluate the client’s response to the Evaluate the client’s response to the

drugdrug

1.1. When administering any drug, When administering any drug, regardless of the route of regardless of the route of administration, the nurse must administration, the nurse must identify the client, inform the client, identify the client, inform the client, administer the drug, provide administer the drug, provide adjunctive interventions as indicated, adjunctive interventions as indicated, record the drug administered, and record the drug administered, and evaluate the client’s response to the evaluate the client’s response to the drug.drug.

The nurse must use at least two The nurse must use at least two client identifiers whenever client identifiers whenever administering medications. administering medications. Acceptable identifiers may be the Acceptable identifiers may be the person’s name, an assigned person’s name, an assigned identification number, a telephone identification number, a telephone number, a photograph, or another number, a photograph, or another personal identifier.personal identifier.

If the client is unfamiliar with the If the client is unfamiliar with the medication, the nurse should explain medication, the nurse should explain the intended action as well as any the intended action as well as any side effects or adverse reactions that side effects or adverse reactions that might occur. It is also very important might occur. It is also very important to listen to the client.to listen to the client.

Before administering the drug, the Before administering the drug, the nurse should read the medication nurse should read the medication administration record (MAR) carefully administration record (MAR) carefully and perform three checks with the and perform three checks with the labeled medication (See Box 35–3). labeled medication (See Box 35–3). In addition the ten “rights” of In addition the ten “rights” of medication administration must be medication administration must be observed observed

The nurse should provide adjunctive The nurse should provide adjunctive interventions as indicated. Clients interventions as indicated. Clients may require physical assistance in may require physical assistance in assuming positions for parenteral assuming positions for parenteral medications or may need guidance medications or may need guidance about measures to enhance drug about measures to enhance drug effectiveness and prevent effectiveness and prevent complications.complications.

The nurse must record the drug The nurse must record the drug administered, following agency administered, following agency regulations.regulations.

In order to evaluate the client’s In order to evaluate the client’s response to the drug, the nurse response to the drug, the nurse should know the kinds of behavior should know the kinds of behavior that reflect the action or lack of action that reflect the action or lack of action of the drug and its untoward effects of the drug and its untoward effects (both minor and major) for each (both minor and major) for each medication the client is receiving. medication the client is receiving.

The nurse may also report the client’s The nurse may also report the client’s response directly to the nurse response directly to the nurse manager and primary care provider.manager and primary care provider.

Ten “Rights” of Accurate Ten “Rights” of Accurate Medication AdministrationMedication Administration

– Right medication (Drug)Right medication (Drug)– Right doseRight dose– Right timeRight time– Right routeRight route– Right clientRight client– Right documentationRight documentation– Right client educationRight client education– Right to refuseRight to refuse– Right assessmentRight assessment– Right evaluationRight evaluation

Describe physiologic Describe physiologic changes in older adults that changes in older adults that

alter medication alter medication administration and administration and

effectivenesseffectiveness ..

–Elder ConsiderationsElder Considerations– Altered memoryAltered memory– Decreased visual acuityDecreased visual acuity– Decrease in renal functionDecrease in renal function

– Less complete and slower absorption Less complete and slower absorption from the gastrointestinal tractfrom the gastrointestinal tract

– Increased proportion of fat to lean body Increased proportion of fat to lean body massmass

– Decreased liver functionDecreased liver function– Decreased organ sensitivityDecreased organ sensitivity– Altered quality of organ responsivenessAltered quality of organ responsiveness– Decrease in manual dexterityDecrease in manual dexterity

Physiologic changes in older adults that Physiologic changes in older adults that alter medication administration and alter medication administration and effectiveness include altered memory; effectiveness include altered memory; decreased visual acuity; decreased decreased visual acuity; decreased renal function, resulting in slower renal function, resulting in slower elimination of drugs and higher drug elimination of drugs and higher drug concentration in the bloodstream for concentration in the bloodstream for longer periods; less complete and longer periods; less complete and slower absorption from the slower absorption from the gastrointestinal tract; gastrointestinal tract;

increased proportion of fat to lean increased proportion of fat to lean body mass, which facilitates body mass, which facilitates retention of fat-soluble drugs and retention of fat-soluble drugs and increases the potential for toxicity; increases the potential for toxicity; decreased liver function, which decreased liver function, which hinders biotransformation of drugs; hinders biotransformation of drugs;

decreased organ sensitivity, which decreased organ sensitivity, which means that the response to the same means that the response to the same drug concentration in the vicinity drug concentration in the vicinity ((surrounding regionsurrounding region) of the target ) of the target organ is less in older people than in organ is less in older people than in the young; altered quality of organ the young; altered quality of organ responsiveness, resulting in adverse responsiveness, resulting in adverse effects becoming pronounced before effects becoming pronounced before therapeutic effects are achieved therapeutic effects are achieved

and decreased manual dexterity and decreased manual dexterity due to arthritis and/or decreased due to arthritis and/or decreased flexibility .flexibility .

Outline steps required to Outline steps required to administer oral medications administer oral medications

safely.safely.

Prior to administering oral Prior to administering oral medications, the nurse should assess medications, the nurse should assess for allergies to medications ,the for allergies to medications ,the client’s ability to swallow the client’s ability to swallow the medication; medication;

presence of vomiting or diarrhea; presence of vomiting or diarrhea; specific drug action, side effects, specific drug action, side effects, interactions, and adverse reactions; interactions, and adverse reactions; the client’s knowledge of and the client’s knowledge of and learning needs about the medication; learning needs about the medication; and determine if assessment data and determine if assessment data influences administration of the influences administration of the medications.medications.

In preparation for administering the In preparation for administering the medication, the nurse should know the medication, the nurse should know the reason why the client is receiving the reason why the client is receiving the medication, the drug classification, medication, the drug classification, contraindications, usual dosage range, contraindications, usual dosage range, side effects, and nursing side effects, and nursing considerations for administering and considerations for administering and evaluating the intended outcomes for evaluating the intended outcomes for the medication. The nurse should the medication. The nurse should check the MAR, verify the client’s check the MAR, verify the client’s ability to take medication orally, and ability to take medication orally, and organize the supplies.organize the supplies.

Outline steps required for nasogastric Outline steps required for nasogastric and gastrostomy tube medication and gastrostomy tube medication administration.administration.

Nasogastric/Gastrostomy Tube Nasogastric/Gastrostomy Tube Medication AdministrationMedication Administration– Check with the pharmacist for a liquid formCheck with the pharmacist for a liquid form– Check to see if medication may be crushedCheck to see if medication may be crushed– Crush a tablet into a fine powder and Crush a tablet into a fine powder and

dissolve in at least 30 mL of warm waterdissolve in at least 30 mL of warm water

– Open capsules and mix the contents Open capsules and mix the contents with water only with the pharmacist’s with water only with the pharmacist’s adviceadvice

– Do not administer whole or undissolved Do not administer whole or undissolved medicationsmedications

– Assess tube placementAssess tube placement– Aspirate stomach contents and measure Aspirate stomach contents and measure

the residual volumethe residual volume

Nasogastric/Gastrostomy Tube Nasogastric/Gastrostomy Tube Medication AdministrationMedication Administration

– Remove the plunger from the syringe Remove the plunger from the syringe and connect the syringe to a pinched and connect the syringe to a pinched or kinked tubeor kinked tube

– Put 15 to 30 mL (5 to 10 mL for Put 15 to 30 mL (5 to 10 mL for children) of water into the syringe children) of water into the syringe barrel to flush the tube before barrel to flush the tube before administering the first medicationadministering the first medication

– Pour liquid or dissolved medication into Pour liquid or dissolved medication into the syringe barrel and allow to flow by the syringe barrel and allow to flow by gravity into the enteral tubegravity into the enteral tube

– Administer each medication separately Administer each medication separately and flush with at least 15 to 30 mL and flush with at least 15 to 30 mL water between each medicationwater between each medication

– When you have finished administering When you have finished administering all medications, flush with another 15 to all medications, flush with another 15 to 30 mL (5 to 10 mL for children) of warm 30 mL (5 to 10 mL for children) of warm water to clear the tubewater to clear the tube

– If the tube is connected to suction, If the tube is connected to suction, disconnect the suction and keep the disconnect the suction and keep the tube clamped to enhance absorptiontube clamped to enhance absorption

Medication Medication AdministrationAdministration