Download medicationsstudentvers

Medications
Chapter 35
60 Minutes- The wrong medicine
1
How are drugs named and classified
•
•
•
•
Prescriptive drugs
Nonprescriptive drugs
Generic name
Trade or Brand name
2
Legal Aspects
•
•
•
•
Nurse Practice Acts
Controlled Substances
US legislation
State laws
3
Effects of Drugs
•
•
•
•
Side effects
Adverse effects
Drug toxicity
Allergy
– Anaphylactic reaction
• Drug interaction
4
Actions of Drugs on the Body
• Half life
• Onset
• Peak plasma level
5
Pharmacokinetics
• Absorption
• Distribution
• Biotransformation
• Excretion
6
Factors Affecting Medication
Action
•
•
•
•
•
•
•
•
Developmental
Sex
Cultural, ethnic, and genetic
Diet
Environment
Psychological
Illness and disease
Time of administration
Oral
•
•
•
•
Tablets, capsules, liquids
Sublingual
Buccal
Enteral medications
8
Figure 35-3 Sublingual administration of a
tablet.
Figure 35-4 Buccal administration of a tablet.
Transdermal
• Applied to the skin
• Local (and sometimes systemic)
effects
• Skin lotions, creams, ointments
• Transdermal patches
11
Parenteral Medications
• Injected via
–
–
–
–
Intradermal
Subcutaneous
Intramuscular
Intravenous
12
Topical
• Applied to skin or in a body cavity
• Eye, ear, vagina, rectum, nose
13
Types of Medication Orders
•
•
•
•
STAT orders
Single order
Standing orders
PRN orders
• If written by the nurse (phone or verbal
order) must read back to verify
accuracy of the order.
14
Essential Parts of a Drug Order
•
•
•
•
•
•
•
Full name of client
Date and time the order is written
Name of the drug
Dosage
Frequency of administration
Route of administration
Signature of the person writing the
order
Communicating Orders
• Telephone/verbal orders
• Order placed on Medication
Administration Record (MAR)
16
• Write the order you receive over the
phone from Dr. Jones.
17
Figure 35-6 Sample medication administration record (MAR).
Administering Medications
Safety
•
•
•
•
•
•
Assessment
Suitable route
Medication history (hx)
Drug allergies
Specifics to drug
Self administration problems
19
Administering Medications:
Practice Guidelines
• Pg. 769
20
Medication Reconciliation
• Ensure clients receive meds as they
move or transfer through or out of a
facility
• Compare complete list of meds to the
physician’s orders
21
Medication Dispensing Systems
• Medication Cart
• Automated
dispensing system
• Unit dosing
22
Process of Administering
Medications
• Identify the client
• Inform the client
• Administer the drug
– After completion of 3 checks
Process of Administering
Medications (cont.)
• Provide adjunctive interventions as
indicated
• Record the drug administered
• Evaluate the client’s response to
the drug
Three Checks Rule (Box 35-5 pg. 772)
• Check the medication label against MAR
• Upon removal
• When preparing med
• At the bedside
25
5 Rights + 5 (p. 773)
• Right Patient
• Right Drug
• Right Route
• Right Time
• Right Dose
• Right Documentation
(the 6th right)
•
•
•
•
Client education
Right to refuse
Right assessment
Right evaluation
26
Compare the medication label to the MAR.
Medication Errors
•
Common errors
•
How can they be avoided?
•
Practice safe medication
administration !!!!
28
What To Do If I Make A
Medication Error?
•
•
•
•
Assess VS and physical status
Notify primary care provider
Notify charge nurse
Complete incident report
29
The nurse is taking an oral tablet of
Tylenol to a client who is in a private
room. He is in the bathroom and says,
“just leave it on the table and I will
take it when I come out.” You are
very familiar with this client and have
cared for him all weekend long.
What would you do? Why?
30
Oral Med. Administration
• Pg. 775-779 per Lab discussion
31
Parental Medications (pg. 780)
•
•
•
•
Intradermal
Subcutaneous (SubQ)
Intramuscular
Intravenously
32
Preparing injectable medications
• Ampule
• Vial
• Reconstituting medications
33
Intradermal Injections
•
•
•
•
•
•
•
Are given in the dermis
Use 1 ml. syringe
25-27 gauge needle, ¼ to 5/8 in.
Dose 0.01 to 0.1 ml
Angle 5-15 degrees
Produces a wheal or bleb
See Skill 35-5 pg. 792
34
Administering an Intradermal Injection ; the
medication forms a bleb or wheal under the epidermis.
Figure 35-32 Body sites commonly used for
intradermal injections.
Sub Q injections
• Sites
• Maximum of 25 gauge needle, 3/8
to 5/8 length
• Dose no more than 1 ml.
• Angle 45 degrees for avg. or thin
client
• Angle 90 degrees for obese client
37
Sub Q injections (cont.)
•
•
•
•
Pinch or spread skin
Insulin
Heparin
Skill 35-6 pg. 794
38
SQ Injection Sites
39
Administering a Subcutaneous Injection Inserting a
needle into the subcutaneous tissue using 90- and 45degree angles.
IM injections
• IM sites
• 23-25 gauge needle, larger for thick
solutions; 1 – 1 ½ in.
• ½-1 ml for deltoid
• 1-4 ml for larger leg muscles
41
IM injections (cont.)
•
•
•
•
1-4 ml for larger leg muscles
Angle- 90 degrees
Aspirate
Skill 35-7 pg. 801
42
Ventrogluteal Site
43
Vastus Lateralis Site
44
Dorsogluteal Site
• Not recommended
• Injection site close to sciatic nerve
45
Rectus Femoris Site
• Located in anterior
thigh
• Used only occasionally
46
Deltoid
IM Injection Technique: Z-Track
•
•
•
•
•
•
•
•
Seals needle track
Displace or pull skin to the side
Insert needle
Aspirate
Inject (wait 5-10 sec.)
Withdraw
Release skin
Skill 35-7
48
Considerations
• A safe distance from nerves, large
blood vessels, and bones
• Free from injury, abscesses,
tenderness, necrosis
• Large enough to accommodate the
volume of medication to be given
49
Discussed in Lab (pg. 813-818)
•
•
•
•
•
•
•
Skin
Ophthalmic (eye)
Otic (ear)
Nasal
Vaginal
Rectal
Inhaled
50
Let’s put it into practice!
51